title: Impact of epicardial fat volume on coronary artery disease in symptomatic patients with a zero calcium score.
abstract: BACKGROUND
  This study sought to evaluate the prevalence of coronary artery disease (CAD) and the impact of epicardial fat volume (EFV) on CAD in symptomatic patients with a zero calcium score (CS) using multislice computed tomography (MSCT).
  
  
  METHODS
  In this study, 1308 consecutive symptomatic patients who underwent 64-slice MSCT with a zero CS were evaluated. EFV was quantified with CS data sets. Presence of an obstructive plaque (diameter stenosis >50%) and a CT-derived vulnerable plaque, which was defined as a plaque with remodeling index >1.10 and mean CT density value <3 0HU, was assessed with a CT coronary angiography.
  
  
  RESULTS
  Obstructive plaques were detected in 86 patients (7%) and CT-derived vulnerable plaques in 63 (5%). EFV was larger in patients with obstructive plaques than no plaque (124.3 ± 43.2 cm(3) vs. 95.1 ± 40.3 cm(3); p<0.01). Patients with CT-derived vulnerable plaques had a greater amount of EFV than no plaque (133.0 ± 40.2 cm(3) vs. 95.1 ± 40.3 cm(3); p<0.01). Multivariate analysis revealed EFV as a predictor of the presence of an obstructive and a CT-derived vulnerable plaque (per 10 cm(3); Odds ratio (OR) 1.10; 95% confidence interval (CI), 1.04-1.16; p<0.01 and OR 1.19; 95% CI, 1.12-1.27; p<0.01). The combination of EFV and Framingham risk score (FRS) resulted in an area under the receiver-operating characteristic curve for prediction of obstructive and CT-derived vulnerable plaque of 0.75 and 0.75, which was significantly higher than 0.68 and 0.64 for FRS alone (p=0.02 and p<0.01).
  
  
  CONCLUSIONS
  A zero CS doesn't exclude CAD and EFV can be a useful marker of CAD in symptomatic zero CS patients.
authors.affiliation: Toyohashi Heart Center, Toyohashi, Japan. tito@heart-center.or.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.forename: Yoriyasu
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Teramoto
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
authors.forename: Genjiro
authors.initials: G
authors.lastname: Kimura
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D002118:Calcium / Q000032:analysis; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010496:Pericardium / Q000000981:diagnostic imaging*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D002118:Calcium