Increased volume of epicardial fat is an independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis.
BACKGROUND
Epicardial adipose tissue (EAT), a metabolically active visceral fat depot surrounding the heart, has been implicated in the pathogenesis of coronary artery disease (CAD) through possible paracrine interaction with the coronary arteries. We examined the association of EAT with metabolic syndrome and the prevalence and progression of coronary artery calcium (CAC) burden.


METHODS
CAC scan was performed in 333 asymptomatic diabetic patients without prior history of CAD (median age 54 years, 62% males), followed by a repeat scan after 2.7±0.3 years. CAC progression was defined as >2.5mm(3) increase in square root transformed volumetric CAC scores. EAT and intra-thoracic fat volumes were quantified using a dedicated software (QFAT), and were examined in relation to the metabolic syndrome, baseline CAC scores and CAC progression.


RESULTS
Both epicardial and intra-thoracic fat were associated with metabolic syndrome after adjustment for conventional cardiovascular risk factors, but the association was attenuated after additional adjustment for body mass index. EAT, but not intra-thoracic fat, showed significant association with baseline CAC scores (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04-1.22, p=0.04) and CAC progression (OR 1.12, 95% CI 1.05-1.19, p<0.001) after adjustment for conventional measures of obesity and risk factors.


CONCLUSIONS
EAT volume measured on non-contrast CT is an independent marker for the presence and severity of coronary calcium burden and also identifies individuals at increased risk of CAC progression. EAT quantification may thus add to the prognostic value of CAC imaging.
Clinical Imaging and Research Centre, Wellington Hospital, London NW8 9LE, United Kingdom. dryerramasu@yahoo.com
Ajay
A
Yerramasu
Damini
D
Dey
Shreenidhi
S
Venuraju
Dhakshinamurthy Vijay
DV
Anand
Satvir
S
Atwal
Roger
R
Corder
Daniel S
DS
Berman
Avijit
A
Lahiri
D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000704:Analysis of Variance; D058070:Asymptomatic Diseases; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D010496:Pericardium / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology