Lack of Association Between Epicardial Fat Volume and Extent of Coronary Artery Calcification, Severity of Coronary Artery Disease, or Presence of Myocardial Perfusion Abnormalities in a Diverse, Symptomatic Patient Population

Abstract

Background Epicardial fat may play a role in the pathogenesis of coronary artery disease (CAD). We explored the relationship of epicardial fat volume (EFV) with the presence and severity of CAD or myocardial perfusion abnormalities in a diverse, symptomatic patient population. Methods and Results Patients (n=380) with known or suspected CAD who underwent 320-detector row CT angiography, nuclear stress perfusion imaging, and clinically driven invasive coronary angiography for the CORE320 international study were included. EFV was defined as adipose tissue within the pericardial borders as assessed by CT utilizing semi-automatic software. We used linear and logistic regression models to assess the relationship of EFV with coronary calcium score, stenosis severity by quantitative coronary angiography (QCA), and myocardial perfusion abnormalities by SPECT. Median EFV among patients (median age 62.6 years) was 102 cm3 [interquartile range 53]. Calcium score ≥ 1 was present in 83% of patients with 59% having ≥ 1 coronary artery stenosis of ≥ 50% by QCA, and 49% having abnormal myocardial perfusion results by SPECT. There were no significant associations between EFV and CACS, presence severity of ≥ 50% stenosis by QCA, or abnormal myocardial perfusion by SPECT. Conclusions In a diverse population of symptomatic patients referred for invasive coronary angiography, we did not find associations of epicardial fat volume with the presence and severity of coronary artery disease or with myocardial perfusion abnormalities. The clinical significance of quantifying epicardial fat volume remains uncertain but may relate to the pathophysiology of acute coronary events rather than the presence of atherosclerotic disease.

The relationship between inflammation and neoangiogenesis of epicardial adipose tissue and coronary atherosclerosis based on computed tomography analysis

“…Nevertheless, while we have recently reported that high EAT volume is associated with the presence of NCP on CCTA in patients with a CCS of zero [26], another group has reported that baseline and serial change in EAT volume are not related to the development of incidental coronary artery calcification in a similar population [27]. Furthermore, a recent study in a diverse population of symptomatic patients did not find a significant relationship between EAT volume and the presence and extent of coronary arterial calcification measured by cardiac CT [28].…”

The ratio of epicardial to body fat improves the prediction of coronary artery disease beyond calcium and Framingham risk scores

“…On a random sample of 100 coronary calcification and atheroma [4]. However, a recent multicenter study reported no association between EAT volume, coronary calcium score, and prevalent CAD [5]. Thus, there is still uncertainty as to whether EAT is a marker of general adiposity or a coronary atherogenic fat depot [6].…”

Epicardial fat volume quantification by noncontrast CT: Trimming away the fat from the meat

“…12 Recently, data from the CORE320 multicenter study database did not find significant adjusted associations between epicardial fat volume and coronary calcium score, CAD as defined by quantitative coronary angiography, or myocardial perfusion abnormalities by single-photon emission tomography in 380 symptomatic patients with intermediate-high risk features. 13 In addition to the question of adequate adjustments in prior studies, these results draw attention to the role of patient characteristics for the significance of epicardial fat volume as a marker for CAD.…”