title: Does quantifying epicardial and intrathoracic fat with noncontrast computed tomography improve risk stratification beyond calcium scoring alone?
abstract: BACKGROUND
  Noncontrast cardiac computed tomography allows calculation of coronary artery calcium score (CACS) and measurement of epicardial adipose tissue (EATv) and intrathoracic fat (ITFv) volumes. It is unclear whether fat volume information contributes to risk stratification.
  
  
  RESULTS
  Cardiac computed tomography was performed in 760 consecutive patients with acute chest pain admitted thorough the emergency department. None had prior coronary artery disease. CACS was calculated using the Agatston method. EATv and ITFv were semiautomatically calculated. Median patient follow-up was 3.3 years. Mean patient age was 54.4±13.7 years and Framingham risk score 8.2±8.2. The 45 patients (5.9%) with major acute cardiac events (MACE) were older (64.8±13.9 versus 53.7±13.4 years), more frequently male (60% versus 40%), and had a higher median Framingham risk score (16 versus 4) and CACS (268 versus 0) versus those without events (all P<0.01). The MACE group had a higher median of EATv (154 versus 116 mL) and ITFv (330 versus 223 mL), and a higher prevalence of EATv >125 mL (67% versus 44%) and ITFv >250 mL (64% versus 42%) (all P<0.01). CACS, EATv, and ITFv were all independently associated with MACE. CACS was associated with MACE after adjustment for fat volumes (P<0.0001), whereas EATv and ITFv improved the risk model only in patients with CACS >400.
  
  
  CONCLUSIONS
  CACS and fat volumes are independently associated with MACE in acute chest pain patients and beyond that provided by clinical information alone. Although fat volumes may add prognostic value in patients with CACS >400, CACS is most strongly correlated with outcome.
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA.
authors.forename: Farshad
authors.initials: F
authors.lastname: Forouzandeh
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
authors.forename: Kamil
authors.initials: K
authors.lastname: Muhyieddeen
authors.forename: Rashid R
authors.initials: RR
authors.lastname: Zaid
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Trevino
authors.forename: Jiaqiong
authors.initials: J
authors.lastname: Xu
authors.forename: Faisal
authors.initials: F
authors.lastname: Nabi
authors.forename: John J
authors.initials: JJ
authors.lastname: Mahmarian
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D050197:Atherosclerosis / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000378:metabolism; D002118:Calcium / Q000378:metabolism*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D035423:Thoracic Cavity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014481:United States / Q000453:epidemiology
chemical_list: D002118:Calcium