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      Correlation of epicardial fat quantification with severity of coronary artery disease: A study in Indian population

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          Abstract

          Objective

          We studied the correlation of quantified epicardial fat with severity of coronary artery disease in patients [suspected cases of coronary artery disease (CAD)] referred for computed tomography (CT) coronary angiography and established cutoffs for epicardial fat volume (EFV) for the presence of CAD and obstructive CAD.

          Methods

          A prospective cum retrospective cross-sectional observational study was carried out on 950 Indian subjects (suspected cases of CAD) who were referred for coronary CT in the year 2013–2016. EFV was quantified using semiautomatic technique on multidetector coronary CT angiography. The presence of atherosclerotic plaques and degree of stenosis was assessed on coronary CT angiography scans. The correlation between quantified EFV and degree of stenosis was assessed. Multivariate analysis was also performed.

          Results

          A higher quantity of epicardial fat is found in patients with increasing severity of coronary artery stenosis. The EFV cutoff for the presence of CAD and obstructive CAD are 49.75 and 67.69 mL with area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 0.68, 81%, 45.9%,58.24%, 72.2%, and 62.84% and 0.709, 64.9%, 66.4%, 35.84%, 86.55%, and 66%, respectively. EFV correlates with age, weight, and body mass index (BMI). Multivariate analysis revealed EFV to be an independent risk factor for the presence of CAD.

          Conclusions

          Higher quantities of EFV are found in patients with greater degree of coronary artery stenosis. EFV correlates with age, weight, and BMI. EFV is an independent risk factor for CAD.

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          Most cited references26

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          Human epicardial adipose tissue is a source of inflammatory mediators.

          Tomasz Mazurek, LiFeng Zhang, Andrew Zalewski … (2003)
          Inflammatory mediators that originate in vascular and extravascular tissues promote coronary lesion formation. Adipose tissue may function as an endocrine organ that contributes to an inflammatory burden in patients at risk of cardiovascular complications. In this study, we sought to compare expression of inflammatory mediators in epicardial and subcutaneous adipose stores in patients with critical CAD. Paired samples of epicardial and subcutaneous adipose tissues were harvested at the outset of elective CABG surgery (n=42; age 65+/-10 years). Local expression of chemokine (monocyte chemotactic protein [MCP]-1) and inflammatory cytokines (interleukin [IL]-1beta, IL-6, and tumor necrosis factor [TNF]-alpha) was analyzed by TaqMan real-time reverse transcription-polymerase chain reaction (mRNA) and by ELISA (protein release over 3 hours). Significantly higher levels of IL-1beta, IL-6, MCP-1, and TNF-alpha mRNA and protein were observed in epicardial adipose stores. Proinflammatory properties of epicardial adipose tissue were noted irrespective of clinical variables (diabetes, body mass index, and chronic use of statins or ACE inhibitors/angiotensin II receptor blockers) or plasma concentrations of circulating biomarkers. In a subset of samples (n=11), global gene expression was explored by DNA microarray hybridization and confirmed the presence of a broad inflammatory reaction in epicardial adipose tissue in patients with coronary artery disease. The above findings were paralleled by the presence of inflammatory cell infiltrates in epicardial adipose stores. Epicardial adipose tissue is a source of several inflammatory mediators in high-risk cardiac patients. Plasma inflammatory biomarkers may not adequately reflect local tissue inflammation. Current therapies do not appear to eliminate local inflammatory signals in epicardial adipose tissue.
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            Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study.

            Guido A. Rosito, Joseph Massaro, Udo Hoffmann … (2008)
            Pericardial fat may be an important mediator of metabolic risk. Correlations with cardiovascular disease risk factors and vascular calcification in a community-based sample are lacking. We sought to examine associations between pericardial fat, metabolic risk factors, and vascular calcification. Participants free of cardiovascular disease from the Framingham Heart Study (n=1155, mean age 63 years, 54.8% women) who were part of a multidetector computed tomography study underwent quantification of intrathoracic fat, pericardial fat, visceral abdominal fat (VAT), coronary artery calcification, and aortic artery calcification. Intrathoracic and pericardial fat volumes were examined in relation to body mass index, waist circumference, VAT, metabolic risk factors, coronary artery calcification, and abdominal aortic calcification. Intrathoracic and pericardial fat were directly correlated with body mass index (r=0.41 to 0.51, P 0.05). Pericardial fat, but not intrathoracic fat, was associated with coronary artery calcification after multivariable and VAT adjustment (odds ratio 1.21, 95% confidence interval 1.005 to 1.46, P=0.04), whereas intrathoracic fat, but not pericardial fat, was associated with abdominal aortic calcification (odds ratio 1.32, 95% confidence interval 1.03 to 1.67, P=0.03). Pericardial fat is correlated with multiple measures of adiposity and cardiovascular disease risk factors, but VAT is a stronger correlate of most metabolic risk factors. However, intrathoracic and pericardial fat are associated with vascular calcification, which suggests that these fat depots may exert local toxic effects on the vasculature.
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              Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study.

              Raimund Erbel, Susanne Moebus, Nico Dragano … (2013)
              This study sought to determine whether epicardial fat volume predicts coronary events in the general population. Epicardial adipose tissue (EAT) is suggested to promote plaque development in the coronary artery tree. We quantified EAT volume in participants from the prospective population-based Heinz Nixdorf Recall cohort study free of cardiovascular disease. Incident coronary events were assessed during a follow-up period of 8.0 ± 1.5 years. Multivariable association of EAT with cardiovascular risk factors, coronary artery calcification (CAC), and coronary events was assessed using regression analysis. From the overall 4,093 participants (age 59.4 years, 47% male), 130 subjects developed a fatal or nonfatal coronary event. Incidence of coronary events increased by quartile of EAT (0.9% vs. 4.7% for 1(st) and 4th quartile, respectively, p < 0.001). Doubling of EAT was associated with a 1.5-fold risk of coronary events when adjusting for cardiovascular risk factors (hazard ratio [HR] [95% confidence interval (CI)]: 1.54 [1.09 to 2.19]), which remained unaltered after further adjustment for CAC score (HR [95% CI]: 1.50 [1.07 to 2.11]). For discrimination of subjects with events from those without, we observed a trend for improvement of Harrell's C and explained variance by EAT over traditional cardiovascular risk factors, which, however, did not reach statistical significance (0.720 to 0.730 for risk factors alone and with EAT added, respectively, p = 0.10, R(2) = 2.73% to R(2) = 2.92%, time-dependent integrated discrimination improvement = 0.196%). Epicardial fat is associated with fatal and nonfatal coronary events in the general population independent of traditional cardiovascular risk factors and complements information from cardiac computed tomography above the CAC score. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Rishabh Khurana
                Anurag Yadav
                T.B.S. Buxi
                J.P.S. Sawhney
                Kishan Singh Rawat
                Samarjit S. Ghuman
                Journal
                Journal ID (nlm-ta): Indian Heart J
                Journal ID (iso-abbrev): Indian Heart J
                Title: Indian Heart Journal
                Publisher: Elsevier
                ISSN (Print): 0019-4832
                Publication date (Print): December 2018
                Publication date (Electronic): 20 August 2018
                Volume: 70
                Issue: Suppl 3
                Pages: S140-S145
                Affiliations
                [a ]Department of CT & MRI, Sir Ganga Ram Hospital, New Delhi, 110060, India
                [b ]Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, 110060, India
                Author notes
                [∗ ]Corresponding author. Department of CT & MRI, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi-110060, India. rishabhkhurana88@ 123456gmail.com
                Article
                Publisher ID: S0019-4832(18)30389-4
                DOI: 10.1016/j.ihj.2018.08.009
                PMC ID: 6310730
                PubMed ID: 30595247
                SO-VID: 1ef64fad-72df-4466-8623-f10f6a3a9a83
                Copyright © © 2018 Cardiological Society of India. Published by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 13 June 2018
                Date accepted : 7 August 2018
                Categories
                Subject: Clinical and Preventive Cardiology

                Keywords: epicardial fat,epicardial fat volume,epicardial fat quantification,regional thoracic fat depots,auc, area under curve,bmi, body mass index,cad, coronary artery disease,ccs, coronary calcium score,ef, epicardial fat,efv, epicardial fat volume,iqr, interquartile range,mdct, multidetector computed tomography,mip, maximum intensity projection,npv, negative predictive value,pfv, pericardial fat volume,ppv, positive predictive value,sd, standard deviation,spss, statistical package for social sciences,vrt, volume rendered technique
                Data availability:
                Keywords: epicardial fat, epicardial fat volume, epicardial fat quantification, regional thoracic fat depots, auc, area under curve, bmi, body mass index, cad, coronary artery disease, ccs, coronary calcium score, ef, epicardial fat, efv, epicardial fat volume, iqr, interquartile range, mdct, multidetector computed tomography, mip, maximum intensity projection, npv, negative predictive value, pfv, pericardial fat volume, ppv, positive predictive value, sd, standard deviation, spss, statistical package for social sciences, vrt, volume rendered technique

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