Skip to main content

Advertisement

Log in

The association of epicardial fat volume with coronary characteristics and clinical outcome

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Recent studies have demonstrated the relationship between epicardial fat volume (EFV) and coronary atherosclerosis, but their association is modest at best. Our purpose is to elucidate the association of epicardial fat with coronary characteristics and clinical outcome. We performed coronary computed tomographic angiography in 651 patients and divided them into three groups according to tertiles of EFV; low-tertile (n = 215), 36–123 ml; middle-tertile (n = 218), 124–165 ml; high-tertile (n = 218), 166–489 ml. The prevalence of coronary calcium score (CCS) >0 (71.6, 73.4, and 83.9% in low-, middle-, and high-tertile group, respectively) and CCS >100 (39.1, 39.9, and 59.2% in each group) was significantly higher in patients with high-tertile EFV compared to the other two groups (p = 0.0047 and p < 0.0001, respectively). The prevalence of CCS >400 was 17.2, 25.7, and 33.1% in each group, which increased stepwise as EFV increased. The significant stenosis (36.2 vs. 27.0%, p = 0.0383), total coronary occlusion (5.5 vs. 0.9%, p = 0.0156), and high-risk plaque (11.0 vs. 5.6%, p = 0.0368) were more prevalent in patients with high-tertile EFV compared to those with low-tertile EFV. The combined rate of cardiac death and myocardial infarction was 0.9, 2.3, and 6.4% in each patient group, respectively, which was significantly higher in patients with high-tertile EFV compared to those with low-tertile EFV (p = 0.0004). The prevalence of coronary artery calcium, significant stenosis, and high-risk plaque increased sharply in patients with high EFV, which was associated with higher rate of cardiac death and myocardial infarction. Thus, high EFV was associated with advanced coronary atherosclerosis and poor prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Mazurek T, Zhang L, Zalewski A et al (2003) Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 108:2460–2466

    Article  PubMed  Google Scholar 

  2. Iacobellis G, Pistilli D, Gucciardo M et al (2005) Adiponectin expression in human epicardial adipose tissue in vivo is lower in patients with coronary artery disease. Cytoline 29:251–255

    CAS  Google Scholar 

  3. Baker AR, Silva NF, Quinn DW et al (2006) Uman epicardial adikpose tissue expresses a pathogenetic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol 5:1

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mahabadi AA, Massaro JM, Rosito GA et al (2009) Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J 30:850–856

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mahabadi AA, Berg MH, Lehmann N et al (2013) 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 61:1388–1395

    Article  PubMed  Google Scholar 

  6. Cheng VY, Dey D, Tamarappoo B et al (2010) Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events. JACC Cardiovasc Imaging 3:352–360

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bos D, Shahzad R, van Walsum T et al (2015) Epicardial fat volume is related to atherosclerotic calcification in multiple vessel beds. Eur Heart J Cardiovasc Imaging 16:1264–1269

    Article  PubMed  Google Scholar 

  8. Gorter PM, de Vos AM, van der Graaf Y et al (2008) Relation of epicardial and pericoronary fat to coronary atherosclerosis and coronary artery calcium in patients undergoing coronary angiography. Am J Cardiol 102:380–385

    Article  CAS  PubMed  Google Scholar 

  9. Djaberi R, Schuijf JD, van Werkhoven JM, Nucifora G, Jukema JW, Bax JJ (2008) Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol 102:1602–1607

    Article  PubMed  Google Scholar 

  10. Tanami Y, Jinzaki M, Kishi S et al (2015) A lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population. Results from the CORE320 multicenter study. Circ Cardiovasc Imaging 8:e002676

    Article  PubMed  PubMed Central  Google Scholar 

  11. Taguchi R, Takasu J, Itani Y et al (2001) Pericardial fat accumulation in men as a risk factor for coronary artery disease. Atherosclerosis 157:203–209

    Article  CAS  PubMed  Google Scholar 

  12. Wheeler GL, Shi R, Beck SR et al (2005) Pericardial and visceral adipose tissue measured volumetrically with computed tomography are highly associated in type 2 diabetes families. Invest Radiol 40:97–101

    Article  PubMed  Google Scholar 

  13. Abbara S, Desai JC, Cury RC, Butler J, Nieman K, Reddy V (2005) Mapping of epicardial fat with multidetector computed tomography to facilitate percutanoeous transepicardial arrhythmia ablation. Eur J Radiol 57:417–422

    Article  Google Scholar 

  14. Gorter PM, van Lindert AS, de Vos AM et al (2008) Quantitation of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis 197:896–903

    Article  CAS  PubMed  Google Scholar 

  15. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  16. Motoyama S, Kondo T, Sarai M et al (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50:319–326

    Article  PubMed  Google Scholar 

  17. Otsuka K, Fukuda S, Tanaka A et al (2013) Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. JACC Cardiovasc Imaging 6:448–457

    Article  PubMed  Google Scholar 

  18. Iwasaki K, Matsumoto T, Aono H, Furukawa H, Samukawa M (2011) Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease. Clin Cardiol 34:166–171

    Article  PubMed  Google Scholar 

  19. Hachamovitch R, Rozanski A, Shaw LJ et al (2011) Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J 32:1012–1024

    Article  PubMed  Google Scholar 

  20. Johnson NP, Tóth GG, Lai D et al (2014) Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol 64:1641–1654

    Article  PubMed  Google Scholar 

  21. Rosito GA, Massaro JM, Hoffmann U et al (2008) Pericardial fat, viscderal abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample. Framingham Heart Study Circ 117:605–613

    Article  Google Scholar 

  22. de Vos AM, Prokop M, Roos CJ et al (2008) Peri-coronary adipose tissue is related to cardiovascular risk factors and coronary artery calcification in post-menopausal women. Eur Heart J 29:777–783

    Article  PubMed  Google Scholar 

  23. Bettencourt N, Toschke AM, Leite D et al (2012) Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden. Int J Cardiol 158:26–32

    Article  CAS  PubMed  Google Scholar 

  24. McClain J, Hsu F, Brown E et al (2013) Pericardial adipose tissue and coronary artery calcification in the Multi-ethnic Study of Atherosclerosis (MESA). Obesity (Silver Spring) 21:1056–1063

    Article  Google Scholar 

  25. Ueno K, Anzai T, Jinzaki M et al (2009) Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions. Circ J 73:1927–1933

    Article  PubMed  Google Scholar 

  26. Alexopoulos N, McLean DS, Janik M, Arepalli CD, Stillman AE, Raggi P (2010) Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis 210:150–154

    Article  CAS  PubMed  Google Scholar 

  27. Oka T, Yamamoto H, Ohashi N et al (2012) Association between epicardial adipose tissue volume and characteristics of non-calcified plaques assessed by coronary computed tomographic angiography. Int J Cardiol 161:45–49

    Article  PubMed  Google Scholar 

  28. Motoyama S,Sarai M, Harigaya H et al (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54:49–57

    Article  PubMed  Google Scholar 

  29. Iwasaki K, Matsumoto T (2016) The relationship between coronary calcium score and high-risk plaque/significant stenosis. World J Cardiol 8:481–487

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rajani R, Shmilovich H, Nakazato R et al (2013) Relationship of epicardial fat volume to coronary plaque, severe coronary stenosis, and high-risk coronary plaque features assessed by coronary CT angiography. J Cardiovasc Comput Tomogr 7:125–132

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We wish to thank Mr. Takeshi Matsumoto, R.T. for his technical support of MDCT procedures.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kohichiro Iwasaki.

Ethics declarations

Conflict of interest

There is no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving with human and animal participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iwasaki, K., Urabe, N., Kitagawa, A. et al. The association of epicardial fat volume with coronary characteristics and clinical outcome. Int J Cardiovasc Imaging 34, 301–309 (2018). https://doi.org/10.1007/s10554-017-1227-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-017-1227-7

Keywords

Navigation