title: Prognostic value of coronary artery calcium and epicardial adipose tissue assessed by non-contrast cardiac computed tomography.
abstract: OBJECTIVE
  Epicardial adipose tissue (EAT) accumulation is believed to be associated with development of coronary atherosclerosis. We investigated whether EAT volume as assessed by computed tomography (CT) has value in prediction of future cardiac events.
  
  
  METHODS
  We studied 722 patients without proven coronary artery disease (CAD) who underwent non-contrast cardiac CT. EAT volume and coronary artery calcium (CAC) score were measured simultaneously. Patients were followed as to the occurrence of coronary events (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and late coronary revascularization≥3 months after CT examination).
  
  
  RESULTS
  During a 3.7±1.7 years follow-up period, 37 coronary events were documented. Annual event rates increased across CAC score categories (0.3%, 1.0%, 2.4%, and 4.3%, in 0, 1-99, 100-399, and ≥400, respectively, p<0.001); these were significantly higher in the higher EAT volume group (>median; 107.2 mL, 0.7% vs., 2.1%, adjusted hazard ratio; 2.65, p=0.0090). Cox-proportional hazard analysis demonstrated that a combination of CAC score≥100 and high EAT volume had a significantly higher event rate than CAC score<100 and low EAT volume group (adjusted hazard ratio 11.6, p<0.0001). Using Cox regression models, incremental prognostic values were identified by adding high EAT volume to clinical risks plus CAC score≥100 (global χ2, 6.7; p=0.059).
  
  
  CONCLUSIONS
  We suggest that high EAT volume may be an independent predictor of future coronary events and increases predictive values of CAC score in patients without proven CAD.
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Eiji
authors: E
authors: Kunita
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Electronic address: hideyayama@hiroshima-u.ac.jp.
authors: Hideya
authors: H
authors: Yamamoto
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Toshiro
authors: T
authors: Kitagawa
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Norihiko
authors: N
authors: Ohashi
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Toshiharu
authors: T
authors: Oka
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Hiroto
authors: H
authors: Utsunomiya
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Yoji
authors: Y
authors: Urabe
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Hiroshi
authors: H
authors: Tsushima
authors: Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors: Kazuo
authors: K
authors: Awai
authors: Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA.
authors: Matthew J
authors: MJ
authors: Budoff
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors: Yasuki
authors: Y
authors: Kihara
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000789:Angina, Unstable / Q000453:epidemiology; D002118:Calcium / Q000032:analysis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000378:metabolism; D003331:Coronary Vessels / Q000737:chemistry / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D014280:Triglycerides / Q000097:blood; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
chemical_list: D002118:Calcium; D006442:Glycated Hemoglobin; D014280:Triglycerides
keywords: Cardiac events; Coronary artery calcium; Epicardial adipose tissue