Epicardial adipose tissue volume but not density is an independent predictor for myocardial ischemia

Hell, Michaela M.; Ding, Xiaowei; Rubeaux, Mathieu; Slomka, Piotr J.; Gransar, Heidi; Terzopoulos, Demetri; Hayes, Sean W.; Marwan, Mohamed; Achenbach, Stephan; Berman, Daniel S.; Dey, Damini

doi:10.1016/j.jcct.2016.01.009

Cited by 51 publications

(46 citation statements)

References 46 publications

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“…In addition, case-control studies identified pericardial fat volume as a strong predictor of myocardial ischemia (113,305). By contrast, some studies did not find such an association between EAT and the extent of CAD in intermediate to high risk patients, suggesting that the relationship is not constant at more advanced stages (263,306).…”

Section: Histological and Radiological Evidencementioning

confidence: 99%

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Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat?

Gaborit

Sengenès

Ancel

et al. 2017

Comprehensive Physiology

122

109

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Epicardial adipose tissue (EAT) is a small but very biologically active ectopic fat depot that surrounds the heart. Given its rapid metabolism, thermogenic capacity, unique transcriptome, secretory profile, and simply measurability, epicardial fat has drawn increasing attention among researchers attempting to elucidate its putative role in health and cardiovascular diseases. The cellular crosstalk between epicardial adipocytes and cells of the vascular wall or myocytes is high and suggests a local role for this tissue. The balance between protective and proinflammatory/profibrotic cytokines, chemokines, and adipokines released by EAT seem to be a key element in atherogenesis and could represent a future therapeutic target. EAT amount has been found to predict clinical coronary outcomes. EAT can also modulate cardiac structure and function. Its amount has been associated with atrial fibrillation, coronary artery disease, and sleep apnea syndrome. Conversely, a beiging fat profile of EAT has been identified. In this review, we describe the current state of knowledge regarding the anatomy, physiology and pathophysiological role of EAT, and the factors more globally leading to ectopic fat development. We will also highlight the most recent findings on the origin of this ectopic tissue, and its association with cardiac diseases. © 2017 American Physiological Society. Compr Physiol 7:1051-1082, 2017.

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Section: Histological and Radiological Evidencementioning

confidence: 99%

“…Other studies highlighted the add-on predictive value of EAT compared to CAD scores such as coronary calcium score (CAC) (113,138,173). EAT significantly correlated with the extent and severity of CAD, chest pain, unstable angina and coronary flow reserve (233,269).…”

Section: Histological and Radiological Evidencementioning

confidence: 99%

Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat?

Gaborit

Sengenès

Ancel

et al. 2017

Comprehensive Physiology

122

109

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“…[ 7 – 9 ] Peri-coronary fat attenuation varies depending on its location,[ 10 ] however, clinical implications of EAT attenuation remain controversial. [ 9 , 11 ] In the present manuscript, we aimed to (1) determine the distribution of CT-derived EAT volume and attenuation as well as their correlation in a retrospective clinical cohort of patients undergoing cardiac CT imaging, (2) investigate the association of EAT volume and attenuation with established risk factors as well as antihypertensive and lipid-lowering therapy, and (3) determine the association of EAT volume and attenuation with the clinical presentation of the patients.…”

Section: Introductionmentioning

confidence: 99%

Cardiac computed tomography-derived epicardial fat volume and attenuation independently distinguish patients with and without myocardial infarction

et al. 2017

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Background and objectiveEpicardial adipose tissue (EAT) volume is associated with coronary plaque burden and adverse events. We aimed to determine, whether CT-derived EAT attenuation in addition to EAT volume distinguishes patients with and without myocardial infarction.Methods and resultsIn 94 patients with confirmed or suspected coronary artery disease (aged 66.9±14.7years, 61%male) undergoing cardiac CT imaging as part of clinical workup, EAT volume was retrospectively quantified from non-contrast cardiac CT by delineation of the pericardium in axial images. Mean attenuation of all pixels from EAT volume was calculated. Patients with type-I myocardial infarction (n = 28) had higher EAT volume (132.9 ± 111.9ml vs. 109.7 ± 94.6ml, p = 0.07) and CT-attenuation (-86.8 ± 5.8HU vs. -89.0 ± 3.7HU, p = 0.03) than patients without type-I myocardial infarction, while EAT volume and attenuation were only modestly inversely correlated (r = -0.24, p = 0.02). EAT volume increased per standard deviation of age (18.2 [6.2–30.2] ml, p = 0.003), BMI (29.3 [18.4–40.2] ml, p<0.0001), and with presence of diabetes (44.5 [16.7–72.3] ml, p = 0.0002), while attenuation was higher in patients with lipid-lowering therapy (2.34 [0.08–4.61] HU, p = 0.04). In a model containing volume and attenuation, both measures of EAT were independently associated with the occurrence of type-I myocardial infarction (OR [95% CI]: 1.79 [1.10–2.94], p = 0.02 for volume, 2.04 [1.18–3.53], p = 0.01 for attenuation). Effect sizes remained stable for EAT attenuation after adjustment for risk factors (1.44 [0.77–2.68], p = 0.26 for volume; 1.93 [1.11–3.39], p = 0.02 for attenuation).ConclusionCT-derived EAT attenuation, in addition to volume, distinguishes patients with vs. without myocardial infarction and is increased in patients with lipid-lowering therapy. Our results suggest that assessment of EAT attenuation could render complementary information to EAT volume regarding coronary risk burden.

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“…Similarly, in 609 asymptomatic low-risk to intermediate-risk patients, Abazid et al 45 observed a negative correlation between EAT attenuation and coronary calcification independent of EAT volume. In contrast, in a cross-sectional analysis of patients with acute MI and stable CAD controls, Mahabadi et al 27 observed a positive association between EAT attenuation and type I acute MI, while Hell et al 35 did not report a link between EAT attenuation and myocardial ischaemia on SPECT. These contradicting results may be explained by a small sample size, the variable nature of the study population, as well as methodological limitations, such as selection bias, reverse causality and the presence of confounders that were not taken into account.…”

Section: Introductionmentioning

confidence: 91%

“…33 These general population cohorts composed of asymptomatic low-risk subjects demonstrated that EAT volume (measured on non-contrast CT scans) was associated with the presence of ischaemic heart disease,29 incidence of major adverse cardiovascular events,32 coronary calcification28 30 and calcium progression 31. Furthermore, among participants recruited from hospital registries with low to intermediate cardiovascular risk (reflecting the current indications for cardiac CT), higher EAT volumes were positively associated with the presence of coronary stenosis,34 myocardial ischaemia,35 calcified,36 non-calcified coronary plaques,37 as well as high-risk plaque features, such as low-attenuation plaque and thin fibrous cap. However, in the CORE320 (Coronary Artery Evaluation using 320-row Multidetector CT Angiography and Myocardial Perfusion) study, Tanami et al 38 did not find an independent association between EAT volume and either obstructive CAD, myocardial ischaemia on single photon-emission CT (SPECT) or coronary calcification.…”

Section: Introductionmentioning

confidence: 99%

Perivascular adipose tissue and coronary atherosclerosis

Mâncio

Oikonomou

Antoniades

2018

Heart

105

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Adipose tissue (AT) is no longer viewed as a passive, energy-storing depot, and a growing body of evidence supports the concept that both quantitative and qualitative aspects of AT are critical in determining an individual's cardiometabolic risk profile. Among all AT sites, perivascular AT (PVAT) has emerged as a depot with a distinctive biological significance in cardiovascular disease given its close anatomical proximity to the vasculature. Recent studies have suggested the presence of complex, bidirectional paracrine and vasocrine signalling pathways between the vascular wall and its PVAT, with far-reaching implications in cardiovascular diagnostics and therapeutics. In this review, we first discuss the biological role of PVAT in both cardiovascular health and disease, highlighting its dual pro-atherogenic and anti-atherogenic roles, as well as potential therapeutic targets in cardiovascular disease. We then review current evidence and promising new modalities on the non-invasive imaging of epicardial AT and PVAT. Specifically, we present how our expanding knowledge on the bidirectional interplay between the vascular wall and its PVAT can be translated into novel clinical diagnostics tools to assess coronary inflammation. To this end, we present the example of a new CT-based method that tracks spatial changes in PVAT phenotype to extract information about the inflammatory status of the adjacent vasculature, highlighting the numerous diagnostic and therapeutic opportunities that arise from our increased understanding of PVAT biology.

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Epicardial adipose tissue volume but not density is an independent predictor for myocardial ischemia

Cited by 51 publications

References 46 publications

Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat?

Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat?

Cardiac computed tomography-derived epicardial fat volume and attenuation independently distinguish patients with and without myocardial infarction

Perivascular adipose tissue and coronary atherosclerosis

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