Association of epicardial fat volume index with coronary artery disease phenotypes based on anatomical and functional imaging: a linkage with the severity of coronary artery disease

Prevalence of Depression in Patients With Chest Pain and Non-Obstructive Coronary Artery Disease

Objective: This study aimed to investigate the association between epicardial fat volume (EFV) and obstructive coronary artery disease (CAD) with myocardial ischemia, and evaluate the incremental value of EFV on top of traditional risk factors and coronary artery calcium (CAC) in predicting obstructive CAD with myocardial ischemia. Methods: This study was a retrospective cross-sectional study. Patients with suspected CAD who underwent coronary angiography (CAG) and single photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) at the Third Affiliated Hospital of Soochow University from March 2018 to November 2019 were consecutively enrolled. EFV and CAC were measured by non-contrast chest computed tomography (CT) scan. Obstructive CAD was defined as coronary artery stenosis≥50% in at least one of the major epicardial coronary arteries, and myocardial ischemia was defined as reversible perfusion defects in stress and rest MPI. Obstructive CAD with myocardial ischemia was defined in patients with coronary stenosis severity≥50% and reversible perfusion defects in the corresponding areas of SPECT-MPI. Patients with myocardial ischemia bot without obstructive CAD were defined as none-obstructive CAD with myocardial ischemia group. We collected and compared the general clinical data, CAC and EFV between the two groups. Multivariable logistic regression analysis was performed to identify the relationship between EFV and obstructive CAD with myocardial ischemia. ROC curves were performed to determine whether addition of EFV improved predictive value beyond traditional risk factors and CAC for obstructive CAD with myocardial ischemia. Results: Among the 164 patients with suspected CAD, 111 patients were males, and average age was (61.4±9.9) years old. 62 (37.8%) patients were included into the obstructive CAD with myocardial ischemia group. 102 (62.2%) patients were included into the none-obstructive CAD with myocardial ischemia group. EFV was significantly higher in obstructive CAD with myocardial ischemia group than in none-obstructive CAD with myocardial ischemia group ((135.63±33.29)cm3 and (105.18±31.16)cm3, P<0.01). Univariate regression analysis showed the risk of obstructive CAD with myocardial ischemia increased by 1.96 times for each SD increase in EFV(OR 2.96; 95%CI, 1.89-4.62; P<0.01). After adjustment for traditional risk factors and CAC, EFV remained as an independent predictor for obstructive CAD with myocardial ischemia (OR, 4.48, 95%CI, 2.17-9.23; P<0.01). Addition of EFV to CAC and traditional risk factors was related to larger AUC for predicting obstructive CAD with myocardial ischemia (0.90 vs. 0.85, P=0.04, 95%CI: 0.85-0.95) and the global chi-square increased by 21.81 (P<0.05). Conclusions: EFV is an independent predictor for obstructive CAD with myocardial ischemia. Addition of EFV to traditional risk factors and CAC has incremental value for predicting obstructive CAD with myocardial ischemia in this patient cohort.

Impact of coronary artery disease phenotype on treatment in chronic coronary syndromes: the EURECA registry

Epicardial adipose tissue may have an important role in the pathogenesis of coronary artery disease (CAD). We aimed to study the association between epicardial fat volume (EFV) and presence of obstructive as well as multivessel CAD. A total of 87 adult subjects with suspected CAD who underwent both quantified by multidetector computerized tomography (MDCT) and Invasive Coronary Angiography (ICA) were enrolled in this observational study. EVF was measured by MDCT by calculating the sum of cross- sectional areas of fat multiplied by slice thickness. EFV measurement and its association with the presence of obstructive CAD (defined as coronary artery stenosis > 70%) was evaluated. Overall, 89.6% patients had obstructive CAD with higher EFV as compared to 10.3% patients with non-obstructive CAD (57 ± 20.14 cm3 vs. 44 ± 7.4 cm3; P < 0.001). Furthermore, EFV was significantly increased in group II as compared with group I (74 ± 24.3 ml vs. 53 ± 16.2 ml; P < 0.003). On the hand, the coronary calcium score (CAC) was insignificantly increased in group II as compared with group I (486.1 vs. 211.2; P = 0.10). Multivariate analysis revealed that, EFV might be an independent risk factor for not only the presence of obstructive CAD (odds ratio [OR], 1.062; 95% CI 1.018- 1.108; P < 0.005) but also in predicting multivessel disease affection. Our results demonstrated that, EFV was significantly increased not only with obstructive CAD, independent of other traditional risk factors and CAC score, but also it can be considered a good predictor of multivessel disease occurrence.

The U.S. multi-societal chest pain guideline – A quick look into a long-awaited document

Letter in response to Andrea K.Y. Lee et al. “Normalcy rate of computed tomographic coronary angiography”

Persistent chest pain at 1-year predicts long-term angina hospitalization in women with and without obstructive coronary artery disease: results from Women's Ischemia Syndrome Evaluation (WISE)

BackgroundEpicardial adipose tissue may be associated with the pathogenesis of coronary artery disease (CAD), but its effect on obstructive CAD risk is uncertain. Therefore, we aimed to examine the relationship between epicardial adipose tissue and obstructive CAD in Chinese patients with suspected CAD.Methods and ResultsThe present study enrolled 194 consecutive inpatients with suspected CAD who underwent both noncontrast computed tomography and coronary angiography. We measured epicardial fat volume (EFV) and evaluated its association with obstructive CAD, which was defined as coronary stenosis severity ≥70%. Overall, 44.3% patients had obstructive CAD and tend to have higher EFV. Age, body mass index, triglycerides, incidence of hypertension, and hyperlipidemia were higher across tertiles of EFV (P for trend <0.05). In univariate regression analysis, a per‐SD increase in EFV was independently associated with obstructive CAD (odds ratio [OR], 2.31; 95% CI, 1.61–3.32; P<0.001). Consistent with these findings, EFV was still significantly related to obstructive CAD as continuous variable after adjustment for all traditional risk factors and coronary artery calcium (OR per SD, 2.82; 95% CI, 1.68–4.74; P<0.001). Generalized additive model indicated that EFV was linearly associated with risk of obstructive CAD. E‐value analysis suggested robustness to unmeasured confounding.ConclusionsOur results suggested that in Chinese patients with suspected CAD, EFV was significantly and positively associated with the risk of obstructive CAD, independent of traditional risk factors and coronary artery calcium.

Background: Epicardial fat volume (EFV) is recognized as an independent risk factor for coronary atherosclerosis. However, it remains unclear whether the computed tomography (CT) attenuation value of epicardial fat is associated with coronary stenosis. Methods: We analyzed the association of epicardial fat CT attenuation value (EFCTA) and EFV with obstructive coronary artery disease (CAD) in 355 patients (203 men; mean age, 68 ± 11 years) who underwent coronary CT angiography. EFCTA was calculated as the mean CT values of 5 regions of interest in epicardial fat. Results: A total of 200 (56.3%) patients were judged to have obstructive CAD. There was a strong correlation between EFCTA and EFV (R=-0.618, P&lt;0.001). EFCTA and EFV were significantly lower and higher, respectively, in patients with obstructive CAD (EFCTA, -93.0 HU [interquartile range, IR -101.0 - -84.6]; EFV, 110 mL [IR 83 - 146]) than in those without (EFCTA, -88.8 HU [IR -95.6 - -79.4], P&lt;0.001; EFV, 89 mL [IR 68 - 122], P&lt;0.001). In logistic regression analysis using age and gender as covariates, the lowest EFCTA quartile (&lt;-98.8 HU) was significantly associated with obstructive CAD (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.68 - 6.34, P&lt;0.001). Age- and gender-adjusted logistic regression analysis showed that the highest EFV quartile (≥138 mL) had a significant association with obstructive CAD (OR 2.59, 95% CI 1.35 - 4.96, P=0.004). When age, gender, body mass index, smoking, estimated glomerular filtration rate (eGFR), hypertension, dyslipidemia, diabetes, and quartiles of EFCTA and EFV were used as independent valuables, the association of the lowest EFCTA quartile, but not the highest EFV quartile, with obstructive CAD remained statistically significant (OR 2.48, 95% CI 1.05 - 5.85, P=0.038). Conclusions: Low EFCTA was significantly associated with obstructive CAD, independent of traditional cardiovascular risk factors, suggesting that EFCTA may be a novel marker for assessment of CAD.

Management of acute coronary syndrome (ACS) patients with nonobstructive epicardial coronary artery disease (CAD) remains poorly understood. Acute coronary syndrome patients with nonobstructive CAD are less likely to receive effective cardiac medications upon discharge from the hospital. We identified patients hospitalized with ACS that underwent coronary angiography and had a 6-month follow-up. Patients were grouped by CAD severity: nonobstructive CAD (<50% blockage in all vessels) or obstructive CAD (> or =50% blockage in > or = 1 vessels). Data were collected on demographics, medications at discharge, and adverse outcomes at 6 months, for all patients. Of the 2264 ACS patients included in the study: 123 patients had nonobstructive CAD and 2141 had obstructive CAD. Cardiac risk factors including hypertension and diabetes were common among patients with nonobstructive CAD. Men and women with nonobstructive CAD were less likely to receive cardiac medications compared to patients with obstructive CAD including aspirin (87.8% vs 95.0%, P = 0.001), beta-blockers (74.0% vs 89.2%, P < 0.001), or statins (69.1% vs 81.2%, P = 0.001). No gender-related differences in discharge medications were observed for patients with nonobstructive CAD. However, women with nonobstructive CAD had similar rates of cardiac-related rehospitalization as men with obstructive CAD (23.3% and 25.9%, respectively). Patients with nonobstructive CAD are less likely to receive evidence-based medications compared to patients with obstructive CAD, despite the presence of CAD risk factors and occurrence of an ACS event. Further research is warranted to determine if receipt of effective cardiac medications among patients with nonobstructive CAD would reduce cardiac-related events.

792 Acute Coronary Syndrome in Patients With Normal or Non-Obstructive Coronary Artery Disease: Patient Characteristics and Long-Term Outcomes

Lipid-Lowering Medication and Outcomes After Anatomical and Functional Imaging in Suspected Coronary Artery Disease.

Correlation of epicardial fat quantification with severity of coronary artery disease: A study in Indian population

The relationship between autoantibodies to oxidized low density lipoprotein (OxLDL) and coronary artery disease (CAD) remains controversial. IgM and IgG OxLDL autoantibodies to malondialdehyde (MDA)-modified LDL, copper oxidized low density lipoprotein (CuOxLDL), and oxidized cholesterol linoleate (OxCL), as well as apolipoprotein B-100 immune complexes (apoB-ICs), were measured in 504 patients undergoing clinically indicated coronary angiography. Patients were followed for cardiovascular events for a median of 4 years. In univariate analysis, IgM OxLDL autoantibodies and IgM apoB-ICs were inversely associated with the presence of angiographically determined CAD, whereas IgG OxLDL autoantibodies and IgG apoB-ICs were positively associated. In logistic regression analysis, compared with the first quartile, patients in the fourth quartile of IgM OxLDL autoantibodies and apoB-ICs showed a lower probability of angiographically determined CAD (>50% diameter stenosis). Odds ratios and (95% confidence intervals) were as follows: MDA-LDL, 0.51 (0.32-0.82; P = 0.005); CuOxLDL, 0.63 (0.39-1.01; P = 0.05); OxCL, 0.63 (0.39-1.01; P = 0.05); and apoB-IC, 0.55 (0.34-0.88; P = 0.013). These relationships were accentuated in the setting of hypercholesterolemia, with the highest IgM levels showing the lowest risk of CAD for the same level of hypercholesterolemia. Multivariable analysis revealed that neither IgM or IgG OxLDL autoantibodies nor apoB-ICs were independently associated with angiographically determined CAD or cardiovascular events. In conclusion, IgG and IgM OxLDL biomarkers have divergent associations with CAD in univariate analysis but are not independent predictors of CAD or clinical events.

Biological markers of endothelial dysfunction and fibrosis, macro- and microcirculation alterations in patients with obstructive and nonobstructive coronary artery disease and diabetes mellitus