title: Association of pericardial fat and coronary high-risk lesions as determined by cardiac CT.
abstract: OBJECTIVE
  Pericardial adipose tissue (PAT) is a pathogenic fat depot associated with coronary atherosclerosis and cardiovascular events. We hypothesized that higher PAT is associated with coronary high-risk lesions as determined by cardiac CT.
  
  
  METHODS
  We included 358 patients (38% female; median age 51 years) who were admitted to the ED with acute chest pain and underwent 64-slice CT angiography. The cardiac CT data sets were assessed for presence and morphology of CAD and PAT. Coronary high-risk lesions were defined as >50% luminal narrowing and at least two of the following characteristics: positive remodeling, low-density plaque, and spotty calcification. PAT was defined as any pixel with CT attenuation of -190 to -30 HU within the pericardial sac.
  
  
  RESULTS
  Based on cardiac CT, 50% of the patients (n=180) had no CAD, 46% (n=165) had CAD without high-risk lesions, and 13 patients had CAD with high-risk lesions. The median PAT in patients with high-risk lesions was significantly higher compared to patients without high-risk lesions and without any CAD (151.9 [109.0-179.4]cm(3) vs. 110.0 [81.5-137.4]cm(3), vs. 74.8 [58.2-111.7]cm(3), respectively p=0.04 and p<0.0001). These differences remained significant after adjusting for traditional risk factors including BMI (all p<0.05). The area under the ROC curve for the identification of high-risk lesions was 0.756 in a logistic regression model with PAT as a continuous predictor.
  
  
  CONCLUSIONS
  PAT volume is nearly twice as high in patients with high-risk coronary lesions as compared to those without CAD. PAT volume is significantly associated with high risk coronary lesion morphology independent of clinical characteristics and general obesity.
authors.affiliation: Cardiac MR, PET, CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02214, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Maros
authors.initials: M
authors.lastname: Ferencik
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Kriegel
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
authors.forename: Subodh B
authors.initials: SB
authors.lastname: Joshi
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology*; D012306:Risk; D014057:Tomography, X-Ray Computed