Preventive cardiology
Epicardial Adipose Tissue as a Predictor of Coronary Artery Disease in Asymptomatic Subjects

https://doi.org/10.1016/j.amjcard.2012.04.024Get rights and content

This study sought to elucidate the relation between epicardial adipose tissue (EAT) thickness measured by multidetector computed tomography and presence of coronary artery atherosclerosis. Recent studies have suggested that fat disposition in visceral organs and epicardial tissue could serve as a predictor of coronary artery disease (CAD). The sample included 190 asymptomatic subjects with ≥1 cardiovascular risk factor who were referred for cardiac computed tomographic angiography. Body mass index, blood pressure, fasting glucose level, and lipid profile were measured. Multidetector computed tomographic results were analyzed for atherosclerosis burden, calcium Agatston score, and EAT thickness: mean EAT values were 3.54 ± 1.59 mm in patients with atherosclerosis and 1.85 ± 1.28 mm in patients without atherosclerosis (p <0.001). On receiver operating characteristic analysis, an EAT value ≥2.4 mm predicted the presence of significant (>50% diameter) coronary artery stenosis. There was a significant difference in EAT values between patients with and without metabolic syndrome (2.58 ± 1.63 vs 2.04 ± 1.46 mm, p <0.05) and between patients with a calcium score >400 and <400 (3.38 ± 1.58 vs 2.02 ± 1.42 mm, p <0.0001). In conclusion, asymptomatic patients with CAD have significantly more EAT than patients without CAD. An EAT thickness of 2.4 mm is the optimal cutoff for prediction of presence of significant CAD.

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Methods

A retrospective single-center study design was used. The study sample consisted of 190 consecutive subjects referred by their primary physician or self-referred for cardiac computed tomographic angiography from November 2007 through January 2009. All patients were asymptomatic before examination. Exclusion criteria were allergy to contrast medium, irregular heart rate, and impaired renal function (creatinine level >1.2 mg). Patients signed an informed consent form on enrollment to the study,

Results

The 190 consecutive subjects consisted of 162 men (85.3%) and 38 women 38 to 74 years old (mean ± SD, 56.48 ± 9.2). All patients had ≥1 risk factor for CAD (type 2 diabetes mellitus 48.9%, hypertension 46.8%, and family history of symptomatic coronary artery atherosclerosis 48.9%) in addition to dyslipidemia, smoking history, and peripheral vascular disease.

Sixty patients were found to have significant CAD on cardiac computed tomographic angiogram: 34 (56.5%) with 1-vessel disease, 22 (36.7%)

Discussion

The present study of the association of EAT to atherosclerotic disease conducted in asymptomatic patients yielded several important findings. First, patients in whom CAD was confirmed by MDCT had significantly more EAT than patients without CAD. Second, on ROC analysis, 2.4 mm was the optimal cutoff point of EAT thickness for the prediction of presence of significant (>50% diameter) coronary artery stenosis. Third, patients with a calcium Agatston score >400 had significantly more EAT than

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Drs. Bachar and Dicker contributed equally to this article.

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