Relation between quantity and quality of peri-coronary epicardial adipose tissue and its underlying hemodynamically significant coronary stenosis

Yu Du,Qian Ma,Yuyang Liu,Lei Xu,Yan Liu,Bangguo Yang,Lin Yang,Zhijian Wang,Yingxin Zhao,Yujie Zhou,Yong Zhu,Dongmei Shi,Hongkai Zhang,Chenping Hu,Sai Lv

doi:10.1186/s12872-020-01499-w

Abstract

BackgroundWe aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia.MethodsWe enrolled 45 patients (55 lesions) with known or suspected coronary artery disease who underwent coronary computed tomography angiography (CTA) followed by invasive fractional flow reserve (FFR) assessment within 30 days. EAT volume (index) and density in patient-, vessel- and lesion-level were measured on CTA images. Lesion-specific ischemia was defined as a lesion with stenosis diameter > 90% or FFR ≤0.80. Multivariate analysis determined the independent association of EAT parameters with lesion-specific ischemia.ResultsMean age of the patients was 60 years, and 75% were male. Overall, 55.6% of patients had ischemic lesions and a mean FFR baseline value of 0.82 ± 0.10. Total EAT volume index was significantly higher in patients with functionally or anatomically significant stenosis. Specifically, peri-lesion EAT volume index, not the density, was positively correlated with lesion-specific ischemia independent of luminal stenosis and plaque characteristics (hazard ratio 1.56, 95% confidence interval 1.04–2.33, P = 0.032; per 0.1 ml/m2 increase). Moreover, peri-lesion EAT volume was negatively correlated with lesion FFR values, whereas total EAT volume was positively correlated with fat accumulation and glucose metabolism. In addition, there was no association of EAT volume or density with myocardial ischemia in vessel-level analysis.ConclusionsLesion-specific EAT volume index, but not density, seems positively and independently associated with myocardial ischemia, while its incremental diagnostic value of lesion-specific ischemia should be further investigated.

Highlights

We aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia
Exclusion criteria included the presence of acute coronary syndrome (ACS) within the past 30 days; a history of myocardial revascularization or old myocardial infarction; presence of co-morbidities; coronary computed tomography angiography (CTA) not performed within 30 days before fractional flow reserve (FFR) evaluation or technical failure to measure FFR or EAT parameters; presence of threevessel disease, left main or chronic totally occluded lesions, or any intermediate lesions on main branch not measured by FFR
LeEAT volume index was markedly higher for ischemic lesions, this index was a lesion-specific predictor of hemodynamic relevance, independent of a variety of lesion-level parameters

Summary

Introduction

We aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia. Epicardial adipose tissue (EAT) is a specific fat depot between the myocardium and the visceral pericardium, mainly surrounding major epicardial coronary arteries or within the myocardium [1]. Numerous studies showed that the accumulation of EAT is closely associated with the presence and severity of coronary artery disease (CAD), myocardial ischemia, plaque vulnerability, and major adverse cardiovascular events (MACE) [2,3,4,5]. Antonopoulos et al found that the peri-coronary EAT attenuation index can expose vascular inflammation, subclinical coronary atherosclerosis, and vulnerable plaque [11] and even independently predict cardiac mortality [12]

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