Relation between quantity and quality of peri-coronary epicardial adipose tissue and its underlying hemodynamically significant coronary stenosis

Abstract

Background: We aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia. Methods: We enrolled 45 patients (55 lesions) with known or suspected coronary artery disease who underwent coronary computed tomography angiography (CTA) followed by invasive fractional flow reserve (FFR) assessment within 30 days. EAT volume (index) and density in patient-, vessel-and lesion-level were measured on CTA images. Lesion-specific ischemia was defined as a lesion with stenosis diameter > 90% or FFR ≤0.80. Multivariate analysis determined the independent association of EAT parameters with lesion-specific ischemia. Results: Mean age of the patients was 60 years, and 75% were male. Overall, 55.6% of patients had ischemic lesions and a mean FFR baseline value of 0.82 ± 0.10. Total EAT volume index was significantly higher in patients with functionally or anatomically significant stenosis. Specifically, peri-lesion EAT volume index, not the density, was positively correlated with lesion-specific ischemia independent of luminal stenosis and plaque characteristics (hazard ratio 1.56, 95% confidence interval 1.04-2.33, P = 0.032; per 0.1 ml/m 2 increase). Moreover, peri-lesion EAT volume was negatively correlated with lesion FFR values, whereas total EAT volume was positively correlated with fat accumulation and glucose metabolism. In addition, there was no association of EAT volume or density with myocardial ischemia in vessel-level analysis. Conclusions: Lesion-specific EAT volume index, but not density, seems positively and independently associated with myocardial ischemia, while its incremental diagnostic value of lesion-specific ischemia should be further investigated.

Lesion-Specific Peri-Coronary Fat Attenuation Index Is Associated With Functional Myocardial Ischemia Defined by Abnormal Fractional Flow Reserve

“…Some investigations have shown that EAT volume was associated with myocardial ischemia detected by nuclear imaging (28,29), but the relationship between EAT volume and abnormal FFR remained unclear. Romijn et al (15) indicated that EAT volume could independently predict FFR dropping while other works arrived at contrary results (13,14,16). The reason for this debate could be explained by the patient population included in the studies.…”

“…Standard quantitative coronary analysis (QCA) was used to quantify the ICA stenosis severity with the method as previously described. FFR was performed with a coronary pressure wire (Volcano, Rancho Cordova, CA, USA or St Jude Medical, Minneapolis, MN, USA) subsequently in vessels with intermediate stenosis between 30 and 90% ( 14 , 16 , 26 ). Maximum hyperemia was induced by intravenous administration of adenosine triphosphate (140–180 μg/kg/min).…”

“…Epicardial adipose tissue (EAT) is a cardiac-specific visceral fat depot that showed a close connection to cardiovascular diseases (10)(11)(12), and its volume could be quantified by coronary CTA. However, prior works did not demonstrate its predictive value for FFR-assessed myocardial ischemia (13)(14)(15)(16).…”

“…As a parameter that reflected the focal inflammatory burden around specific lesions, the association between lesion-specific PCAT attenuation and abnormal FFR was investigated in limited studies. Yu et al indicated that lesion-specific PCAT attenuation could help to identify ischemic lesions ( 24 ), while the results of Du et al showed that there was no connection between lesion-specific PCAT attenuation and abnormal FFR ( 16 ).…”

The Value of Epicardial Adipose Tissue for the Patients Treated with Percutaneous Coronary Intervention: A Systemic Review and Meta-analysis

“…This urges us to determine the quality of EAT rather than the solely thickness or volume of EAT. Recently, Yu Du and his colleagues have shown that lesion-speci c EAT volume index, but not density, seems positively and independently associated with myocardial ischemia [43]. In some way, quanti cation of epicardial fat using 3D cine Dixon MRI may play a pivotal role in determining the quality of EAT [44].…”