Epicardial Fat Volume Research Articles

The relationship between epicardial fat volume and myocardial perfusion scintigraphy findings

Objectives: We investigated the epicardial fat volume (EFV) between patients with normal perfusion and reversible perfusion abnormalities in the myocardial perfusion scintigraphy (MPS) in patients with suspected coronary artery disease (CAD). In addition, we aimed to investigate the relationship of automated analysis parameters obtained in the MPS SPECT examination with EFV. Methods: A total of 295 patients (182 F, 113 M) who underwent MPS in our unit with the suspicion of CAD in the last 1 year and who had a recent thorax CT examination were included. EFV measurement in CT scans was done with Invesalius software. MPS was performed in all patients with a one-day stress and rest imaging protocol. In the stress study, imaging was performed approximately 30-45 minutes after intravenous injection of ~12 mCi Tc99m Sestamibi. Rest study imaging was performed approximately 30-60 minutes after intravenous injection of ~25 mCi Tc99m Sestamibi. Results: Median EFV was 53.00 ml (interquartile range: 23 ml, range 17-238 ml) in patients with normal MPS, and 62.00 ml in patients with myocardial ischemia on scintigraphy (interquartile range: 53 ml, range: 25-207 ml). The EFV value was statistically significantly higher in patients with reversible ischemia on MPS compared to patients with normal scintigraphy findings (p < 0.001). There was a statistically significant, low, and positive correlation between EFV and summed difference score (SDS) values (p = 0.002, r = 0.178). Conclusions: The EFV value was significantly higher in patients with reversible ischemia on MPS compared to patients with normal scintigraphy findings. Also there was a statistically low and positive correlation between EFV and SDS values. The automatic calculation of the EFV value during this examination may be a good additional parameter to detect the presence of ischemia.

Incremental value of epicardial fat volume on predicting obstructive coronary artery disease with myocardial ischemia

Objective: This study aimed to investigate the association between epicardial fat volume (EFV) and obstructive coronary artery disease (CAD) with myocardial ischemia, and evaluate the incremental value of EFV on top of traditional risk factors and coronary artery calcium (CAC) in predicting obstructive CAD with myocardial ischemia. Methods: This study was a retrospective cross-sectional study. Patients with suspected CAD who underwent coronary angiography (CAG) and single photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) at the Third Affiliated Hospital of Soochow University from March 2018 to November 2019 were consecutively enrolled. EFV and CAC were measured by non-contrast chest computed tomography (CT) scan. Obstructive CAD was defined as coronary artery stenosis≥50% in at least one of the major epicardial coronary arteries, and myocardial ischemia was defined as reversible perfusion defects in stress and rest MPI. Obstructive CAD with myocardial ischemia was defined in patients with coronary stenosis severity≥50% and reversible perfusion defects in the corresponding areas of SPECT-MPI. Patients with myocardial ischemia bot without obstructive CAD were defined as none-obstructive CAD with myocardial ischemia group. We collected and compared the general clinical data, CAC and EFV between the two groups. Multivariable logistic regression analysis was performed to identify the relationship between EFV and obstructive CAD with myocardial ischemia. ROC curves were performed to determine whether addition of EFV improved predictive value beyond traditional risk factors and CAC for obstructive CAD with myocardial ischemia. Results: Among the 164 patients with suspected CAD, 111 patients were males, and average age was (61.4±9.9) years old. 62 (37.8%) patients were included into the obstructive CAD with myocardial ischemia group. 102 (62.2%) patients were included into the none-obstructive CAD with myocardial ischemia group. EFV was significantly higher in obstructive CAD with myocardial ischemia group than in none-obstructive CAD with myocardial ischemia group ((135.63±33.29)cm3 and (105.18±31.16)cm3, P<0.01). Univariate regression analysis showed the risk of obstructive CAD with myocardial ischemia increased by 1.96 times for each SD increase in EFV(OR 2.96; 95%CI, 1.89-4.62; P<0.01). After adjustment for traditional risk factors and CAC, EFV remained as an independent predictor for obstructive CAD with myocardial ischemia (OR, 4.48, 95%CI, 2.17-9.23; P<0.01). Addition of EFV to CAC and traditional risk factors was related to larger AUC for predicting obstructive CAD with myocardial ischemia (0.90 vs. 0.85, P=0.04, 95%CI: 0.85-0.95) and the global chi-square increased by 21.81 (P<0.05). Conclusions: EFV is an independent predictor for obstructive CAD with myocardial ischemia. Addition of EFV to traditional risk factors and CAC has incremental value for predicting obstructive CAD with myocardial ischemia in this patient cohort.

Comparison of Epicardial Fat Volume and Coronary Calcification in Diabetic Versus Non-Diabetic Patients Detected by CT Coronary

Comparison of Epicardial Fat Volume and Coronary Calcification in Diabetic Versus Non-Diabetic Patients Detected by CT Coronary

Metabolic-Associated Fatty Liver Disease (MAFLD) is associated with immune activation, increased epicardial fat volume, and steatohepatitis among people with HIV in a Thai cohort.

A change in terminology from fatty liver disease to metabolic-associated fatty liver disease (MAFLD), along with modified diagnostic criteria, was proposed in 2020, and data regarding MAFLD burden in people living with HIV are limited. We investigated associations between MAFLD and immune activation, cardiovascular disease (CVD) risks including epicardial fat volume, and steatohepatitis in an Asian cohort. We evaluated CVD risk (epicardial fat tissue, coronary artery calcium [CAC] score, and 10-year atherosclerotic CVD [ASCVD] score) in people living with HIV aged >50 years. Individuals with excessive alcohol consumption and viral hepatitis infections were excluded. MAFLD diagnosis was based on 2020 International Consensus criteria. Non-alcoholic steatohepatitis (NASH) with significant activity and liver fibrosis was defined as FibroScan-aspartate aminotransferase (FAST) score ≥0.67 and >0.35. Multivariate logistic regression models were used to investigate factors associated with MAFLD and NASH with significant activity and liver fibrosis. The median age was 54 years (interquartile range [IQR] 52-60) and current CD4 count was 613 (IQR 467-804) cells/mm3 . A total of 37% were female, and most (98%) people living with HIV were virally suppressed. The prevalence of MAFLD and non-alcoholic fatty liver disease was 35% and 38%, respectively. In multivariate analyses, higher body mass index, albumin, epicardial fat volume, and liver stiffness were significantly associated with MAFLD. A higher CD4/CD8 ratio was associated with a lower risk of MAFLD. People with HIV with MAFLD had higher odds of having NASH with significant activity and liver fibrosis (adjusted odds ratio 3.3; 95% confidence interval 1.6-6.6), and similar associations were also observed among different MAFLD categories. The complex relationship between MAFLD and immune activation, steatohepatitis, and epicardial fat tissue suggests an increased risk of advanced liver disease and CVDs beyond the traditional risk factors in people living with HIV with fatty liver disease.

Epicardial and thoracic subcutaneous fat texture analysis in patients undergoing cardiac CT

IntroductionThe aim of our study was to evaluate the feasibility of texture analysis of epicardial fat (EF) and thoracic subcutaneous fat (TSF) in patients undergoing cardiac CT (CCT). Materials and methodsWe compared a consecutive population of 30 patients with BMI ≤25 kg/m2 (Group A, 60.6 ± 13.7 years) with a control population of 30 patients with BMI >25 kg/m2 (Group B, 63.3 ± 11 years). A dedicated computer application for quantification of EF and a texture analysis application for the study of EF and TSF were employed. ResultsThe volume of EF was higher in group B (mean 116.1 cm3 vs. 86.3 cm3, p = 0.014), despite no differences were found neither in terms of mean density (−69.5 ± 5 HU vs. −68 ± 5 HU, p = 0.28), nor in terms of quartiles distribution (Q1, p = 0.83; Q2, p = 0.22, Q3, p = 0.83, Q4, p = 0.34). The discriminating parameters of the histogram class were mean (p = 0.02), 0,1st (p = 0.001), 10th (p = 0.002), and 50th percentiles (p = 0.02). DifVarnc was the discriminating parameter of the co-occurrence matrix class (p = 0.007).The TSF thickness was 15 ± 6 mm in group A and 19.5 ± 5 mm in group B (p = 0.003). The TSF had a mean density of −97 ± 19 HU in group A and −95.8 ± 19 HU in group B (p = 0.75). The discriminating parameters of texture analysis were 10th (p = 0.03), 50th (p = 0.01), 90th percentiles (p = 0.04), S(0,1)SumAverg (p = 0.02), S(1,-1)SumOfSqs (p = 0.02), S(3,0)Contrast (p = 0.03), S(3,0)SumAverg (p = 0.02), S(4,0)SumAverg (p = 0.04), Horzl_RLNonUni (p = 0.02), and Vertl_LngREmph (p = 0.0005). ConclusionsTexture analysis provides distinctive radiomic parameters of EF and TSF. EF and TSF had different radiomic features as the BMI varies.

Prognostic value of ventricle epicardial fat volume by cardiovascular magnetic resonance in chronic heart failure

The purpose of this study is to explore the prognostic values of ventricle epicardial fat volume (EFV) calculated by cardiac magnetic resonance in patients with chronic heart failure (CHF). A total of 516 patients with CHF (left ventricular ejection fraction ≤ 50%) were recruited, and 136 (26.4%) of whom experienced major adverse cardiovascular events (MACE) within median follow-up of 24months. The target marker-EFV was found to be associated with MACE in both univariate and multivariable analysis adjusted for various clinical variables (p<0.01), regardless as a continuous variable and categorized by X-tile program. EFV also showed promising predictive ability, with an area under the curve of 0.612, 0.618, and 0.687 for the prediction of 1-year, 2-year, and 3-year MACE, respectively. In conclusion, EFV could be a useful prognostic marker for CHF patients, helping to identify individuals at greater risk of MACE.

Association of epicardial fat with cardiac structure and function and cardiovascular outcomes: A protocol for systematic review and meta-analysis.

Epicardial fat represents visceral adiposity. Many observational studies have reported that increased epicardial is associated with adverse metabolic profile, cardiovascular risk factors, and coronary atherosclerosis in patients with cardiovascular diseases and in general population. We and others have previously reported the association of increased epicardial fat with left ventricular (LV) hypertrophy and diastolic dysfunction as well as the development of heart failure (HF) and coronary artery disease in these populations. In some studies, however, the association did not reach statistical significance. The inconsistent results may be due to limited power, different imaging modalities for quantifying epicardial fat volume, and different outcome definitions. Accordingly, we aim to perform the systematic review and meta-analysis of studies on the association of epicardial fat with cardiac structure and function and cardiovascular outcomes. This systematic review and meta-analysis will include observational studies examining the association of epicardial fat with cardiac structure and function or the cardiovascular outcomes. Relevant studies will be identified by searching electronic databases including PubMed, Web of Science, and Scopus and by manual screening of reference lists of relevant reviews and retrieved studies. The primary outcome will be cardiac structure and function. The secondary outcome will be cardiovascular events including death from cardiovascular causes, hospitalization for HF, nonfatal myocardial infarction, and unstable angina. The results of our systematic review and meta-analysis will provide evidence regarding the clinical usefulness of epicardial fat assessment. INPLASY 202280109.

Quantification of epicardial fat volume using low-dose cardiac scan in patients with low calcium score.

We investigated the accuracy of quantifying epicardial adipose tissue volume (EATV) using low-dose cardiac scan (EATVcardiac scan) and evaluated its clinical utility in predicting coronary heart disease in patients with low or mild calcification. In total, 204 patients with clinical symptoms of coronary heart disease and coronary artery calcium score (CACS) of <100 AU were enrolled in this retrospective study. After obtaining EATVcardiac scan and EATV measured using computed tomography angiography (EATVCTA), the agreement between the two measurements was evaluated using Pearson correlation coefficient and Bland-Altman analysis. Multivariate logistic regression was used to analyze the utility of EATV in predicting plaque and vulnerable plaque. Receiver operating characteristic curves were constructed. The mean EATVcardiac scan (101.51±41.57 cm3) and EATVCTA (104.57±41.34 cm3) of all patients were similar, and the two measurements were strongly correlated (r=0.9596, P<0.001). The difference between EATVcardiac scan and EATVCTA was -3.0549, with only 4.9% (10/204) of patients having values outside the 95% confidence interval (CI) range (-26.15 to 20.04; P for agreement =0.0003). Further, a significant agreement was observed between EATVcardiac scan and EATVCTA in 126 patients with plaques, with an estimated difference of -3.354, and 6.35% (8/126) of patients had values outside the 95% CI range (-31.37 to 24.66; P for agreement =0.0095). After adjustment for age and sex, EATVcardiac scan and EATVCTA were significantly associated with plaque (all P values <0.001), and the areas under the curve (AUCs) were 0.662 and 0.670 (P=0.4331), respectively. In contrast, EATVcardiac scan and EATVCTA were not associated with vulnerable plaque (P>0.05), with AUCs of 0.550 and 0.530, respectively (P=0.2157). The study results indicate that EATVcardiac scan and EATVCTA are equivalent. In addition, both methods provide comparable values for predicting coronary arteriosclerosis in patients with low-to-mild calcification (CACS of <100 AU).

Epicardial fat density, coronary artery disease and inflammation in people living with HIV.

Studies have shown an increased risk of coronary artery disease (CAD) in the human immunodeficiency virus (HIV) population. Epicardial fat (EF) quality may be linked to this increased risk. In our study, we evaluated the associations between EF density, a qualitative characteristic of fat, and inflammatory markers, cardiovascular risk factors, HIV-related parameters, and CAD. Our study was cross-sectional, nested in the Canadian HIV and Aging Cohort Study, a large prospective cohort that includes participants living with HIV (PLHIV) and healthy controls. Participants underwent cardiac computed tomography angiography to measure volume and density of EF, coronary artery calcium score, coronary plaque, and low attenuation plaque volume. Association between EF density, cardiovascular risk factors, HIV parameters, and CAD were evaluated using adjusted regression analysis. A total of 177 PLHIV and 83 healthy controls were included in this study. EF density was similar between the two groups (-77.4 ± 5.6 HU for PLHIV and -77.0 ± 5.6 HU for uninfected controls, P = .162). Multivariable models showed positive association between EF density and coronary calcium score (odds ratio, 1.07, P = .023). Among the soluble biomarkers measured in our study, adjusted analyses showed that IL2Rα, tumor necrosis factor alpha and luteizing hormone were significantly associated with EF density. Our study showed that an increase in EF density was associated with a higher coronary calcium score and with inflammatory markers in a population that includes PLHIV.

Epicardial fat volume assessed with cardiac magnetic resonance imaging in patients with Takotsubo cardiomyopathy

PurposeThe aims of our study were to investigate with cardiovascular magnetic resonance (CMR) the role of Epicardial Fat Volume (EFV) and distribution in patients with Takotsubo cardiomyopathy (TTC). Moreover, we explored EFV in patients with TTC and related this to comorbidities, cardiac biomarkers, and cardiac function. MethodsThis retrospective study performed CMR scans in 30 consecutive TTC patients and 20 healthy controls. The absolute amount of EFV was quantified in consecutive short-axis cine stacks through the modified Simpson’s rule. In addition, the left atrio-ventricular groove (LV) and right ventricle (RV) Epicardial Fat Thickness (EFT) were measured as well. Besides epicardial fat, LV myocardial strain parameters and T2 mapping measurements were obtained. ResultsTTC patients and controls were of comparable age, sex, and body mass index. Compared to healthy controls, patients with TTC demonstrated a significantly increased EFV, epicardial fat mass, and EFV indexed for body 7surface area (p = 0.005; p = 0.003; p = 0.008; respectively). In a multiple regression model including age, sex, BMI, atrial fibrillation, and dyslipidemia, TTC remained an independent association with EFV (p = 0.008). Global T2 mapping and Global longitudinal strain in patients with TTC were correlated with EFV (r = 0.63, p = 0.001, and r = 0.44, p = 0.02, respectively). ConclusionPatients with TTC have increased EFV compared to healthy controls, despite a similar body mass index. The amount of epicardial fat was associated with CMR markers of myocardial inflammation and subclinical contractile dysfunction.

Epicardial fat volume evaluated with multidetector computed tomography and other risk factors for prevalence of three-vessel coronary lesions

PurposeTo retrospectively investigate the epicardial fat volume with multidetector computed tomography (MDCT) and other risk factors for the prevalence of three-vessel coronary lesion.Materials and methodsMDCT was performed on 424 subjects with or without three-vessel coronary lesion. Blood was tested for triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A (ApoA), apolipoprotein B (ApoB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lipoprotein a, and fasting blood glucose.ResultsAmong all the subjects, a significant (P < 0.05) negative linear correlation existed between age and ALT or ALT/AST. The epicardial fat had a significant (P < 0.05) negative linear correlation with HDL and Apo A but a positive correlation with age and ApoB/ApoA. The epicardial fat volume and the fasting blood glucose were significantly (P = 0.001) greater in the patients than in the control group, whereas HDL and Apo A were both significantly (P < 0.0001) smaller in the patients than in the control groups. A significant prediction value (P < 0.05) existed in age increase, male gender, epicardial fat increase, low HDL, high LDL, and elevated fasting blood glucose.ConclusionThree-vessel coronary lesions are more prevalent in subjects with greater volume of epicardial fat and in male gender.

Beyond the Calcium Score: What Additional Information from a CT Scan Can Assist in Cardiovascular Risk Assessment?

Coronary artery disease (CAD) still represents a leading cause of mortality worldwide. Early identification of patients at the highest risk of CAD is crucial to prevent acute adverse events and reduce morbidity and mortality. The coronary artery calcium (CAC) score is a reliable cardiovascular (CV) risk index with an independent prognostic value. Guidelines recommend using it as a risk enhancer in individuals with low or moderate CV risk. However, other computed tomography (CT) measurable parameters have recently been proposed as CV risk markers. Increasing evidence demonstrates the association between epicardial fat volume and coronary atherosclerosis in chronic and acute coronary syndromes. Furthermore, other parameters obtainable from CT, such as aortic stiffness, liver fat, aortic calcium, and myocardial scarring, are under investigation. This review aims to describe all CT potential in atherosclerosis detection and cardiovascular risk assessment beyond the CAC, trying to understand how to integrate CT parameters with traditional risk factors and to improve clinicians' ability to detect CAD early, allowing appropriate therapies promptly.

Epicardial Fat Volume, Cardiac Function, and Incident Heart Failure: The Rotterdam Study.

Background Larger epicardial fat volume (EFV) has been associated with increased risks of cardiovascular disease and atrial fibrillation. Yet, evidence on the association of EFV with cardiac function and incident heart failure (HF) remains scarce. Methods and Results We included 2103 participants (mean age, 68 years; 54.4% women) from the prospective population-based RS (Rotterdam Study) with computed tomography-based EFV and repeated echocardiography-based assessment of left ventricular (LV) systolic and diastolic function. Linear mixed effects and Cox-proportional hazard regression models, adjusted for cardiovascular risk factors, were used to assess the associations of EFV with repeated measurements of echocardiographic parameters and with incident HF. During a median follow-up of 9.7 years, 124 HF events occurred (incidence rate, 6.37 per 1000 person-years). For LV systolic function, 1-SD larger EFV was associated with 0.76 (95% CI, 0.54-0.98) mm larger LV end-diastolic dimension, 0.66 (95% CI, 0.47-0.85) mm larger LV end-systolic dimension, and 0.56% (95% CI, -0.86% to -0.27%) lower LV ejection fraction. Interactions between EFV and time were small. For LV diastolic function, 1-SD larger EFV was associated with 1.02 (95% CI, 0.78-1.27) mm larger left atrial diameter. Larger EFV was also associated with incident HF (hazard ratio per 1-SD increase in EFV, 1.34 [95% CI, 1.07-1.68] per 1-SD larger EFV). Conclusions We report an independent association between EFV with new-onset HF in the general population. EFV seems to exert its influence on HF through different pathways contributing to deteriorations in systolic function and larger left atrial size in part, likely through mechanical restraint and hypertrophy.

Cardiac Findings on Non-Contrast Thoracic Tomography in Patients with Acromegaly

Aim: Acromegaly occurs as a result of excessive and permanent secretion of growth hormone from the pituitary. Mortality is mostly related to cardiovascular system involvement. In our study, we aimed to evaluate the correlation between epicardial fat volume (EFV) and growth hormone level in thorax computed tomography in patients with acromegaly and coronary artery calcification, pulmonary artery diameter, ascending aorta diameter, cardiothoracic ratio (CTO) measurements with the control group patients.&#x0D; Method: Our study was retrospective and included 16 patients with acromegaly who were previously diagnosed and treated by the endocrinology clinic and a control group consisting of 32 patients matched for gender and age.In thorax CT, EFV measurement of the patients was performed and main pulmonary artery diameters, ascending aorta diameters, cardio thoracic ratios, presence of coronary artery calcification were evaluated.&#x0D; Results: The number of patients with large ascending aorta was higher in patients with acromegaly and it was statistically significant (p=0.041). Although the rate of patients with large main pulmonary artery diameter was higher in patients with acromegaly, no significant difference was found between the groups (p=0.355). There was no significant difference between the groups in terms of increased CTO (p=0.818) and coronary artery calcification (p=0.157).&#x0D; Conclusion: In our study, a difference was found between the acromegaly and control group patients only in terms of ascending aorta diameters, but no significant difference was found in terms of other parameters. We think that regular follow-up and treatment of patients is effective in this result. Cardiovascular risks can be reduced in patients with acromegaly with early diagnosis, regular follow-up and treatment.

VALUE OF EPICARDIAL ADIPOSE TISSUE ASSESSMENT BY CARDIAC COMPUTERIZED TOMOGRAPHY IN HEART FAILURE PATIENTS WITH PRESERVED EJECTION FRACTION

Objectives: A major problem that increases the morbidity and mortality is Heart failure with preserved ejection fraction (HFpEF)in comparison toheart failure with reduced ejection fraction (HFrEF). Adipose tissue and the linked inflammation were shown to contribute in HF pathogenesis and constitute a unique phenotype of HF. HFpEF patients tend to be obese. So, we aimed to assess the epicardial adipocytes (EAT) noninvasively by measuring the volume of EATthroughComputerizedtomography (CT) among HFpEFpatients and correlates it with echocardiographic diastolic dysfunction measures. Study design: We enrolled 76 participants divided into two groups: 38 patients with HFpEF with LVEF &gt; 50% on echocardiography and 38 controls at outpatient clinic and a radiology department at National Heart Institute. All included participants had noninvasive assessment of the epicardial adipose tissue volume using cardiac CT. Results: Regarding Baseline Demographic characteristics, mean age (SD) of participants:57.45 (6.0) with high prevalence of risk factors (DM, Dyslipidemia, smoking) among HFpEF patients with no significant difference statistically among groups. Also, asiginificant difference statistically was found amongthe enrolled groups regarding echocardiographic findings (LVEF%, Mean E/e`ratio, est. LVEDP and Tricuspid Regurge V). The epicardial fat Volume was significantly high at HFpEF group (P &lt; 0.001). Conclusions: We found that high grade diastolic dysfunction was associated with epicardial fat that appeared to be greater in HFpEF patients. As a result, we found that epicardial fat could be used as a different marker for both HFpEF and diastolic dysfunction.

Abstract 11888: Interplay Between Metabolic Biomarkers, Adipose Tissue Depots and Coronary Artery Disease in the PROMISE Clinical Trial

Background. Visceral adipose depots such as hepatic steatosis (HS) and epicardial fat (EAT) have been implicated as markers for CVD. Higher BCAA have been implicated in HS progression, but the interplay between BCAA, different adipose tissue depots (ATDs) and CAD has not been evaluated. We leveraged the PROMISE clinical trial with centrally adjudicated coronary CTA imaging to determine relationships between ATDs, BCAA dysregulation and CAD. Methods. The PROMISE trial randomized 10,003 outpatients with stable chest pain to CTA vs. standard of care diagnostics. We included 4,019 participants with available CTA and biospecimens. ATDs (HS [presence/absence] and EAT volume) and CAD were determined by a CT core lab. NMR spectroscopy was used to measure serum BCAA (total). We determined association between (1) BMI and ATDs with obstructive CAD ( &gt; 50% stenosis in a major epicardial coronary vessel); (2) BCAA and ATDs; and (3) BCAA and CAD, using univariate and multivariate regressions. Association between BCAA with time-to-incident CVD events (all-cause death, myocardial infarction, or unstable angina hospitalization) was performed using Cox proportional hazard models. Individual BCAA SNPs were used as the instruments for Mendelian randomization (MR) analyses to evaluate if BCAA are in the casual pathway for HS or CAD. Results. The population had a mean age of 60 years, BMI of 30.8, was 53% female, 27.1% had HS, 13.9% had CAD, and 15.4% had high risk coronary plaque. EAT was associated with CAD in the multivariate models (OR 1.004, 95% CI [1.00-1.01], p=0.019). HS was not associated with CAD. Total BCAA levels were associated with HS in multivariate models (OR 1.46, 95% CI [1.28-1.67], p&lt;0.001), but BCAA were not associated with EAT. BCAA were associated with CAD in univariate (OR 1.18, CI 1.04-1.34, p&lt;0.001), but were not associated with incident events. Mendelian randomization did not support the role of BCAA as in the casual pathway of HS or CAD. Conclusions. Leveraging a large clinical trial, we found that CTA-derived ATDs are associated with CAD. We further established the role of dysregulated BCAA catabolism in HS, although this relationship did not seem to be associated with or in the causal pathway of CAD.

Effect of epicardial fat volume on outcomes after left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation.

Greater epicardial adipose tissue (EAT) is related to higher recurrences after atrial fibrillation catheter ablation (AFCA). We investigated the effects of posterior wall box isolation (POBI) in conjunction with circumferential pulmonary vein isolation (CPVI) on rhythm outcomes according to varying EAT volumes among patients with persistent atrial fibrillation (PeAF). We included 1,187 patients with PeAF undergoing a de novo AFCA including those receiving CPVI alone (n = 687) and those receiving additional POBI (n = 500). The rhythm outcomes at 2 years post-AFCA were compared in subgroups stratified by the EAT volume using propensity overlap weighting. A reduced EAT volume was linearly associated with more favorable rhythm outcomes for additional POBI than for CPVI alone (P for interaction = 0.002). Among the patients with smaller EAT volumes (≤116.23 mL, the median value, n = 594), additional POBI was associated with a reduced AF recurrence risk as compared to CPVI only [weighted HR (hazard ratio) 0.74, 95% CI (confidence interval) 0.56-0.99]. In contrast, among the remaining 593 patients with greater EAT volumes (>116.23 mL), No difference was observed in the recurrence risk between the additional POBI and CPVI alone groups (weighted HR 1.13, 95% CI 0.84-1.52). Among 205 patients with repeat ablations, the POBI reconnection rate was more frequent in the large EAT group (77.4%) than in the small EAT group (56.7%, P = 0.034). While PeAF patients with a smaller EAT volume averted AF recurrence by additional POBI after CPVI, no benefit of the POBI was observed in those with a greater EAT volume.

Epicardial Fat Volume Is Associated with Endothelial Dysfunction, but not with Coronary Calcification: From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

The increase in epicardial fat volume (EFV) is related to coronary artery disease (CAD), independent of visceral or subcutaneous fat. The mechanism underlying this association is unclear. Coronary artery calcium (CAC) score and endothelial dysfunction are related to coronary events, but whether EFV is related to these markers needs further clarification. To evaluate the association between automatically measured EFV, cardiovascular risk factors, CAC, and endothelial function. In 470 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with measures of EFV, CAC score and endothelial function, we performed multivariable models to evaluate the relation between cardiovascular risk factors and EFV (response variable), and between EFV (explanatory variable) and endothelial function variables or CAC score. Two-sided p <0.05 was considered statistically significant. Mean age was 55 ± 8 years, 52.3% of patients were men. Mean EFV was 111mL (IQ 86-144), and the prevalence of CAC score=0 was 55%. In the multivariable analyses, increased EFV was related to female sex, older age, waist circumference, and triglycerides (p<0.001 for all). Higher EFV was associated with worse endothelial function: as compared with the first quartile, the odds ratio for basal pulse amplitude were (q2=1.22, 95%CI 1.07-1.40; q3=1.50, 95%CI 1.30-1.74; q4=1.50, 95%CI 1.28-1.79) and for peripheral arterial tonometry ratio were (q2=0.87, 95%CI 0.81-0.95; q3=0.86, 95%CI 0.79-0.94; q4=0.80, 95%CI 0.73-0.89), but not with CAC score>0. Higher EFV was associated with impaired endothelial function, but not with CAC. The results suggest that EFV is related to the development of CAD through a pathway different from the CAC pathway, possibly through aggravation of endothelial dysfunction and microvascular disease.

High epicardial fat volume is associated with atrial fibrillation recurrences after catheter ablation

Abstract Background Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation therapy for atrial fibrillation (AF). However, even with important technological improvements, AF recurrences are common in long-term follow-up. Recently, epicardial fat tissue (EFT) has been proposed as a potential AF modulator promoting and sustaining atrial arrhythmogenic milieu. Aim In this retrospective single-centre study, we sought to evaluate the association between CT-quantified EFT volume and long-term primary PVI outcome assed by means of continuous ECG monitoring with implantable loop recorders (ILR) in paroxysmal AF patients. Methods A cohort of 92 patients (median age 60.2 [IQR 51.9–64.0]; 74% male) with paroxysmal AF (a single persistent AF episode was accepted) undergoing catheter ablation targeted at PVI was analysed. Prior to CA all patients underwent cardiac CT imaging with subsequent implantation of implantable loop recorder (ILR). Radiofrequency CA ablation with electro-anatomical mapping for PVI was used in 79 patients, balloon cryoablation was used in 13 patients. Verified complete PVI was defined as procedural endpoint. EFT volume was semi-automatically segmented and quantified on contrast enhanced CT studies. AF recurrence, defined as AF burden &amp;gt;0.1% after the blanking period (90 days), was continuously assessed by ILR. Kaplan-Meier analysis of AF recurrence-free survival at 1-year, 2-year and 3-year follow-up periods compared patients stratified into EFT volume tertiles. Results During a median follow-up of 52.6 months [IQR 43–64], AF recurrence was detected in 58 (63%) patients, 29 (50%) of them underwent a repeat ablation. Patients in high, mid, and low total EFT volume tertiles had a median time to late AF recurrence of 154, 373, and 284 days (Fig. 1A). At a 1-year follow-up, patients in the high EFT volume tertile had the worst AF ablation outcome (p=0.023). However, this difference gradually faded-out and became non-significant at 2 and 3 years. ROC analysis revealed an EFT of 95 ml as an optimal cut-off (p=0.002) for expected arrhythmia recurrence post acutely successful PVI (Fig. 1B). Conclusion EFT volume quantification in a relatively homogenous, continuously monitored cohort of patients undergoing catheter ablation for paroxysmal AF revealed a significant association between AF recurrence at 1 year post ablation and volume of epicardial fat. These results suggest a possible role of epicardial adipose tissue as an adverse pro-fibrillatory factor. Identified EFT volume cut-offs have to be validated prospectively on a larger and balanced patient population. Funding Acknowledgement Type of funding sources: None.

Epicardial and pericoronary fat volume and attenuation, lipid lowering therapy and coronary high risk coronary plaque burden

Abstract Background Epicardial (EAT) and pericoronary adipose tissue (PCAT) are known as risk predictors of subclinical atherosclerosis and coronary artery disease. We aimed to evaluate the association of EAT and PCAT volume and attenuation with the presence of high risk coronary plaque burden in patients with vs. without lipid lowering therapy. Methods In the present retrospective analysis a total of 321 patients undergoing coronary CTA at the XXX were included. EAT and PCAT were manually traced from CT imaging for assessment of fat volume and attenuation. According to the SCCT guidelines for the interpretation of coronary CTA, each coronary segment was evaluated for the presence of high risk plaque features (napkin ring sign, spotty calcification, positive remodeling, and low attenuation plaque). Results Overall data from 321 patients (mean age: 55.5±14.7 years, 62% male) and a total of 5778 coronary segments were included in our analysis. The cohorts consists of 116 patients without plaque and stenosis, 96 patients with plaque but no significant stenosis and 109 patients with obstructive coronary stenosis. Highest rates of the presence of coronary plaque were detected in proximal LAD (17.9%), followed by mid LAD (12.9%) and proximal RCA (10.8%). Coronary stenosis was also most common in proximal LAD (14.6%), followed by mid LAD (12.1%) and proximal RCA (11%). High risk plaque features were found in 401 segments and were most frequently located in the proximal LAD (21.4%). EAT volume increased with higher rates of stenosis and plaque (44.7±25.2ml vs. 68,2±28,5ml vs. 85.2±31.7ml, p&amp;lt;0.001). Prevalence of high risk plaque increased by higher EAT volume (OR [95% CI]: 3.17 [2.33–4.33], p&amp;lt;0.0001) and remains stable after upon adjustment for risk factors (2.32 [1.46–3.7], p&amp;lt;0.0001). EAT attenuation also significantly associated with the presence of high risk plaques with 0.68-folded risk in the unadjusted (0.68 [0.53–0.88], p=0.003), and 0.62-folded risk in the multivariate (MV) adjusted regression analysis (0.62 [0.45–0.85], p=0.003). However, for PCAT only its volume but not its attenuation was significantly associated with presence of high risk plaques in MV-adjusted regression analysis (PCAT volume: 2.25 [1.02–4.96], p=0.044; PCAT attenuation: 0.84 [0.63–1.12], p=0.24). Furthermore, patients receiving lipid-lowering therapy showed a significantly lower probability for high risk plaque detection (0.17 [0.14–0.21], p&amp;lt;0.0001). These findings remained stable after multivariate adjustment (0.27 [0.21–0.35], p&amp;lt;0.0001). Conclusion EAT volume and attenuation as well as PCAT volume associate with high risk plaques independent of traditional cardiovascular risk factors. In contrast, we found no significant association of PCAT attenuation with high risk coronary atherosclerosis. Our results encourage further research to evaluate the interplay of lipid-lowering therapy and EAT on plaque composition. Funding Acknowledgement Type of funding sources: None.