The relation of location-specific epicardial adipose tissue thickness and obstructive coronary artery disease: systemic review and meta-analysis of observational studies

Abstract

BackgroundThere is growing evidence about the importance of epicardial adiposity on cardiometabolic risk. However, the relation of location-specific epicardial adipose tissue (EAT) thickness to coronary atherosclerotic burden is still unclear.MethodsThis meta-analysis was used to study the relations between location-specific EAT thickness and obstructive coronary artery disease (CAD). A systemic literature search to identify eligible studies that met the inclusion criteria from the beginning until January 2014 was made. We conducted the meta-analysis of all included 10 published studies. Pre-specified subgroup analyses were performed according to ethnicity, body mass index, diagnostic tools for CAD, and measurement tool if presence of high heterogeneity between studies. Potential publication bias was also assessed.ResultsWe identified ten observed studies with a total of 1625 subjects for planned comparison. With regard to the association between obstructive CAD and location-specific EAT thickness at the right ventricular free wall, caution is warranted. The pooled estimate showed that location-specific EAT thickness at the right ventricular free wall was significantly higher in the CAD group than non-CAD group (standardized mean difference (SMD): 0.70 mm, 95% CI: 0.26-1.13, P = 0.002), although heterogeneity was high (I2 = 93%). It should be clear that only the result of echocardiography-based studies showed a significant association (SMD: 0.98 mm, 95% CI: 0.43-1.53, P = 0.0005), and the result of all included CT-based studies showed a non-significant association (SMD: 0.06 mm, 95% CI: -0.12-0.25, P = 0.50). In the subgroup analysis, the “diagnostic tools for CAD” or “measurement tool of EAT thickness” are potential major sources of heterogeneity between studies. With regard to location-specific EAT thickness at the left atrioventricular (AV) groove, it was significantly higher in the CAD group than non-CAD group (SMD: 0.74 mm, 95% CI: 0.55-0.92, P <0.00001; I2 = 0%).ConclusionOur meta-analysis suggests that significantly elevated location-specific EAT thickness at the left AV groove is associated with obstructive CAD. Based on the current evidence, the location-specific EAT thickness at the left AV groove appears to be a good predictor in obstructive CAD, especially in Asian populations. Furthermore well-designed studies are warranted because of the current limited number of studies.

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

“…Furthermore some investigators found that epicardial fat thickness measured at the left atrioventricular groove was the best predictor of obstructive coronary artery disease (116,338). This finding was confirmed in a meta-analysis but confirmation is needed in other populations than Asians (337).…”

Epicardial Adipose Tissue Contributes to the Development of Non-Calcified Coronary Plaque: A 5-Year Computed Tomography Follow-up Study

“…Second, we could not evaluate the impact of location-specific EAT on the development of plaques in adjacent coronary arteries. Current evidence suggests an association between the location-specific EAT thickness at the atrioventricular groove and the presence of obstructive CAD 41) , so evaluation of this relationship would provide interesting insight regarding the pathobiology of EAT on the development of coronary atherosclerosis. Third, we excluded participants with metabolic syndrome from this study, since there is a strong relationship between the presence of metabolic syndrome and EAT.…”

Local Thickness of Epicardial Adipose Tissue Surrounding the Left Anterior Descending Artery Is a Simple Predictor of Coronary Artery Disease ― New Prediction Model in Combination With Framingham Risk Score ―

“…20- 22 Wang et al showed that EAT thickness in the LAVG, but not EATV, was significantly associated with coronary atherosclerosis; 20 also, a meta-analysis confirmed that increases in location-specific EAT thicknesses at the LAVG are associated with obstructive CAD. 21 Our previous study found that EATLAD was greater in the CAD group than in the non-CAD group, and that it had added diagnostic value over other conventional risk factors. 22 Ohyama et al reported that the local EATV around the LAD, but not around the RCA or LCX, was significantly increased in patients with LAD spasms, suggesting the involvement of coronary EAT in the pathogenesis of coronary spasms, a form of atherosclerosis.…”