Epicardial and paracardial adipose tissue volume and attenuation - Association with high-risk coronary plaque on computed tomographic angiography in the ROMICAT II trial.
To determine whether epicardial (EAT) and paracardial adipose tissue (PAT) volume and attenuation are associated with high-risk coronary plaque features.



In subjects with suspected acute coronary syndrome (ACS) enrolled in the ROMICAT II trial, EAT and PAT volumes indexed to body surface area (BSA) and attenuation were measured on non-contrast coronary artery calcium score (CACS) CT. High-risk plaque features (napkin-ring sign, positive remodeling, low density plaque, spotty calcium) and stenosis were assessed on coronary CT angiography (CTA). The association of EAT and PAT volume and attenuation with high-risk plaque and whether this was independent of clinical risk assessment, CACS and significant coronary artery disease (CAD) was determined.



Of 467 (mean 54 ± 8 yrs, 53% male) with CACS and CTA, 167 (36%) had high-risk plaque features. Those with high-risk plaque had significantly higher indexed EAT (median 59 (Q1-Q3:45-75) cc/m(2) vs. 49 (35-65) cc/m(2), p < 0.001) and PAT volume (median:51 (36-73) cc/m(2) vs. 33 (22-52) cc/m(2), p < 0.001). Higher indexed EAT volume was associated with high-risk plaque [univariate OR 1.02 (95%-CI:1.01-1.03) per cc/m(2) of EAT, p < 0.001], which remained significant [univariate OR 1.04 (95%-CI:1.00-1.08) per cc/m(2) of EAT, p = 0.040] after adjustment for risk factors, CACS, and stenosis ≥50%. Higher indexed PAT volume was associated with high-risk plaque in univariate analysis [OR 1.02 (1.01-1.03) per cc/m(2) of PAT, p < 0.001], though this was not significant in multivariate analysis. At a threshold of >62.3 cc/m(2), EAT volume was associated with high-risk plaque [univariate OR 2.50 (95%-CI:1.69-3.72), p < 0.001)], which remained significant [OR 1.83 (95%-CI:1.10-3.05), p = 0.020] after adjustment. Subjects with high-risk plaque had lower mean attenuation EAT (-88.1 vs. -86.9 HU, p = 0.008) and PAT (-106 vs. -103 HU, p < 0.001), though this was not significant in multivariable analysis.



Greater volumes of EAT are associated with high-risk plaque independent of risk factors, CACS and obstructive CAD. This observation supports possible local influence of EAT on development of high-risk coronary plaque.
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: mlu@mgh.harvard.edu.
Michael T
MT
Lu
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; University of Heidelberg, Heidelberg, Germany.
Jakob
J
Park
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Khristine
K
Ghemigian
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
Thomas
T
Mayrhofer
Division of Cardiovascular and Interventional Radiology, Vienna University Hospital, Vienna, Austria.
Stefan B
SB
Puchner
First Affiliated Hospital of China Medical University, Shenyang, China.
Ting
T
Liu
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
Jerome L
JL
Fleg
Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA.
James E
JE
Udelson
Weill Cornell Medical College, New York City, NY, USA.
Quynh A
QA
Truong
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Oregon Health & Science University, Portland, OR, USA.
Maros
M
Ferencik
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Udo
U
Hoffmann
D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology*; D023921:Coronary Stenosis / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010496:Pericardium / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000150:complications; D015203:Reproducibility of Results; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications
Coronary CT angiography; Coronary atherosclerosis; Epicardial adipose tissue; High-risk coronary plaque; Paracardial adipose tissue