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.
Highlights
Epicardial adipose tissue belongs to the endocrine active assemblage of visceral body fat with paracrine impact on the initiation and progression of coronary artery disease (CAD) [1,2,3,4].Previous large cohort studies demonstrated that epicardial adipose tissue (eCAT) volume is associated with atherogenic risk factors, the presence of CAD and plaque burden [3, 5,6,7,8,9]
Univariate regression analysis demonstrated an association of eCAT volume with age, total number of atherogenic risk factors, BMI and the biomarkers hs-CRP and high-sensitive Troponin T (hs-TnT) (Fig 2A–2E)
*Dichotomous variable; CAD indicates coronary artery disease; Hazard Ratios (HR), hazard ratio; 95% CI, 95% confidence interval; hs-CRP, high-sensitive C-reactive protein; hs-TnT, high-sensitive Troponin T; CCTA, cardiac computed tomography angiography. doi:10.1371/journal.pone.0155120.t004
Summary
Previous large cohort studies demonstrated that eCAT volume is associated with atherogenic risk factors, the presence of CAD and plaque burden [3, 5,6,7,8,9]. This observation is supported by the evidence of metabolic activity of eCAT as a source of several proatherogenic mediators, accompanied by paracrine or vasocrine mechanisms [10]. To the best of our knowledge, the association of eCAT volume and quantitative plaque composition with biomarkers like hs-TnT and hs-CRP has not been reported so far
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