Perivascular Adipose Tissue and Coronary Atherosclerosis: from Biology to Imaging Phenotyping

Lin, Andrew; Dey, Damini; Wong, D.; Nerlekar, Nitesh

doi:10.1007/s11883-019-0817-3

Cited by 91 publications

(76 citation statements)

References 92 publications

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“…Several reports have shown abdominal visceral fat area quantified on CT to associate with critical illness in patients with COVID-19 [26,37], however data on thoracic fat depots are lacking. It is established that CT-derived EAT measures correlate strongly with abdominal visceral adiposity and metabolic risk factors [38] and associate with coronary atherosclerosis [39]. Prior studies utilizing manual measurements of EAT thickness on chest CT of COVID-19 patients have failed to show an association of this metric with extent of pneumonia or clinical course [26,27].…”

Section: Discussionmentioning

confidence: 99%

Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19

et al. 2021

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We sought to examine the association of epicardial adipose tissue (EAT) quantified on chest computed tomography (CT) with the extent of pneumonia and adverse outcomes in patients with coronavirus disease 2019 (COVID-19). Methods: We performed a post-hoc analysis of a prospective international registry comprising 109 consecutive patients (age 64 ± 16 years; 62% male) with laboratory-confirmed COVID-19 and noncontrast chest CT imaging. Using semi-automated software, we quantified the burden (%) of lung abnormalities associated with COVID-19 pneumonia. EAT volume (mL) and attenuation (Hounsfield units) were measured using deep learning software. The primary outcome was clinical deterioration (intensive care unit admission, invasive mechanical ventilation, or vasopressor therapy) or in-hospital death. Results: In multivariable linear regression analysis adjusted for patient comorbidities, the total burden of COVID-19 pneumonia was associated with EAT volume (β = 10.6, p = 0.005) and EAT attenuation (β = 5.2, p = 0.004). EAT volume correlated with serum levels of lactate dehydrogenase (r = 0.361, p = 0.001) and C-reactive protein (r = 0.450, p < 0.001). Clinical deterioration or death occurred in 23 (21.1%) patients at a median of 3 days (IQR 1-13 days) following the chest CT. In multivariable logistic regression analysis, EAT volume (OR 5.1 [95% CI 1.8-14.1] per doubling p = 0.011) and EAT attenuation (OR 3.4 [95% CI 1.5-7.5] per 5 Hounsfield unit increase, p = 0.003) were independent predictors of clinical deterioration or death, as was total pneumonia burden (OR 2.5, 95% CI 1.4-4.6, p = 0.002), chronic lung disease (OR 1.3 [95% CI 1.1-1.7], p = 0.011), and history of heart failure (OR 3.5 [95% 1.1-8.2], p = 0.037). Conclusions: EAT measures quantified from chest CT are independently associated with extent of pneumonia and adverse outcomes in patients with COVID-19, lending support to their use in clinical risk stratification.

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Section: Discussionmentioning

confidence: 99%

Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19

et al. 2021

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“…Obesity induces adverse remodeling of visceral adipose tissue, leading to expression of a proinflammatory phenotype [ 47 ]. EAT is contiguous with the coronary arterial adventitia, allowing inflammatory mediators to diffuse directly into the vessel wall and incite atherogenesis [ 7 ] and endothelial dysfunction [ 48 ]. There is also a strong association between obesity, EAT inflammation and development of atrial fibrillation [ 49 ], myocardial fibrosis, and heart failure [ 50 ], which may partly explain the excess cardiac mortality in participants with MetS or NAFLD in our study.…”

Section: Discussionmentioning

confidence: 99%

Metabolic syndrome, fatty liver, and artificial intelligence-based epicardial adipose tissue measures predict long-term risk of cardiac events: a prospective study

Lin

Wong

Razipour

et al. 2021

Cardiovasc Diabetol

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Background We sought to evaluate the association of metabolic syndrome (MetS) and computed tomography (CT)-derived cardiometabolic biomarkers (non-alcoholic fatty liver disease [NAFLD] and epicardial adipose tissue [EAT] measures) with long-term risk of major adverse cardiovascular events (MACE) in asymptomatic individuals. Methods This was a post-hoc analysis of the prospective EISNER (Early-Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study of participants who underwent baseline coronary artery calcium (CAC) scoring CT and 14-year follow-up for MACE (myocardial infarction, late revascularization, or cardiac death). EAT volume (cm3) and attenuation (Hounsfield units [HU]) were quantified from CT using fully automated deep learning software (< 30 s per case). NAFLD was defined as liver-to-spleen attenuation ratio < 1.0 and/or average liver attenuation < 40 HU. Results In the final population of 2068 participants (59% males, 56 ± 9 years), those with MetS (n = 280;13.5%) had a greater prevalence of NAFLD (26.0% vs. 9.9%), higher EAT volume (114.1 cm3 vs. 73.7 cm3), and lower EAT attenuation (−76.9 HU vs. −73.4 HU; all p < 0.001) compared to those without MetS. At 14 ± 3 years, MACE occurred in 223 (10.8%) participants. In multivariable Cox regression, MetS was associated with increased risk of MACE (HR 1.58 [95% CI 1.10–2.27], p = 0.01) independently of CAC score; however, not after adjustment for EAT measures (p = 0.27). In a separate Cox analysis, NAFLD predicted MACE (HR 1.78 [95% CI 1.21–2.61], p = 0.003) independently of MetS, CAC score, and EAT measures. Addition of EAT volume to current risk assessment tools resulted in significant net reclassification improvement for MACE (22% over ASCVD risk score; 17% over ASCVD risk score plus CAC score). Conclusions MetS, NAFLD, and artificial intelligence-based EAT measures predict long-term MACE risk in asymptomatic individuals. Imaging biomarkers of cardiometabolic disease have the potential for integration into routine reporting of CAC scoring CT to enhance cardiovascular risk stratification. Trial registration NCT00927693.

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“…This finding may be due to EATd representing a mean attenuation of the totality of EATv and there may be influence on regional EAT differences or on pericoronary adipose tissue attenuation, a novel proposed imaging biomarker of vascular inflammation 24 . A higher adipose tissue attenuation (less negative HU on CT) is suggestive of inflammation due to arrest of lipid maturation 25 . Therefore, another explanation for our findings is the symptom status of patients: baseline CTCA was performed in symptomatic patients whereas the follow-up scan was a research study performed when patients were stable.…”

Section: Discussionmentioning

confidence: 99%

“…One recent sub-study of serial CT evaluation in asymptomatic statin prescribed patients demonstrated an overall lowering of EATd independent of lipid lowering on follow-up, but there was no comparative control group, density was measured in a single region of interest and EATv was not described on follow-up scans 29 . Given the increasing reports of cardiac adipose tissue and its effect on high risk plaque presence, plaque progression and mortality 25 , further investigation of the behaviour and measurement of the activity of these fat depots is needed to translate these results into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study

Nerlekar

Thakur

Lin

et al. 2020

Sci Rep

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epicardial adipose tissue (eAt) is associated with cardiovascular risk. the longitudinal change in eAt volume (eAtv) and density (eAtd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (ctcA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (cVRf) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline −76 ± 6 HU vs. −86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. in this select group of patients, eAtv consistently increased and eAtd consistently decreased at long-term follow-up and these changes were independent of cVRf, age and statin use. together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that eAt is an independent parameter rather than a surrogate for cardiovascular risk. open Scientific RepoRtS | (2020) 10:7109 | https://doi.org/10.1038/s41598-020-63135-z www.nature.com/scientificreports www.nature.com/scientificreports/ Scientific RepoRtS | (2020) 10:7109 | https://doi.org/10.1038/s41598-020-63135-zwww.nature.com/scientificreports www.nature.com/scientificreports/ however, this is reflective of the current literature in examining relevant associations of EAT. Finally, there is potential for error in using delta EAT values with potential overlap from test-retest variability. Our previous work has demonstrated limits of agreement up to 10 mL higher or lower between observers with a mean bias however of only 1 mL, however our inter-observer correlation was excellent at 0.98 with assessors blinded to scan timing and patient details. conclusion Epicardial adipose tissue volume and density demonstrate significant longitudinal changes in patients with non-obstructive coronary artery disease with a consistent increase in EAT volume and consistent decrease in EAT density. There are no clinical risk factors that appear to associate with the change in EAT parameters and this effect is also independent of statin therapy. This finding may suggest that EAT is an independent marker, rather than surrogate of cardiovascular risk.

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Perivascular Adipose Tissue and Coronary Atherosclerosis: from Biology to Imaging Phenotyping

Cited by 91 publications

References 92 publications

Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19

Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19

Metabolic syndrome, fatty liver, and artificial intelligence-based epicardial adipose tissue measures predict long-term risk of cardiac events: a prospective study

The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study

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