Epicardial Adipose Tissue Density Research Articles

Epicardial adipose tissue density predicts the presence of atrial fibrillation and its recurrence after catheter ablation: three-dimensional reconstructed image analysis.

Epicardial adipose tissue (EAT) induces inflammation in the atria and is associated with atrial fibrillation (AF). Several studies have examined the relationship between EAT volume (EAT-V) and density (EAT-D) and the presence of AF after catheter ablation. However, conclusions have been inconsistent. This study included 43 consecutive patients who underwent catheter ablation for AF and 30 control patients. EAT-V and EAT-D around the entire heart, entire atrium, left atrium (LA), and right atrium (RA) were measured in detail using reconstructed three-dimensional (3D) EAT images from dual-source computed tomography (CT). None of the measurements of EAT-V differed significantly between patients with AF and controls or between patients with recurrent AF and those without. On the other hand, all measurements of EAT-D were higher in patients with AF than in controls (entire atrium, p < 0.001; RA, p < 0.001; LA, p = 0.002). All EAT-D measurements were associated with the presence of AF. Among patients with AF who underwent ablation, all EAT-D measurements were higher in patients with recurrent AF than in those without. The difference was significant for EATRA-D (p = 0.032). All atrial EAT-D values predicted recurrent AF (EATRA-D: hazard ratio [HR], 1.208; 95% confidence interval [95% CI], 1.053-1.387; p = 0.007; EATLA-D: HR, 1.108; 95% CI 1.001-1.225; p = 0.047; EATatrial-D: HR, 1.174; 95% CI 1.040-1.325; p = 0.010). The most sensitive cutoffs for predicting recurrent AF were highly accurate for EATRA-D (area under the curve [AUC], 0.76; p < 0.01) and EATatrial-D (AUC = 0.75, p < 0.05), while the cutoff for EATLA-D had low accuracy (AUC, 0.65; p = 0.209). For predicting the presence of AF and recurrent AF after catheter ablation, 3D analysis of atrial EAT-D, rather than EAT-V, is useful.

Abstract 16865: Epicardial Adipose Tissue Density Predicts the Presence of Atrial Fibrillation and Its Recurrence After Catheter Ablation: Three-Dimensional Reconstructed Image Analysis

Introduction: Epicardial adipose tissue (EAT) induces inflammation in the atria and is associated with atrial fibrillation (AF). Several studies have examined the relationship between EAT volume (EAT-V) and density (EAT-D) and the recurrence of AF after catheter ablation. However, the conclusions of these studies have not always been consistent, which might be due to the differences in the location and method of EAT measurement. Methods: This study included 43 consecutive patients who underwent catheter ablation for AF and 30 control patients with no documented history of AF who were matched for baseline characteristics. EAT-V and EAT-D around the entire heart, both atria, left atrium (LA), and right atrium (RA) were measured in detail using reconstructed three-dimensional (3D) EAT images from dual-source computed tomography before ablation. Results: None of the measurements of EAT-V differed significantly between patients with AF and controls or between patients with recurrent AF and those without. On the other hand, all measurements of EAT-D were higher in patients with AF than in controls (both atria, p&lt;0.001; RA, p&lt;0.001; LA, p=0.002). All EAT-D measurements were associated with the presence of AF. Among patients with AF who underwent ablation, all EAT-D measurements were higher in patients with recurrent AF than in those without. The difference was significant for EATRA-D (p=0.032). All atrial EAT-D values predicted recurrent AF (EATRA-D: hazard ratio [HR], 1.208; 95% confidence interval [95%CI], 1.053-1.387; p=0.007; EATLA-D: HR, 1.108; 95% CI,1.001-1.225; p=0.047; EATatrial-D: HR, 1.174; 95% CI,1.040-1.325; p=0.010). According to the ROC curve analysis, EATatrial-D&gt; –80.9 HU is associated with AF recurrence with 100% sensitivity and 58% specificity (AUC, 0.75; p&lt;0.05), and EATRA-D &gt; –80.9 HU could distinguish patients with AF recurrence with 86% sensitivity and 61% specificity (AUC, 0.76; p&lt;0.01). However, EATLA-D &gt; –85.3 HU had low accuracy (sensitivity, 100%; specificity, 33%; AUC, 0.65; p=0.209). Conclusion: For predicting the presence of AF, 3D analysis of EAT-D, rather than EAT-V, is useful. Peri-atrial EAT-D is responsible for recurrent AF after ablation and useful for predicting recurrent AF after catheter ablation.

Epicardial adipose tissue density is a better predictor of cardiometabolic risk in HFpEF patients: a prospective cohort study

BackgroundEpicardial adipose tissue (EAT) accumulation is associated with multiple cardiometabolic risk factors and prognosis of heart failure with preserved ejection fraction (HFpEF). The correlation between EAT density and cardiometabolic risk and the effect of EAT density on clinical outcome in HFpEF remain unclear. We evaluated the relationship between EAT density and cardiometabolic risk factors, also the prognostic value of EAT density in patients with HFpEF.MethodsWe included 154 HFpEF patients who underwent noncontrast cardiac computed tomography (CT) and all patients received follow-up. EAT density and volume were quantified semi-automatically. The associations of EAT density and volume with cardiometabolic risk factors, metabolic syndrome and the prognostic impact of EAT density were analyzed.ResultsLower EAT density was associated with adverse changes in cardiometabolic risk factors. Each 1 HU increase in fat density, BMI was 0.14 kg/m2 lower (95% CI 0.08–0.21), waist circumference was 0.34 cm lower (95% CI 0.12–0.55), non-HDL-cholesterol was 0.02 mmol/L lower (95% CI 0–0.04), triglyceride was 0.03 mmol/L lower (95% CI 0.01–0.04), fasting plasma glucose was 0.05 mmol/L lower (95% CI 0.02–0.08), TyG index was 0.03 lower (95% CI 0.02–0.04), Log2(TG/HDL-C) was 0.03 lower (95% CI 0.02–0.05), METS-IR was 0.36 lower (95% CI 0.23–0.49), MetS Z-score was 0.04 lower (95% CI 0.02–0.06), and Log2(CACS + 1) was 0.09 lower (95% CI 0.02–0.15). After adjusting for BMI and EAT volume, the associations of non-HDL-cholesterol, triglyceride, fasting plasma glucose, insulin resistance indexes, MetS Z-score, and CACS with fat density remained significant. The area under the curve (AUC) for the presence and severity of metabolic syndrome was greater in EAT density than volume (AUC: 0.731 vs 0.694, 0.735 vs 0.662, respectively). Over a median follow-up of 16 months, the cumulative incidence of heart failure readmission and composite endpoint increased with lower level of EAT density (both p < 0.05).ConclusionsEAT density was an independent impact factor of cardiometabolic risk in HFpEF. EAT density might have better predictive value than EAT volume for metabolic syndrome and it might have prognostic value in patients with HFpEF.

Cardiac Computed Tomography Evaluation of Association of Left Ventricle Disfunction and Epicardial Adipose Tissue Density in Patients with Low to Intermediate Cardiovascular Risk

Background and objectives: Epicardial adipose tissue density (EAD) has been associated with coronary arteries calcium score, a higher load of coronary artery disease (CAD) and plaque vulnerability. This effect can be related to endocrine and paracrine effect of molecules produced by epicardial adipose tissue (EAT), that may influence myocardial contractility. Using coronary computed tomography angiography (CCT) the evaluation of EAD is possible in basal scans. The aim of the study is to investigate possible associations between EAD and cardiac function. Material and Methods: 93 consecutive patients undergoing CCT without and with contrast medium for known or suspected coronary CAD were evaluated. EAD was measured on basal scans, at the level of the coronary ostia, the lateral free wall of the left ventricle, at the level of the cardiac apex, and at the origin of the posterior interventricular artery. Cardiac function was evaluated in post-contrast CT scans in order to calculate ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Results: A statistically significant positive correlation between EAD and ejection fraction (r = 0.29, p-value < 0.01) was found. Additionally, a statistically significant negative correlation between EAD and ESV (r = -0.25, p-value < 0.01) was present. Conclusion: EAD could be considered a new risk factor associated with reduced cardiac function. The evaluation of this parameter with cardiac CT in patients with low to intermediate cardiovascular risk is possible.

Association between epicardial adipose tissue density and characteristics of coronary plaques assessed by coronary computed tomographic angiography.

To investigate the relationship between the epicardial adipose tissue density (EATD) and the coronary plaque components as assessed by coronary computed tomographic angiography (CCTA). The study cohort included 240 patients with chest pain or precardiac discomfort (mean age 62.01 ± 7.45years, 55.83% male). Patients were assigned to the high-risk plaque (HRP) group (n = 133) or non-HRP group (n = 107). All patients underwent CCTA to assess plaque composition, and quantitative analysis of EATD and epicardial adipose tissue volume (EATV). Age, gender, EATV, EATD, diabetes history and family history were all correlated with HRP. There was no linear correlation between EATD and EATV among the subjects (R2 = 0.008, p = 0.177), but there was a curvilinear correlation (R2 = 0.102, p < 0.001). After adjusting other traditional factors, and we observed robust associations of EAT volume and density with HRP (all p < 0.05). For per 1 standard deviation increase in EATD, the risk of HRP was 3.120 times the risk than that of non-HRP. For per 1 standard deviation increase in EATV, the risk of HRP was 1.499 times the risk than that of non-HRP. The receiver operating characteristic curve showed that EATD was more predictive of HRP than EATV (AUC = 0.761, 95% CI 0.701-0.822). Our study found that EATD and EATV are both independent factors affecting the presence of HRPs, and EATD had a high predictive value for the presence of HRP.

CT-derived epicardial adipose tissue density: Systematic review and meta-analysis

PurposeThe aim of our work was to systematically review and meta-analyze epicardial adipose tissue (EAT) density values reported in literature, assessing potential correlations of EAT density with segmentation thresholds and other technical and clinical variables. MethodA systematic search was performed, aiming for papers reporting global EAT density values in Hounsfield Units (HU) in patients undergoing chest CT for any clinical indication. After screening titles, abstract and full text of each retrieved work, studies reporting mean and standard deviation for EAT density were ultimately included. Technical, clinical and EAT data were extracted, and divided into subgroups according to clinical conditions of reported subjects. Pooled density analyses were performed both overall and for subgroups according to clinical conditions. Metaregression analyses were done to appraise the impact of clinical and technical variables on EAT volume. ResultsOut of 152 initially retrieved works, 13 were ultimately included, totaling for 7683 subjects. EAT density showed an overall pooled value of −85.86 HU (95% confidence interval [95% CI] −91.84, −79.89 HU), being −86.40 HU (95% CI −112.69, −60.12 HU) in healthy subjects and −80.71 HU (95% CI −87.43, −73.99 HU) in patients with coronary artery disease. EAT volume and lower and higher segmentation thresholds were found to be significantly correlated with EAT density (p = 0.044, p < 0.001 and p< 0.001 respectively). ConclusionsPatients with coronary artery disease appear to present with higher EAT density values, while the correlations observed at metaregression highlight the need for well-established, shared thresholds for EAT segmentation.

Subcutaneous, Paracardiac, and Epicardial Fat CT Density Before/After Contrast Injection: Any Correlation with CAD?

Adipose tissue, in particular epicardial adipose tissue, has been identified as a potential biomarker of cardiovascular pathologies such as coronary artery disease (CAD) in the light of its metabolic activity and close anatomic and pathophysiologic relationship to the heart. Our purpose was to evaluate epicardial adipose tissue density at both unenhanced and contrast-enhanced computed tomography (CT), along with CT densities of paracardiac and subcutaneous adipose tissue, as well as the relations of such densities with CAD. We retrospectively reviewed patients who underwent cardiac CT at our institution for CAD assessment. We segmented regions of interest on epicardial, paracardiac, and subcutaneous adipose tissue on unenhanced and contrast-enhanced scans. A total of 480 patients were included, 164 of them presenting with CAD. Median epicardial adipose tissue density measured on contrast-enhanced scans (−81.5 HU; interquartile range −84.9 to −78.0) was higher than that measured on unenhanced scans (−73.4 HU; −76.9 to −69.4) (p < 0.001), whereas paracardiac and subcutaneous adipose tissue densities were not (p ≥ 0.055). Patients with or without CAD, did not show significant differences in density of epicardial, paracardiac, and subcutaneous adipose tissue either on unenhanced or contrast-enhanced scans (p ≥ 0.092). CAD patients may experience different phenomena (inflammation, fibrosis, increase in adipose depots) leading to rises or drops in epicardial adipose tissue density, resulting in variations that are difficult to detect.

Association between epicardial adipose tissue density and outcomes after persistent atrial fibrillation catheter ablation

Epicardial adipose tissue (EAT), through a paracrine secretion of various molecules, seems to be implicated in left atrial (LA) adverse remodelling, promoting persistent atrial fibrillation (PersAF). Computed tomography (CT) density appears to be a marker of EAT secretory activity. We sought to assess whether EAT density alone or combined with EAT volume is associated with the occurrence of PersAF after a first catheter ablation (CA) procedure. This retrospective study included all consecutive patients undergoing a first CA procedure for PersAF in Nancy University Hospital in 2016 and 2017 with a one-year follow-up. Cardiac CT performed before the ablation allowed quantitative (volume) and qualitative (density) analysis of EAT. One hundred and seventy-seven patients were included. After adjustment, determinants of EAT volume were age (β = 0.97, P = 0.014), triglycerides level (β = 10.61, P = 0.002), LA area (β = 4.06, P < 0.001), and LA volume (β = −1.05, P = 0.005). Overall EAT density was associated with increased BMI (β=0.19, P = 0.005) and BNP level (β = 0.002, P = 0.005), while peri-LA EAT density correlated with higher BMI (β = 0.37, P = 0.01) and total cholesterol level (β = 2.53, P = 0.017). Patients showing AF recurrence were more likely to be females (30.2% vs. 14.8%, P = 0.016), diabetics (21.9% vs. 9.9%, P = 0.032) and symptomatic (NYHA III/IV: 20.8% vs. 8.6%, P = 0.025). AF recurrence was associated with a lower density of overall EAT (−97.7 ± 4.4 vs. −96.3 ± 3.9, P = 0.024) and peri-LA EAT (P < 0.001). EAT density assessed by cardiac CT seems to be correlated with the risk of recurrence after a first PersAF CA. EAT density might be useful to predict PersAF recurrence after CA and could also become a therapeutic target.

Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects

BackgroundWe investigated whether epicardial adipose tissue (EAT) volume and density are related to early atherosclerosis, plaque inflammation and major adverse cardiac events (MACE, cardiac death and myocardial infarction) in asymptomatic subjects. MethodsEAT volume and density were quantified from non-contrast cardiac CT in 456 asymptomatic individuals (age 60.3 ± 8.3; 68% with CCS>0) from the prospective EISNER trial. EAT volume and density were examined in relation to coronary calcium score (CCS), inflammatory biomarkers and MACE. ResultsEAT volume was higher and EAT density lower in subjects with coronary calcium compared to subjects without [89 vs 74 cm3, p < 0.001] [-76.9 vs -75.7 HU,p = 0.024]. EAT volume was lowest in individuals with no coronary calcium and was significant higher in subjects with early atherosclerosis (CCS 1-99) [74 vs 87 cm3,p = 0.016] and in subjects with more advanced atherosclerosis (CCS≥100) [89 cm3,p = 0.002]). EAT volume was independently related to serum levels of PAI-1, and MCP-1 and inversely related to adiponectin and HDL-cholesterol (p < 0.05). EAT density was inversely related to PAI-1 and LDL-cholesterol and positively associated to adiponectin, sICAM-1 and HDL-cholesterol (p < 0.05). EAT density was more significantly associated with MACE [(HR 0.8, 95%CI:0.7–0.98), p = 0.029] than EAT volume or CCS. ConclusionEAT volume was higher and density lower in subjects with coronary calcium compared to subjects with CCS = 0, with similar EAT volume in CCS<100 and CCS≥100. Lower EAT density and increased EAT volume were associated with coronary calcification, serum levels of plaque inflammatory markers and MACE, suggesting that dysfunctional EAT may be linked to early plaque formation and inflammation.

Relation between cardiovascular disease risk factors and epicardial adipose tissue density on cardiac computed tomography in patients at high risk of cardiovascular events.

Background The radiodensity of epicardial adipose tissue may provide information on cardiovascular risk in addition to epicardial adipose tissue volume. The aim of this study was to quantify the relation between cardiovascular risk factors and the radiodensity of epicardial adipose tissue in patients at high risk of cardiovascular disease. Design This was a cross-sectional study in 140 patients at high risk of cardiovascular disease. Methods Patients from the Secondary Manifestations of ARTerial disease (SMART) cohort study were invited to undergo cardiac computed tomography angiography. The radiodensity (in Hounsfield units; HU) and volume (in cm3) of epicardial adipose tissue were quantified semi-automatically. Multivariable linear regression was used to quantify the relation between cardiovascular risk factors and the radiodensity of epicardial adipose tissue. Results The cardiovascular risk factors most strongly associated with epicardial adipose tissue density were sex, body mass index and visceral fat, with a lower adipose tissue attenuation of 3.5 HU (95% confidence interval (CI) 2.0-5.0 HU) for female sex, 1.6 HU (95%CI 0.2-2.9 HU) for body mass index >25 kg/m2 and 1.3 HU (95% CI 0.6-2.0 HU) for a one standard deviation higher quantity of visceral fat, adjusted for age, sex, coronary artery bypass graft history and epicardial adipose tissue volume. Conclusion Low epicardial adipose tissue computed tomography attenuation is associated with an adverse cardiovascular risk factor profile in patients at high risk of cardiovascular disease, independent of the volume of epicardial adipose tissue and waist circumference. These findings support the potential role for epicardial adipose tissue radiodensity as a valid biomarker of cardiovascular risk. Adipose tissue radiodensity may be a more sensitive marker than epicardial adipose tissue volume with which to study the contribution of epicardial adipose tissue to the coronary atheromatous disease process.