Incremental diagnostic value of epicardial adipose tissue for the detection of functionally relevant coronary artery disease.
BACKGROUND AND AIM
To determine the incremental diagnostic value of epicardial adipose tissue (EAT) volume in addition to the coronary artery calcium (CAC) score for detecting hemodynamic significant coronary artery disease (CAD).


METHODS AND RESULTS
122 patients (mean age 61 ± 10 years, 61% male) without a previous cardiac history underwent a non-contrast CT scan for calcium scoring and EAT volume measurements. Subsequently all patients underwent invasive coronary angiography (ICA) in conjunction with fractional flow reserve (FFR) measurements. A stenosis >90% and/or a FFR ≤0.80 were considered significant. Mean EAT volume and CACscore were 128 ± 51 cm(3) and 418 ± 704, respectively. The correlation between EAT volume and the CACscore was poor (r = 0.11, p = 0.24). Male gender (odds ratio [OR] 2.86, p = 0.01), CACscore ([cut-off value 100] OR 3.31, p = 0.003, and EAT volume ([cut-off value 92 cm(3)] OR 4.28, p = 0.01) were associated with flow-limiting disease. The multivariate model revealed that only male gender (OR 2.50, p = 0.045), CAC score (OR 3.60, p = 0.005), and EAT volume (OR 4.95, p = 0.02) were independent predictors of myocardial ischemia. Using the cut-off values of 100 (CAC score) and 92 cm(3) (EAT volume), sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for detecting functionally relevant CAD as indicated by FFR were 71, 57, 77, 50 and 63% and 91, 29, 85, 44 and 52% for the CACscore and EAT volume, respectively. Adding EAT volume to the CAC score and cardiovascular risk factors did not enhance diagnostic performance for the detection of significant CAD (p = 0.57).


CONCLUSION
EAT volume measurements have no diagnostic value beyond calcium scoring and cardiovascular risk factors in the detection of hemodynamic significant CAD.
['Romijn|M A|MA|', 'Danad|I|I|', 'Bakkum|M J|MJ|', 'Stuijfzand|W J|WJ|', 'Tulevski|I I|II|', 'Somsen|G A|GA|', 'Lammertsma|A A|AA|', 'van Kuijk|C|C|', 'van de Ven|P M|PM|', 'Min|J K|JK|', 'Leipsic|J|J|', 'van Rossum|A C|AC|', 'Raijmakers|P G|PG|', 'Knaapen|P|P|']
D000273:Adipose Tissue D000368:Aged D019540:Area Under Curve D006328:Cardiac Catheterization D017023:Coronary Angiography D003324:Coronary Artery Disease D003331:Coronary Vessels D003430:Cross-Sectional Studies D005260:Female D053805:Fractional Flow Reserve, Myocardial D006439:Hemodynamics D006801:Humans D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D015588:Observer Variation D016017:Odds Ratio D010496:Pericardium D011237:Predictive Value of Tests D012372:ROC Curve D015203:Reproducibility of Results D012189:Retrospective Studies D012307:Risk Factors D012737:Sex Factors D014057:Tomography, X-Ray Computed D061205:Vascular Calcification
Epicardial adipose tissue Diagnostic performance Hemodynamic significant CAD Coronary artery calcium score