Abstract
Background and objectiveEpicardial adipose tissue (EAT) volume is associated with coronary plaque burden and adverse events. We aimed to determine, whether CT-derived EAT attenuation in addition to EAT volume distinguishes patients with and without myocardial infarction.Methods and resultsIn 94 patients with confirmed or suspected coronary artery disease (aged 66.9±14.7years, 61%male) undergoing cardiac CT imaging as part of clinical workup, EAT volume was retrospectively quantified from non-contrast cardiac CT by delineation of the pericardium in axial images. Mean attenuation of all pixels from EAT volume was calculated. Patients with type-I myocardial infarction (n = 28) had higher EAT volume (132.9 ± 111.9ml vs. 109.7 ± 94.6ml, p = 0.07) and CT-attenuation (-86.8 ± 5.8HU vs. -89.0 ± 3.7HU, p = 0.03) than patients without type-I myocardial infarction, while EAT volume and attenuation were only modestly inversely correlated (r = -0.24, p = 0.02). EAT volume increased per standard deviation of age (18.2 [6.2–30.2] ml, p = 0.003), BMI (29.3 [18.4–40.2] ml, p<0.0001), and with presence of diabetes (44.5 [16.7–72.3] ml, p = 0.0002), while attenuation was higher in patients with lipid-lowering therapy (2.34 [0.08–4.61] HU, p = 0.04). In a model containing volume and attenuation, both measures of EAT were independently associated with the occurrence of type-I myocardial infarction (OR [95% CI]: 1.79 [1.10–2.94], p = 0.02 for volume, 2.04 [1.18–3.53], p = 0.01 for attenuation). Effect sizes remained stable for EAT attenuation after adjustment for risk factors (1.44 [0.77–2.68], p = 0.26 for volume; 1.93 [1.11–3.39], p = 0.02 for attenuation).ConclusionCT-derived EAT attenuation, in addition to volume, distinguishes patients with vs. without myocardial infarction and is increased in patients with lipid-lowering therapy. Our results suggest that assessment of EAT attenuation could render complementary information to EAT volume regarding coronary risk burden.
Highlights
Epicardial adipose tissue (EAT) volume is associated with coronary artery plaque burden and the prevalence and incidence of myocardial infarction.[1,2,3,4,5,6] In subjects with subsequent myocardial infarction, the fat volume surrounding the coronary segment developing the culprit lesion years later was even further increased compared to other segments in the same patients, suggesting that changes in adipose tissue locally influence plaque development.[3]
Our results suggest that assessment of EAT attenuation could render complementary information to EAT volume regarding coronary risk burden
The low standard deviation of computed tomography (CT) derived attenuation reflected its low variation compared to EAT volume
Summary
Epicardial adipose tissue (EAT) volume is associated with coronary artery plaque burden and the prevalence and incidence of myocardial infarction.[1,2,3,4,5,6] In subjects with subsequent myocardial infarction, the fat volume surrounding the coronary segment developing the culprit lesion years later was even further increased compared to other segments in the same patients, suggesting that changes in adipose tissue locally influence plaque development.[3] In addition to volume, CT-derived fat attenuation is suggested to reflect unfavorable metabolic activity, as it increases with vascularization, reflects higher concentration of mitochondria and is correlated with local and systemic inflammatory markers.[7,8,9] Peri-coronary fat attenuation varies depending on its location,[10] clinical implications of EAT attenuation remain controversial.[9, 11] In the present manuscript, we aimed to (1) determine the distribution of CTderived EAT volume and attenuation as well as their correlation in a retrospective clinical cohort of patients undergoing cardiac CT imaging, (2) investigate the association of EAT volume and attenuation with established risk factors as well as antihypertensive and lipid-lowering therapy, and (3) determine the association of EAT volume and attenuation with the clinical presentation of the patients. Whether CT-derived EAT attenuation in addition to EAT volume distinguishes patients with and without myocardial infarction
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