Epicardial Adipose Tissue Contributes to the Development of Non-Calcified Coronary Plaque: A 5-Year Computed Tomography Follow-up Study

Abstract

Aim: Epicardial adipose tissue (EAT) has been suggested as a contributing factor for coronary atherosclerosis based on the previous cross-sectional studies and pathophysiologic background. However, a causal relationship between EAT and the development of non-calcified coronary plaque (NCP) has not been investigated.Methods: A total of 122 asymptomatic individuals (age, 56.0 ± 7.6 years; male, 80.3%) without prior history of coronary artery disease (CAD) or metabolic syndrome and without NCP or obstructive CAD at baseline cardiac computed tomography (CT) were enrolled. Repeat cardiac CT was performed with an interval of more than 5 years. Epicardial fat volume index (EFVi; cm3/m2) was assessed in relation to the development of NCP on the follow-up CT where the results were classified into “calcified plaque (CP),” “no plaque,” and “NCP” groups.Results: On the follow-up CT performed with a median interval of 65.4 months, we observed newly developed NCP in 24 (19.7%) participants. Baseline EFVi was significantly higher in the NCP group (79.9 ± 30.3 cm3/m2) than in the CP group (63.7 ± 22.7 cm3/m2; P = 0.019) and in the no plaque group (62.5 ± 24.7 cm3/m2; P = 0.021). Multivariable logistic regression analysis demonstrated that the presence of diabetes (OR, 9.081; 95% CI, 1.682–49.034; P = 0.010) and the 3rd tertile of EFVi (OR, 4.297; 95% CI, 1.040–17.757; P = 0.044 compared to the 1st tertile) were the significant predictors for the development of NCP on follow-up CT.Conclusions: Greater amount of EAT at baseline CT independently predicts the development of NCP in asymptomatic individuals.

Epicardial fat thickness and severity of coronary artery disease: a review

“…25 Similar follow up studies states that EFT on CT is independently predicting the development of non-calcium coronary plague in asymptomatic patients especially in type II diabetes. 17,26 In contrast to previous study Meenakshi K et al showed no significant difference in EFT among male and female patients with matched BMI in both gender and gender is not affecting the correlation between EFT and CAD. 18 Ng et al used 3D echocardiography in 130 patients and found that EFT affects the systolic function of left ventricle despite of preserved ejection fraction and absence of significant CAD.…”

Advanced Coronary Atherosclerosis and Fatal Myocardial Infarction in Mild Dyslipidemic, Low Risk Young Man: A Case Report With Literature Reviewed

“…All of these studies supported the paracrine effect of EAT by creating local inflammation, from outside to inside the coronary artery, and contributed to atheromatous plaque formation. [47][48][49][50] Without studying the inflammatory marker of EAT, we could only ask the question but could not confirm this hypothesis in this reported case.…”

“…They found that epicardial fat is independently and linearly associated with CAD severity. Recently, Hwang et al, 49 performed a serial Coronary Computerized Tomogram of coronary artery (CTA) in 122 asymptomatic cases who had no CAD at baseline study. After the mean follow up of 65.4 months, EAT and diabetes mellitus independently predicted the development of new non-calcified plaque with the odd ratio of 4.29 and 9.0 respectively.…”

Relationship Between Epicardial Fat Volume and Coronary Microvascular Dysfunction in Patients with Chest Pain and Unobstructed Coronary Arteries

“…Previous studies have reported an association among epicardial fat volume (EFV), obstructive coronary artery disease [2], coronary artery calcium score (CACS) [3,4], and high-risk plaque measured on cardiac CT [5]. This relationship is thought to be a result of production of inflammatory mediators by EF and its CVIA proximity to the coronary arteries.…”