Epicardial Adipose Tissue Is Associated with Plaque Burden and Composition and Provides Incremental Value for the Prediction of Cardiac Outcome. A Clinical Cardiac Computed Tomography Angiography Study

Abstract

ObjectivesWe sought to investigate the association of epicardial adipose tissue (eCAT) volume with plaque burden, circulating biomarkers and cardiac outcomes in patients with intermediate risk for coronary artery disease (CAD).Methods and Results177 consecutive outpatients at intermediate risk for CAD and completed biomarker analysis including high-sensitive Troponin T (hs-TnT) and hs-CRP underwent 256-slice cardiac computed tomography angiography (CCTA) between June 2008 and October 2011. Patients with lumen narrowing ≥50% exhibited significantly higher eCAT volume than patients without any CAD or lumen narrowing <50% (median (interquartile range, IQR): 108 (73–167) cm3 vs. 119 (82–196) cm3, p = 0.04). Multivariate regression analysis demonstrated an independent association eCAT volume with plaque burden by number of lesions (R2 = 0.22, rpartial = 0.29, p = 0.026) and CAD severity by lumen narrowing (R2 = 0.22, rpartial = 0.23, p = 0.038) after adjustment for age, diabetes mellitus, hyperlidipemia, body-mass-index (BMI), hs-CRP and hs-TnT. Univariate Cox proportional hazards regression analysis identified a significant association for both increased eCAT volume and maximal lumen narrowing with all cardiac events. Multivariate Cox proportional hazards regression analysis revealed an independent association of increased eCAT volume with all cardiac events after adjustment for age, >3 risk factors, presence of CAD, hs-CRP and hs-TnT.ConclusionEpicardial adipose tissue volume is independently associated with plaque burden and maximum luminal narrowing by CCTA and may serve as an independent predictor for cardiac outcomes in patients at intermediate risk for CAD.

Epicardial Adipose Tissue Role as a Marker of Higher Vulnerability in Patients with Coronary Artery Disease

“…12,13 Studies revealed that subjects with an increased EAT value evaluated either by CT or cardiac echocardiography exhibit a more FIGURE 1. Epicardial adipose tissue diameter in the two studied groups severe extension of coronary atherosclerosis, and EAT is also related to total plaque load and cardiovascular risk factors, [14][15][16] results confirmed by the present study where patients with MI showed significantly higher volumes of total cholesterol and presented dyslipidemia more frequently than patients with stable angina. In addition, the incidence of MI appears to be directly proportional to the increase in epicardial fat, which is also related to a higher rate of MACE in subjects with known CAD.…”

Original research. The Assessment of Epicardial Adipose Tissue in Acute Coronary Syndrome Patients. A Systematic Review

“…10,11 Subjects with an increased EAT, assessed either by echocardiography or cardiac CT, have a more severe extension of coronary atherosclerosis, and EAT is also linked to the overall plaque burden and cardiovascular risk factors. [12][13][14] Furthermore, the incidence of myocardial infarction seems to be directly proportional to the increase in epicardial fat, which is also related to a higher rate of major adverse cardiovascular events in subjects with known coronary artery disease (CAD). 15,16 Due to its paracrine properties, by secreting serum inflammatory biomarkers EAT brings a significant contribution to the vulnerability of the coronary atheromatous plaque, either by local inflammation or by stimulating neo-angiogenesis and the development of vasa-vasorum and subsequent intra-plaque hemorrhage, plaque rupture and thrombosis.…”

Association of Epicardial Adipose Tissue Volume and Total Coronary Plaque Burden in Patients with Coronary Artery Disease

“…There have already been some reports about the relationship between EAT and coronary plaque burden based on coronary CT data, 14,15) but there have been none about the association between EAT and coronary plaque burden based on IVUS. EAT is not only a site of energy storage as free fatty acids (FFA), 16) but also acts as a paracrine organ that releases both FFA and vasoactive cytokines directly into the coronary vessels.…”