Coronary artery disease
Impact of Location of Epicardial Adipose Tissue, Measured by Coronary Artery Calcium-Scoring Computed Tomography on Obstructive Coronary Artery Disease

https://doi.org/10.1016/j.amjcard.2013.05.022Get rights and content

Epicardial adipose tissue (EAT) is considered to play a role in the pathogenesis of coronary atherosclerosis. However, whether total EAT volume or location-specific EAT thickness may be a better predictor of obstructive coronary artery disease (CAD) is inconclusive. We investigated whether the total volume or location-specific thickness of EAT measured on computed tomography (CT) could be a useful marker of CAD on top of clinical risk factors and Agatston score. Two hundred eight consecutive subjects with clinical suspicion of CAD receiving coronary arterial calcium (CAC)–scoring CT and CT coronary angiography were retrospectively divided into 2 groups: an obstructive CAD group (n = 97) and a nonobstructive CAD group (n = 111). Total EAT volume and EAT thicknesses at different locations were measured on CAC-scoring CT. Left atrioventricular groove (AVG) EAT thickness was the sole EAT measurement that showed association with increasing number of vessels exhibiting ≥50% stenosis (p for trend <0.001). Logistic regression showed that left AVG EAT thickness was the most important EAT predictor of obstructive CAD (odds ratio 1.16, 95% confidence interval 1.04 to 1.29, p = 0.006; optimal threshold ≥15 mm, odds ratio 4.62, 95% confidence interval 2.24 to 9.56, p <0.001). Adding left AVG EAT thickness on top of clinical risk factors plus Agatston score improved prediction of obstructive CAD (area under the curve from 0.848 to 0.912, p = 0.002). In conclusion, excessive left AVG EAT adiposity is an important risk factor for obstructive CAD, independent of clinical risk factors and Agatston score. However, further trials are needed in investigation of combined assessment of location-specific EAT thickness and Agatston score on CAC scan as to whether this biomarker could improve CAD risk stratification in the general population.

Section snippets

Methods

The study was approved by our Institutional Review Board, and the requirement for informed consent was waived. From January 2007 to June 2010, 219 consecutive subjects receiving CAC-scoring CT and CTCA in 1 session for clinical suspicion of CAD were listed on the intuitional Radiological Information System. We applied exclusion criteria of (1) poor image quality of CTCA (5 subjects), (2) previous cardiac surgery (2 subjects), and (3) incomplete clinical risk factors (4 subjects). Finally, 208

Results

The clinical characteristics of the subjects are listed in Table 1. The age, male gender, waist circumference, high-density lipoprotein cholesterol, statin use, diabetes mellitus, smoking habits, hypertension, and Agatston score were significantly greater in the O-CAD group than in the NO-CAD group, except for BMI, low-density lipoprotein cholesterol, and triglycerides. A variety of CT measurements of EAT are listed in Table 2. There were no significant differences in the total EAT volume

Discussion

In this study, we systematically investigated the role of EAT thickness at different locations and total EAT volume in association with obstructive CAD. We found that left AVG EAT thickness, instead of total EAT volume, was the most important EAT adiposity predictor of obstructive CAD, independent of clinical risk factors and Agatston score. Although EAT volume is generally accepted as a contributor of coronary atherosclerosis, several studies have failed to show a distinct association of EAT

Acknowledgment

The authors wish to thank research assistants Yin-Fan Lai, MS, Hui-Chu Chang, BS, You-Yin Lin, BS, and Chin-Yin Tsai, BS for data management.

References (30)

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    There are a few publications which revealed an association between EAT thickness particularly at the LAVG and CAD. Studies by Wang and Wu et al concluded that EAT measured at the LAVG, rather than epicardial fat volume, provides a more accurate assessment of atherogenic risk and is a predictor of obstructive CAD.29–31 The association of LAVG EAT with atherosclerosis was not restricted to the left circumflex artery territory, but it related to the extent of disease in the entire coronary tree.

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    Notably, a few contrasting results have also been published: in one study the association was demonstrated only in patients with low body mass index [35]; other investigators who used echocardiography to measure EAT thickness failed to show any association with coronary artery disease [36], and in a Japanese study EAT was associated with coronary artery disease only in men but not in women [37]. Some have questioned whether the total volume of EAT or the volume of fat surrounding a specific coronary artery, for instance fat surrounding the left anterior descending coronary artery in the interventricular groove, is more closely associated with the development of coronary atherosclerosis [31,38]. In most studies, both pericardial [39–42] and epicardial [27,33,43] adipose tissue have been associated with the presence and extent of markers of atherosclerosis such as coronary artery calcium, although a few failed to show an association [44,45].

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This study was supported by grant NSC97-2314-B-010-045-MY3 from the National Science Council (Taiwan, R.O.C.) and the grants VGHKS101-020 and VGHKS100-074 from the Kaohsiung Veterans General Hospital (Taiwan, R.O.C.).

See page 948 for disclosure information.

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