title: Epicardial adipose tissue volume and coronary artery calcium to predict myocardial ischemia on positron emission tomography-computed tomography studies.
abstract: BACKGROUND
  There appears to be an association of epicardial adipose tissue (EAT) with coronary artery disease (CAD) and its risk factors. EAT is assumed to influence CAD development by altering vasomotor tone and via toxic paracrine effects. The relationship of EAT to myocardial perfusion has not been studied.
  
  
  METHODS
  Quantification of EAT and CAC was performed on positron emission tomography/computed tomography (PET/CT) studies in 45 subjects (77% intermediate pre-test probability of CAD) with mild-moderate myocardial ischemia (5-14% perfusion defect, n = 23), severe ischemia (≥15% defect, n = 22) and a control group with no ischemia matched for CAD risk factors (n = 52).
  
  
  RESULTS
  EAT volume showed a better correlation with myocardial ischemia than total CAC (r = .47 vs r = .28, P < .01). EAT volume increased significantly from the control group to subjects with mild-moderate and severe ischemia (96.9, 124.5, and 143.9 cm(3), P < .01 for both ischemia groups vs controls). Total mean CAC was significantly higher in the severe ischemia group (676.3) than in control group (229.4) (P < .01). Multivariable logistic regression analyses showed that EAT volume was, but CAC was not, a significant predictor of ischemia after adjustment for age, sex, body mass index, and each other. EAT volume was a better predictor of ischemia than total CAC [area under the curve (AUC): .764 vs .6291, P = .04]. The combination of EAT + CAC (AUC = .7694) did not improve over EAT volume alone (P = .57).
  
  
  CONCLUSIONS
  In this study, EAT volume assessed by CT was an independent predictor of ischemia on PET, and outperformed CAC score in a CAD naïve population at intermediate pre-test probability of disease.
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University, 1365 Clifton Road, AT-504, Atlanta, GA 30322, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Janik
authors.forename: Gregory
authors.initials: G
authors.lastname: Hartlage
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Alexopoulos
authors.forename: Zaur
authors.initials: Z
authors.lastname: Mirzoyev
authors.forename: Dalton S
authors.initials: DS
authors.lastname: McLean
authors.forename: Chesnal D
authors.initials: CD
authors.lastname: Arepalli
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Stillman
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D002118:Calcium / Q000378:metabolism*; D003331:Coronary Vessels / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D010496:Pericardium / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D002118:Calcium