Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Abstract
Background: Epicardial adipose tissue is defined as the adipose tissue located between the outer wall of the myocardium and the visceral layer of the pericardium. Epicardial adipose tissue can be measured by echocardiography and more precisely by computed tomography (CT). The present study aimed to investigate the relationship between epicardial fat volume (EFV) assessed by multi-detector CT and the severity of coronary artery disease (CAD).
Methods: This cross-sectional study was conducted on 140 patients with a low-to-intermediate pretest probability of CAD referred for multi-detector CT coronary angiography. EFV was quantified during the non-contrast phase of the imaging protocol, and the severity of CAD was assessed in terms of segment involvement and segment stenosis scores during the contrast phase.
Results: The study population included 105 men (75%) at a mean age of 56±10.27 years. Risk factors of atherosclerosis were analyzed among the patients. Body mass index ranged between 24 kg/m2 and 30.9 kg/m2, hypertension was detected in 77.5%, diabetes mellitus was reported in 55%, and 67.5% were smokers. While 17.5% of the studied patients had normal coronaries, 37.5% had single-vessel disease and 45% had multi-vessel disease. A significant relationship existed between EFV and the coronary artery calcium score (P=0.011). Highly significant relationships were also detected between EFV and both segment involvement and segment stenosis scores (P=0.001 and P=0.003, respectively). Patients with normal coronary arteries had a lower EFV than those with coronary lesions (a highly significant relationship, P=0.004), whether with single-vessel or with multi-vessel disease.
Conclusions: EFV increased in patients with either significant coronary artery stenosis or coronary calcification. Risk factors of atherosclerosis showed direct relationships with EFV. (Iranian Heart Journal 2021; 22(4): 54-65)
Rimm E, Stampfer M, Giovannucci E, et al. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol 1995; 141:1117–1127.
Sacks H, Fain JN. Human epicardial adipose tissue: a review. Am Heart J 2007; 153:907–17.
Iacobellis G, Corradi D, Sharma A, et al. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005; 2:536–43.
Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003; 108: 2460–2466.
Baker A, Silva N, Quinn D, et al. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol 2006; 5:1.
Bettencourt N, Toschke A, Leite D, et al. Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden. Int J Cardiol 2012; 158:26–32.
Mahabadi A, Berg M, Lehmann N, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol 2013; 61:1388–95.
Kim MK, Tomita T, Kim MJ, et al. Aerobic exercise training reduces epicardial fat in obese men. J Appl Physiol. 2009; 106:5–11.
Sun Z, Dimpudus FJ, Nugroho J, et al. CT virtual intravascular endoscopy assessment of coronary artery plaques: A preliminary study. Eur J Radiol 2010; 75:e112-9.
Diamond G and Forrester J. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med1979; 300:1350-8.
Min J, Shaw L, Devereux R, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 2007; 50:1161–1170.
Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Circulation. 1996; 94:1175–1192.
Shmilovich H, Dey D, Cheng V, et al. Threshold for the upper normal limit of indexed epicardial fat volume: derivation in a healthy population and validation in an outcome-based study. Am J Cardiol. 2011; 108(11):1680–1685.
Akyol B., Boyraz M. and Aysoy C., “Relationship of epicardial adipose tissue thickness with early indicators of atherosclerosis and cardiac functional changes in obese adolescents with metabolic syndrome,” Journal of Clinical Research in Pediatric Endocrinology, vol. 5, no. 3, pp. 156–163, 2013.
Mohammadzadeh, M, Mohammadzadeh, V, Shakiba M, et al. Assessing the Relation of Epicardial Fat Thickness and Volume, Quantified by 256-Slice Computed Tomography Scan, With Coronary Artery Disease and Cardiovascular Risk Factors. Archives of Iranian medicine, 2018, 21.3: 95
R, Yadav A, Buxi T, et al. Correlation of epicardial fat quantification with severity of coronary artery disease: A study in Indian population, Indian Heart Journal (2018), doi: 10.1016/j.ihj.2018.08.009.
Mahabadi A, Berg M, Lehmann N, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol 2013; 61:1388–95.
Okada K, Ohshima S, Isobe S, et al. “Epicardial fat volume correlates with severity of coronary artery disease in non-obese patients,” Journal of Cardiovascular Medicine, vol. 15, no. 5, pp. 384–390, 2014.
Abazid, Smettei, Kattea, et al. Relation between epicardial fat and subclinical atherosclerosis in asymptomatic individuals. Journal of thoracic imaging, 2017, 32.6: 378-382
Ito T, Suzuki Y, Ehara M, et al. Impact of epicardial fat volume on coronary artery disease in symptomatic patients with a zero calcium score. Int J Cardiol 2013;167:2852–8.
Abdelmonaem, M., Khashaba, A., & Onsy, A. (2021). Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and Its Relationship With the Severity of Coronary Artery Disease. Iranian Heart Journal, 22(4), 54-65.
MLA
Mostafa Mohamed Abdelmonaem; Ahmed Khashaba; Ahmed Onsy. "Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and Its Relationship With the Severity of Coronary Artery Disease". Iranian Heart Journal, 22, 4, 2021, 54-65.
HARVARD
Abdelmonaem, M., Khashaba, A., Onsy, A. (2021). 'Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and Its Relationship With the Severity of Coronary Artery Disease', Iranian Heart Journal, 22(4), pp. 54-65.
VANCOUVER
Abdelmonaem, M., Khashaba, A., Onsy, A. Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and Its Relationship With the Severity of Coronary Artery Disease. Iranian Heart Journal, 2021; 22(4): 54-65.
)