title: Incremental diagnostic value of epicardial adipose tissue for the detection of functionally relevant coronary artery disease.
abstract: OBJECTIVE
  To determine the incremental diagnostic value of epicardial adipose tissue (EAT) volume in addition to the coronary artery calcium (CAC) score for detecting hemodynamic significant coronary artery disease (CAD).
  
  
  RESULTS
  122 patients (mean age 61 ± 10 years, 61% male) without a previous cardiac history underwent a non-contrast CT scan for calcium scoring and EAT volume measurements. Subsequently all patients underwent invasive coronary angiography (ICA) in conjunction with fractional flow reserve (FFR) measurements. A stenosis >90% and/or a FFR ≤0.80 were considered significant. Mean EAT volume and CACscore were 128 ± 51 cm(3) and 418 ± 704, respectively. The correlation between EAT volume and the CACscore was poor (r = 0.11, p = 0.24). Male gender (odds ratio [OR] 2.86, p = 0.01), CACscore ([cut-off value 100] OR 3.31, p = 0.003, and EAT volume ([cut-off value 92 cm(3)] OR 4.28, p = 0.01) were associated with flow-limiting disease. The multivariate model revealed that only male gender (OR 2.50, p = 0.045), CAC score (OR 3.60, p = 0.005), and EAT volume (OR 4.95, p = 0.02) were independent predictors of myocardial ischemia. Using the cut-off values of 100 (CAC score) and 92 cm(3) (EAT volume), sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for detecting functionally relevant CAD as indicated by FFR were 71, 57, 77, 50 and 63% and 91, 29, 85, 44 and 52% for the CACscore and EAT volume, respectively. Adding EAT volume to the CAC score and cardiovascular risk factors did not enhance diagnostic performance for the detection of significant CAD (p = 0.57).
  
  
  CONCLUSIONS
  EAT volume measurements have no diagnostic value beyond calcium scoring and cardiovascular risk factors in the detection of hemodynamic significant CAD.
authors.affiliation: VU University Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Romijn
authors.affiliation: VU University Medical Center, Department of Cardiology, Amsterdam, The Netherlands. Electronic address: i.danad@vumc.nl.
authors.forename: I
authors.initials: I
authors.lastname: Danad
authors.affiliation: VU University Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bakkum
authors.affiliation: VU University Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Stuijfzand
authors.affiliation: Cardiology Centers of the Netherlands, Amsterdam, The Netherlands.
authors.forename: I I
authors.initials: II
authors.lastname: Tulevski
authors.affiliation: Cardiology Centers of the Netherlands, Amsterdam, The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: Somsen
authors.affiliation: VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands.
authors.forename: A A
authors.initials: AA
authors.lastname: Lammertsma
authors.affiliation: VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van Kuijk
authors.affiliation: VU University Medical Center, Department of Epidemiology and Biostatistics, Amsterdam, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and The NewYork-Presbyterian Hospital, New York, NY, United States.
authors.forename: J K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Department of Medical Imaging and Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: VU University Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: van Rossum
authors.affiliation: VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands.
authors.forename: P G
authors.initials: PG
authors.lastname: Raijmakers
authors.affiliation: VU University Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Knaapen
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000368:Aged; D019540:Area Under Curve; D006328:Cardiac Catheterization; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D016017:Odds Ratio; D010496:Pericardium; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Coronary artery calcium score; Diagnostic performance; Epicardial adipose tissue; Hemodynamic significant CAD