Pericardial Fat Burden on ECG-Gated Noncontrast CT in Asymptomatic Patients Who Subsequently Experience Adverse Cardiovascular Events

Abstract

Background Pericardial fat volume (PFV) and thoracic fat volume (TFV) can be routinely measured from noncontrast CT (NCT) performed for calculating coronary calcium score (CCS) and may predict major adverse cardiovascular event (MACE) risk. Methods From a registry of 2751 asymptomatic patients without known CAD and 4-year follow-up for MACE (cardiac death, myocardial infarction, stroke, late revascularization) after NCT, we compared 58 patients with MACE (“EVENTS”) to 174 same-sex event-free controls matched by a propensity score to account for age, risk factors, and CCS. TFV was automatically calculated, and PFV was calculated with manual assistance in defining the pericardial contour, within which fat voxels were automatically identified. Independent relationships of PFV and TFV to MACE were evaluated using conditional multivariable logistic regression. Results EVENTS had higher mean PFV (101.8±49.2 cm3 vs. 84.9±37.7 cm3, p=0.007) and TFV (204.7±90.3 cm3 vs. 177±80.3 cm3, p=0.029) and higher frequencies of PFV>125 cm3 (33% vs. 14%, p=0.002) and TFV>250 cm3 (31% vs. 17%, p=0.025). After adjusting for Framingham Risk Score, CCS, and body-mass-index, PFV and TFV were significantly associated with MACE (odds ratio (OR) 1.74, 95%CI 1.03–2.95 for each doubling of PFV; OR 1.78, 95%CI 1.01–3.14 for TFV). Areas-under-the-curve from receiver operating characteristic analyses showed a trend of improved MACE prediction when PFV was added to FRS and CCS (0.73 vs 0.68, p=0.058). Addition of PFV, but not TFV, to FRS and CCS improved estimated specificity (0.72 vs 0.66, p=0.008) and overall accuracy (0.70 vs 0.65, p=0.009) in predicting MACE. Conclusion Asymptomatic patients who experience MACE exhibit greater PFV on pre-MACE NCT when compared to event-free controls with similar cardiovascular risk profiles. Our preliminary findings suggest that PFV may help improve prediction of MACE.

Increased Coronary Perivascular Adipose Tissue Volume in Patients With Vasospastic Angina

“…3 Notably, epicardial adipose tissue volume (EATV) measured by cardiac computed tomography (CT) is related to coronary plaque burden, 4 and is also significantly associated with cardiovascular events. 5, 6 Importantly, we recently demonstrated that adventitial inflammatory changes (eg, VV formation) are enhanced at the spastic coronary segment in patients with vasospastic angina (VSA), with a positive correlation with the extent of coronary vasoconstrictive responses. 7 Indeed, recent studies have suggested that coronary PVAT impairs coronary vasomotion, 8 but it remains to be elucidated whether coronary PVAT is altered in VSA patients.…”

Beyond the Coronary Arteries: Evolving Applications of Multi-detector Cardiac Computed Tomography in the Assessment of Non-coronary Structures

“…MDCT provides excellent delineation of pericardial anatomy of the entire chest, including the presence of any pericardial effusion, thickening or calcification. It also quantifies pericardial fat volume, a marker of cardiovascular disease 21,22 and may identify extra-cardiac lesions related to pericardial pathology.…”

Epicardial adipose tissue: a review of physiology, pathophysiology, and clinical applications

“…EAT mediates the inflammatory process within the atherosclerotic plaque (42). The paracrine or vasocrine secretion of epicardial inflammatory adipokines, such as tumor necrosis factor alpha, plasminogen activator inhibitor-1, interleukin-6, interleukin -1b, monocyte chemo-attractant protein-1, and resistin contribute to the metabolic and inflammatory milieu that promotes atherogenesis (43).…”