Abstract
Background: CCT allows for calculation of CACS and measurement of EATv and ITFv. It is unclear whether EATv and ITFv provide additional value over CACS and clinical information in predicting CE. Methods: 760 consecutive symptomatic patients without known coronary disease underwent CCT and were followed up to 5 years (median 3.3 years) for CE (cardiac death, non fatal MI, and acute coronary syndrome with >70% coronary artery stenosis). The mean age was 54.4 ±13.7 years, 60 % were female, 15% were diabetics, mean body mass index (BMI) of 30.6 kg/m 2 and mean Framingham risk score (FRS) of 8.2. The ITFv and EATv were calculated with semiautomated method. Fat tissue were automatically recognized by threshold between -40 and-200 HU. Results: Compared to 715 event-free patients, the 45 patients who had CE were older (64.8 vs 53.7 y/o p<0.001), more male (60% vs 40% p=0.008), higher mean FRS (14.3 vs 7.8 p<0.001) and higher median CACS (268 vs 0 p <0.001). They also had higher median EATv (154 vs.116 ml, p = 0.006) and ITFv (330 vs 223 ml, p = 0.001), higher prevalence of EATv >125 ml (67% vs. 44%, p = 0.005)and ITFv>250 ml (64% vs. 42%, p = 0.003). Both EATv and ITFv were predictors of CE and remained so after adjustment for FRS, BMI and CACS >400 (Table 1). The area under the curve from ROC analyses showed trends to improve CE prediction when fat volume was added to FRS, BMI and log (CACS±1) (0.839 for EATv>125ml, 0.843 for ITFv>250ml vs. 0.828, p=0.14 and 0.11 respectively). On the other hand, CACS significantly improved the prediction when added to FRS and BMI (0.828 vs 0.724 p=0.001) Conclusions: Symptomatic patients with CE had larger ITFv and EATv and higher CACS. Although both EATv and ITFv provided some incremental value over clinical information, CACS remained the strongest predictor of outcome
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