Pericardial fat inflammation correlates with coronary artery disease

Abstract

Objectives We sought to assess the association between inflammation in pericardial fat (PF) and coronary artery disease (CAD) by pathological examination and clinical evaluation with cardiac computed tomography (CT). Background Inflammation of adipose tissue is involved in cardio-metabolic disorders and shows high density in CT. Methods We quantified, by immunohistochemical means, the PF inflammation in 39 autopsy cases by counting leukocyte common antigen (LCA)-positive cells. We then measured the CT density of PF in 39 patients with acute coronary syndromes and 69 patients suspected of CAD. Results Pericoronary PF had significantly more LCA-positive cells in CAD autopsy cases ( n = 21) than non-CAD cases ( n = 18) (44 ± 21 vs. 24 ± 22 cells/mm 2, p = 0.006). The CT density of PF around culprit lesions was significantly higher than non-culprit lesions in patients with acute coronary syndromes (−72 ± 11 vs. −82 ± 14 HU, p = 0.002), which may reflect PF inflammation. Among patients suspected of CAD, the pericardial CT density gradient (PDG; difference in CT density between pericoronary PF and PF apart from coronary arteries) was significantly greater in CAD patients ( n = 30) than non-CAD patients ( n = 39) (22 ± 16 vs. 16 ± 10 HU, p = 0.046). Multiple logistic regression analysis demonstrated that the PF inflammation index (PFI; PDG × PF volume, which could be the integrated index of inflammatory activity and abundance of PF) was significantly associated with the presence of CAD (odds ratio [95% confidence interval]; 1.234 [1.012–1.503] per 1000 HU cm 3, p = 0.037) independent of other metabolic risk factors such as hypertension, dyslipidemia, and diabetes. Conclusions Active inflammation in PF correlates with CAD. PF inflammation may be involved in pathogenesis of CAD.