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Dhore-Patil A, Urina-Jassir D, Samson R, Le Jemtel TH, Oparil S. Epicardial Adipose Tissue Thickness and Preserved Ejection Fraction Heart Failure. Curr Hypertens Rep 2024; 26:381-388. [PMID: 38642285 PMCID: PMC11324708 DOI: 10.1007/s11906-024-01302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE OF THE REVIEW Preserved ejection fraction heart failure and obesity frequently coexist. Whether obesity plays a consistent role in the pathogenesis of preserved ejection fraction heart failure is unclear. Accumulation of visceral adiposity underlies the pathogenic aftermaths of obesity. However, visceral adiposity imaging is assessed by computed tomography or magnetic resonance and thus not routinely available. In contrast, epicardial adiposity thickness is assessed by echocardiography and thus routinely available. We review the rationale for assessing epicardial adiposity thickness in patients with preserved ejection fraction heart failure and elevated body mass index. RECENT FINDINGS Body mass index correlates poorly with visceral, and epicardial adiposity. Visceral and epicardial adiposity enlarges as preserved ejection fraction heart failure progresses. Epicardial adiposity may hasten the progression of coronary artery disease and impairs left ventricular sub-endocardial perfusion and diastolic function. Epicardial adiposity thickness may help monitor the therapeutic response in patients with preserved ejection failure heart failure and elevated body mass index.
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Affiliation(s)
- Aneesh Dhore-Patil
- Division of Cardiovascular Imaging, Weill Cornell Medical College, Houston Methodist DeBakey Heart & Vascular Center, 6505 Fanin St., Houston, TX, 77030, USA
| | - Daniela Urina-Jassir
- Section of Cardiology, John W. Deming Department of Medicine, Tulane Avenue, SL-48, New Orleans, LA, 70112, USA
| | - Rohan Samson
- Advanced Heart Failure Therapies Program, University of Louisville Health-Heart Hospital, 201Abraham Flexner Way, Suite 1001, Louisville, KY, 40202, USA
| | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane Avenue, SL-48, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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Langenbach MC, Langenbach IL, Foldyna B, Mauri V, Klein K, Macherey-Meyer S, Heyne S, Meertens M, Lee S, Baldus S, Maintz D, Halbach M, Adam M, Wienemann H. Advanced CT measures of coronary artery disease with intermediate stenosis in patients with severe aortic valve stenosis. Eur Radiol 2024; 34:4897-4908. [PMID: 38189982 PMCID: PMC11255039 DOI: 10.1007/s00330-023-10549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Coronary artery disease (CAD) and severe aortic valve stenosis (AS) frequently coexist. While pre-transcatheter aortic valve replacement (TAVR) computed tomography angiography (CTA) allows to rule out obstructive CAD, interpreting hemodynamic significance of intermediate stenoses is challenging. This study investigates the incremental value of CT-derived fractional flow reserve (CT-FFR), quantitative coronary plaque characteristics (e.g., stenosis degree, plaque volume, and composition), and peri-coronary adipose tissue (PCAT) density to detect hemodynamically significant lesions among those with AS and CAD. MATERIALS AND METHODS We included patients with severe AS and intermediate coronary lesions (20-80% diameter stenosis) who underwent pre-TAVR CTA and invasive coronary angiogram (ICA) with resting full-cycle ratio (RFR) assessment between 08/16 and 04/22. CTA image analysis included assessment of CT-FFR, quantitative coronary plaque analysis, and PCAT density. Coronary lesions with RFR ≤ 0.89 indicated hemodynamic significance as reference standard. RESULTS Overall, 87 patients (age 77.9 ± 7.4 years, 38% female) with 95 intermediate coronary artery lesions were included. CT-FFR showed good discriminatory capacity (area under receiver operator curve (AUC) = 0.89, 95% confidence interval (CI) 0.81-0.96, p < 0.001) to identify hemodynamically significant lesions, superior to anatomical assessment, plaque morphology, and PCAT density. Plaque composition and PCAT density did not differ between lesions with and without hemodynamic significance. Univariable and multivariable analyses revealed CT-FFR as the only predictor for functionally significant lesions (odds ratio 1.28 (95% CI 1.17-1.43), p < 0.001). Overall, CT-FFR ≤ 0.80 showed diagnostic accuracy, sensitivity, and specificity of 88.4% (95%CI 80.2-94.1), 78.5% (95%CI 63.2-89.7), and 96.2% (95%CI 87.0-99.5), respectively. CONCLUSION CT-FFR was superior to CT anatomical, plaque morphology, and PCAT assessment to detect functionally significant stenoses in patients with severe AS. CLINICAL RELEVANCE STATEMENT CT-derived fractional flow reserve in patients with severe aortic valve stenosis may be a useful tool for non-invasive hemodynamic assessment of intermediate coronary lesions, while CT anatomical, plaque morphology, and peri-coronary adipose tissue assessment have no incremental or additional benefit. These findings might help to reduce pre-transcatheter aortic valve replacement invasive coronary angiogram. KEY POINTS • Interpreting the hemodynamic significance of intermediate coronary stenoses is challenging in pre-transcatheter aortic valve replacement CT. • CT-derived fractional flow reserve (CT-FFR) has a good discriminatory capacity in the identification of hemodynamically significant coronary lesions. • CT-derived anatomical, plaque morphology, and peri-coronary adipose tissue assessment did not improve the diagnostic capability of CT-FFR in the hemodynamic assessment of intermediate coronary stenoses.
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Affiliation(s)
- Marcel C Langenbach
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany.
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Isabel L Langenbach
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Victor Mauri
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Konstantin Klein
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany
| | - Sascha Macherey-Meyer
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Sebastian Heyne
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Max Meertens
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Samuel Lee
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - David Maintz
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany
| | - Marcel Halbach
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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Krauz K, Kempiński M, Jańczak P, Momot K, Zarębiński M, Poprawa I, Wojciechowska M. The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration. Int J Mol Sci 2024; 25:3583. [PMID: 38612394 PMCID: PMC11011833 DOI: 10.3390/ijms25073583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Epicardial adipose tissue (EAT) is a fat deposit surrounding the heart and located under the visceral layer of the pericardium. Due to its unique features, the contribution of EAT to the pathogenesis of cardiovascular and metabolic disorders is extensively studied. Especially, EAT can be associated with the onset and development of coronary artery disease, myocardial infarction and post-infarct heart failure which all are significant problems for public health. In this article, we focus on the mechanisms of how EAT impacts acute coronary syndromes. Particular emphasis was placed on the role of inflammation and adipokines secreted by EAT. Moreover, we present how EAT affects the remodeling of the heart following myocardial infarction. We further review the role of EAT as a source of stem cells for cardiac regeneration. In addition, we describe the imaging assessment of EAT, its prognostic value, and its correlation with the clinical characteristics of patients.
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Affiliation(s)
- Kamil Krauz
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Marcel Kempiński
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Paweł Jańczak
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Karol Momot
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Maciej Zarębiński
- Department of Invasive Cardiology, Independent Public Specialist Western Hospital John Paul II, Lazarski University, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland; (M.Z.); (I.P.)
| | - Izabela Poprawa
- Department of Invasive Cardiology, Independent Public Specialist Western Hospital John Paul II, Lazarski University, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland; (M.Z.); (I.P.)
| | - Małgorzata Wojciechowska
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
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Yu W, Yang L, Zhang F, Liu B, Shi Y, Wang J, Shao X, Chen Y, Yang X, Wang Y. Machine learning to predict hemodynamically significant CAD based on traditional risk factors, coronary artery calcium and epicardial fat volume. J Nucl Cardiol 2023; 30:2593-2606. [PMID: 37434084 DOI: 10.1007/s12350-023-03333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023]
Abstract
We sought to establish an explainable machine learning (ML) model to screen for hemodynamically significant coronary artery disease (CAD) based on traditional risk factors, coronary artery calcium (CAC) and epicardial fat volume (EFV) measured from non-contrast CT scans. 184 symptomatic inpatients who underwent Single Photon Emission Computed Tomography/Myocardial Perfusion Imaging (SPECT/MPI) and Invasive Coronary Angiography (ICA) were enrolled. Clinical and imaging features (CAC and EFV) were collected. Hemodynamically significant CAD was defined when coronary stenosis severity ≥ 50% with a matched reversible perfusion defect in SPECT/MPI. Data was randomly split into a training cohort (70%) on which five-fold cross-validation was done and a test cohort (30%). The normalized training phase was preceded by the selection of features using recursive feature elimination (RFE). Three ML classifiers (LR, SVM, and XGBoost) were used to construct and choose the best predictive model for hemodynamically significant CAD. An explainable approach based on ML and the SHapley Additive exPlanations (SHAP) method was deployed to generate individual explanation of the model's decision. In the training cohort, hemodynamically significant CAD patients had significantly higher age, BMI and EFV, higher proportions of hypertension and CAC comparing with controls (P all < .05). In the test cohorts, hemodynamically significant CAD had significantly higher EFV and higher proportion of CAC. EFV, CAC, diabetes mellitus (DM), hypertension, and hyperlipidemia were the highest ranking features by RFE. XGBoost produced better performance (AUC of 0.88) compared with traditional LR model (AUC of 0.82) and SVM (AUC of 0.82) in the training cohort. Decision Curve Analysis (DCA) demonstrated that XGBoost model had the highest Net Benefit index. Validation of the model also yielded a favorable discriminatory ability with the AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 0.89, 68.0%, 96.8%, 94.4%, 79.0% and 83.9% in the XGBoost model. A XGBoost model based on EFV, CAC, hypertension, DM and hyperlipidemia to assess hemodynamically significant CAD was constructed and validated, which showed favorable predictive value. ML combined with SHAP can offer a transparent explanation of personalized risk prediction, enabling physicians to gain an intuitive understanding of the impact of key features in the model.
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Affiliation(s)
- Wenji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Le Yang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Yongjun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaoyu Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China.
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Zhu J, Xie Z, Huang H, Li W, Zhuo K, Bai Z, Huang R. Association of Epicardial Adipose Tissue With Left Ventricular Strain and MR Myocardial Perfusion in Patients With Known Coronary Artery Disease. J Magn Reson Imaging 2023; 58:1490-1498. [PMID: 36794488 DOI: 10.1002/jmri.28619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) may have a paracrine effect on coronary microcirculation and myocardium. However, it is unclear whether EAT is linked to cardiac function and perfusion. PURPOSE To investigate the association of EAT with left ventricular (LV) strain and myocardial perfusion in patients with coronary artery disease (CAD). STUDY TYPE Retrospective. POPULATION A total of 78 patients with CAD and 20 healthy controls. The patients were further divided into high (n = 39) and low EAT volume (n = 39) groups according to median EAT volume. FIELD STRENGTH/SEQUENCE A 1.5 T, balanced steady-state free precession, inversion recovery prepared echo-planar, and segmented-turbo fast low-angle shot (FLASH) phase-sensitive inversion recovery (PSIR) sequences. ASSESSMENT EAT volume was measured by manually tracing the epicardial border and the visceral layer of pericardium on the short-axis cine stacks. LV strain parameters included global radial (GRS), circumferential (GCS), and longitudinal peak strain (GLS). Perfusion indices included upslope, perfusion index, time-to-maximum signal intensity (TTM), and maximum signal intensity (MaxSI). STATISTICAL TESTS One-way analysis of variance or Kruskal-Wallis rank tests, Chi-squared or Fisher exact tests. Multivariate linear regression analyses. A P value < 0.05 was considered statistically significant. RESULTS The parameters of GRS GCS, GLS, upslope, perfusion index, and MaxSI were significantly lower in the patients when compared to the controls. Moreover, the high EAT volume group presented significantly longer TTM values and lower GRS, GCS, GLS, upslope, perfusion index, and MaxSI than the low EAT volume group. Multivariate linear regression analyses demonstrated that EAT was independently associated with GRS, GCS, GLS, upslope, perfusion index, TTM, and MaxSI in patients. EAT and upslope were independently associated with GRS, while EAT and perfusion index were both independently associated with GCS and GLS. DATA CONCLUSION EAT was associated with parameters of LV function and perfusion, and myocardial perfusion was independently associated with LV strain in patients with CAD. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- Jing Zhu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Zhen Xie
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Hao Huang
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Wenjia Li
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Kaimin Zhuo
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Zhicheng Bai
- Department of Radiology, Xindu District People's Hospital of Chengdu, Chengdu, China
| | - Ruijue Huang
- Department of Basic Medicine, Hainan Vocational University of Science and Technology, Haikou, China
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Jin X, Gao B, Zheng J, Wu X, Zhang N, Zhu L, Zhu X, Xie J, Wang Z, Tong G, Huang J. Impact of epicardial adipose tissue volume on hemodynamically significant coronary artery disease in Chinese patients with known or suspected coronary artery disease. Front Cardiovasc Med 2023; 10:1088961. [PMID: 37025685 PMCID: PMC10071511 DOI: 10.3389/fcvm.2023.1088961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Background Epicardial adipose tissue (EAT) is directly related to coronary artery disease (CAD), but little is known about its role in hemodynamically significant CAD. Therefore, our goal is to explore the impact of EAT volume on hemodynamically significant CAD. Methods Patients who underwent coronary computed tomography angiography (CCTA) and received coronary angiography within 30 days were retrospectively included. Measurements of EAT volume and coronary artery calcium score (CACs) were performed on a semi-automatic software based on CCTA images, while quantitative flow ratio (QFR) was automatically calculated by the AngioPlus system according to coronary angiographic images. Results This study included 277 patients, 112 of whom had hemodynamically significant CAD and showed higher EAT volume. In multivariate analysis, EAT volume was independently and positively correlated with hemodynamically significant CAD [per standard deviation (SD) cm3; odds ratio (OR), 2.78; 95% confidence interval (CI), 1.86-4.15; P < 0.001], but negatively associated with QFRmin (per SD cm3; β coefficient, -0.068; 95% CI, -0.109 to -0.027; P = 0.001) after adjustment for traditional risk factors and CACs. Receiver operating characteristics curve analysis demonstrated a significant improvement in predictive value for hemodynamically significant CAD with the addition of EAT volume to obstructive CAD alone (area under the curve, 0.950 vs. 0.891; P < 0.001). Conclusion In this study, we found that EAT volume correlated substantially and positively with the existence and severity of hemodynamically significant CAD in Chinese patients with known or suspected CAD, which was independent of traditional risk factors and CACs. In combination with obstructive CAD, EAT volume significantly improved diagnostic performance for hemodynamically significant CAD, suggesting that EAT could be a reliable noninvasive indicator of hemodynamically significant CAD.
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Affiliation(s)
- Xiangbo Jin
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Beibei Gao
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiamin Zheng
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xueer Wu
- Graduate School, Wenzhou Medical University, Wenzhou, China
| | - Ning Zhang
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijun Zhu
- Department of Cardiology, Ningbo Municipal Medical Center LiHuili Hospital, Ningbo, China
| | - Xinyu Zhu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianchang Xie
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen Wang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoxin Tong
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinyu Huang
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Incremental diagnostic value of radiomics signature of pericoronary adipose tissue for detecting functional myocardial ischemia: a multicenter study. Eur Radiol 2023; 33:3007-3019. [PMID: 36729175 DOI: 10.1007/s00330-022-09377-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine the incremental diagnostic value of radiomics signature of pericoronary adipose tissue (PCAT) in addition to the coronary artery stenosis and plaque characters for detecting hemodynamic significant coronary artery disease (CAD) based on coronary computed tomography angiography (CCTA). METHODS In a multicenter trial of 262 patients, CCTA and invasive coronary angiography were performed, with fractional flow reserve (FFR) in 306 vessels. A total of 13 conventional quantitative characteristics including plaque characteristics (N = 10) and epicardial adipose tissue characteristics (N = 3) were obtained. A total of 106 radiomics features depicting the phenotype of the PCAT surrounding the lesion were calculated. All data were randomly split into a training dataset (75%) and a testing dataset (25%). Then three models (including the conventional model, the PCAT radiomics model, and the combined model) were established in the training dataset using multivariate logistic regression algorithm based on the conventional quantitative features and the PCAT radiomics features after dimension reduction. RESULTS A total of 124/306 vessels showed functional ischemia (FFR ≤ 0.80). The radiomics model performed better in discriminating ischemia from non-ischemia than the conventional model in both training (area under the receiver operating characteristic (ROC) curve (AUC): 0.770 vs 0.732, p < 0.05) and testing datasets (AUC: 0.740 vs 0.696, p < 0.05). The combined model showed significantly better discrimination than the conventional model in both training (AUC: 0.810 vs 0.732, p < 0.05) and testing datasets (AUC: 0.809 vs 0.696, p < 0.05). CONCLUSIONS The PCAT radiomics model showed good performance in predicting myocardial ischemia. Addition of PCAT radiomics to lesion quantitative characteristics improves the predictive power of functionally relevant CAD. KEY POINTS • Based on the plaque characteristics and EAT characteristics, the conventional model showed poor performance in predicting myocardial ischemia. • The PCAT radiomics model showed good prospect in predicting myocardial ischemia. • When combining the radiomics signature with the conventional quantitative features (including plaque features and EAT features), it showed significantly better performance in predicting myocardial ischemia.
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Wang Q, Chi J, Wang C, Yang Y, Tian R, Chen X. Epicardial Adipose Tissue in Patients with Coronary Artery Disease: A Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9080253. [PMID: 36005417 PMCID: PMC9410067 DOI: 10.3390/jcdd9080253] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022] Open
Abstract
Objective: The aim of this study is to assess the association between epicardial adipose tissue (EAT) and coronary artery disease (CAD) via meta−analysis. Methods: Specific searches of online databases from January 2000 to May 2022 were conducted. All observational studies evaluating the association between EAT and CAD in PubMed, Web of Science, and the Cochrane Library databases were screened. A meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta−Analyses guidelines (PRISMA). In total, 21 studies encompassing 4975 subjects met the inclusion criteria, including 2377 diagnosed and assigned as the CAD group, while the other 2598 were assigned as the non−CAD group. Subjects in the CAD group were further divided into the severe stenosis group (stenosis ≥ 50%, n = 846) and the mild/moderate stenosis group (stenosis < 50%, n = 577). Results: Both the volume and thickness of EAT in the CAD group were larger compared to the non−CAD group (p < 0.00001). In a subgroup analysis within the CAD group, the severe stenosis group had a larger volume and thickness with respect to EAT when compared to the mild/moderate group (p < 0.001). Conclusions: The enlargement of EAT presented in CAD patients with an association with CAD severity. Although limited by different CAD types and measuring methods for EAT, as well as a smaller sample size, our results suggest that EAT is a novel predictor and a potential therapeutic target for CAD.
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Affiliation(s)
- Qingpeng Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiangyang Chi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chen Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yun Yang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rui Tian
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xinzhong Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence:
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Additive value of epicardial adipose tissue quantification to coronary CT angiography-derived plaque characterization and CT fractional flow reserve for the prediction of lesion-specific ischemia. Eur Radiol 2022; 32:4243-4252. [PMID: 35037968 DOI: 10.1007/s00330-021-08481-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Epicardial adipose tissue (EAT) from coronary CT angiography (CCTA) is strongly associated with coronary artery disease (CAD). We investigated the additive value of EAT volume to coronary plaque quantification and CT-derived fractional flow reserve (CT-FFR) to predict lesion-specific ischemia. METHODS Patients (n = 128, 60.6 ± 10.5 years, 61% male) with suspected CAD who had undergone invasive coronary angiography (ICA) and CCTA were retrospectively analyzed. EAT volume and plaque measures were derived from CCTA using a semi-automatic software approach, while CT-FFR was calculated using a machine learning algorithm. The predictive value and discriminatory power of EAT volume, plaque measures, and CT-FFR to identify ischemic CAD were assessed using invasive FFR as the reference standard. RESULTS Fifty-five of 152 lesions showed ischemic CAD by invasive FFR. EAT volume, CCTA ≥ 50% stenosis, and CT-FFR were significantly different in lesions with and without hemodynamic significance (all p < 0.05). Multivariate analysis revealed predictive value for lesion-specific ischemia of these parameters: EAT volume (OR 2.93, p = 0.021), CCTA ≥ 50% (OR 4.56, p = 0.002), and CT-FFR (OR 6.74, p < 0.001). ROC analysis demonstrated incremental discriminatory value with the addition of EAT volume to plaque measures alone (AUC 0.84 vs. 0.62, p < 0.05). CT-FFR (AUC 0.89) showed slightly superior performance over EAT volume with plaque measures (AUC 0.84), however without significant difference (p > 0.05). CONCLUSIONS EAT volume is significantly associated with ischemic CAD. The combination of EAT volume with plaque quantification demonstrates a predictive value for lesion-specific ischemia similar to that of CT-FFR. Thus, EAT may aid in the identification of hemodynamically significant coronary stenosis. KEY POINTS • CT-derived EAT volume quantification demonstrates high discriminatory power to identify lesion-specific ischemia. • EAT volume shows incremental diagnostic performance over CCTA-derived plaque measures in detecting lesion-specific ischemia. • A combination of plaque measures with EAT volume provides a similar discriminatory value for detecting lesion-specific ischemia compared to CT-FFR.
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Ma S, Chen X, Ma Y, Liu H, Zhang J, Xu L, Wang Y, Liu T, Wang K, Yang J, Hou Y. Lesion-Specific Peri-Coronary Fat Attenuation Index Is Associated With Functional Myocardial Ischemia Defined by Abnormal Fractional Flow Reserve. Front Cardiovasc Med 2021; 8:755295. [PMID: 34805310 PMCID: PMC8595266 DOI: 10.3389/fcvm.2021.755295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023] Open
Abstract
Background: The association between abnormal invasive fractional flow reserve (FFR) and the fat attenuation index (FAI) of lesion-specific peri-coronary adipose tissue (PCAT) is unclear. Method: Data of patients who underwent coronary computed tomography angiography (CTA) and subsequent invasive coronary angiography (ICA) and FFR measurement within 1 week were retrospectively included. Lesion-specific FAI (FAIlesion), lesion-free FAI (FAInormal), epicardial adipose tissue (EAT) volume and attenuation was collected, along with stenosis severity and plaque characteristics. Lesions with FFR <0.8 were considered functionally significant. The association between FFR and each parameter was analyzed by logistic regression or receiver operating characteristic curve. Result: A total of 227 patients from seven centers were included. EAT volume or attenuation, traditional risk factors, and FAInormal (with vs. without ischemia: −82 ± 11 HU vs. −81 ± 11 HU, p = 0.65) were not significantly different in patients with or without abnormal FFR. In contrast, lesions causing functional ischemia presented more severe stenosis, greater plaque volume, and higher FAIlesion (with vs. without ischemia: −71 ± 8 HU vs. −76 ± 9 HU, p < 0.01). Additionally, the CTA-assessed stenosis severity (OR 1.06, 95%CI 1.04–1.08, p < 0.01) and FAIlesion (OR 1.08, 95%CI 1.04–1.12, p < 0.01) were determined to be independent factors that could predict ischemia. The combination model of these two CTA parameters exhibited a diagnostic value similar to the invasive coronary angiography (ICA)-assessed stenosis severity (AUC: 0.820 vs. 0.839, p = 0.39). Conclusion: It was FAIlesion, not general EAT parameters, that was independently associated with abnormal FFR and the diagnostic performance of CTA-assessed stenosis severity for functional ischemia was significantly improved in combination with FAIlesion.
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Affiliation(s)
- Shaowei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xujiao Chen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Kunhua Wang
- Department of Radiology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Jinzhu Yang
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Xie Z, Zhu J, Li W, Liu L, Zhuo K, Yang R, Hu F. Relationship of epicardial fat volume with coronary plaque characteristics, coronary artery calcification score, coronary stenosis, and CT-FFR for lesion-specific ischemia in patients with known or suspected coronary artery disease. Int J Cardiol 2021; 332:8-14. [PMID: 33775790 DOI: 10.1016/j.ijcard.2021.03.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We explored the association of epicardial fat volume (EFV) with coronary plaque characteristics, coronary artery calcification (CAC) score, coronary stenosis, lesion-specific ischemia in patients with known or suspected coronary artery disease (CAD). METHODS 88 controls and 221 patients were analyzed in the study. High-risk plaque was defined as existing≥2 features, including positive remodeling, low attenuation, napkin-ring sign and spotty calcification. EFV, CAC score was measured. The severity of coronary stenosis was quantified using Gensini score. CT-FFR was performed in three major coronary arteries, with a threshold of ≤0.8 considered the presence of ischemia. Univariate and multivariate regression was used to evaluate the association of EFV with CAD, palque characteristics, CAC score, Gensini score, and lesion-specific ischemia derived from CT-FFR. RESULTS Median EFV was 104.97 cm3 (85.47-136.09) in controls and 129.28cm3 (101.19-159.44) in patients (P < 0.001). Logistic regression analysis revealed a significant association of EFV with CAD even after adjusting for confounding factors (P < 0.05). At linear regression analysis, EFV was significantly correlated with high-risk plaque and lesion-specific ischemia, but not with non-calcified plaque, mixed plaque, calcified plaque, CAC score and Gensini score (P ≥ 0.05). CONCLUSION We found that EFV was associated with CAD, suggesting that it may be a promising marker of CAD. EFV was also correlated with high-risk plaque and lesion-specific ischemia, indicating that EAT was likely to be involved in myocardial ischemia and had the potential to definite patients' risk profile.
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Affiliation(s)
- Zhen Xie
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Jing Zhu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Wenjia Li
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Luzhou Liu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Kaimin Zhuo
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Ru Yang
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Fubi Hu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China.
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12
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Vascular-specific epicardial adipose tissue in predicting functional myocardial ischemia for patients with stable chest pain. J Thromb Thrombolysis 2020; 51:915-923. [PMID: 33068280 DOI: 10.1007/s11239-020-02316-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
The relationship between vascular-specific epicardial adipose tissue (vEAT) volume and myocardial ischemia measured by fractional flow reserve (FFR) was not well investigated. Patients with typical and atypical chest pain undergoing coronary computed tomographic angiography scan followed by invasive coronary angiography in combination with FFR examination within one month were retrospectively included. EAT volume and CT attenuation was calculated. The patient with FFR ≤ 0.8 in at least one vessel was referred to as functional ischemia. The mean age of all patients was 61.7 ± 8.9 years and 66.7% of patients were male. There was a significant difference for left anterior descending branch (LAD) vEAT volume between patients with and without functional myocardial ischemia (28.7 ± 10.6 cm3 vs. 23.9 ± 8.7 cm3, p = 0.005). After adjusted by cardiac risk factors and CAD-RADS categories in multivariable logistic regression analysis, LAD-vEAT volume ≥ 24.6 cm3 (OR 3.355, 95% CI 1.546-7.281, p = 0.002) remained an independent predictor of functional ischemia. After adding LAD-vEAT volume ≥ 24.6 cm3 to a prediction model composed with cardiac risk factors and CAD-RADS categories, receiver operating characteristic curve analysis showed significantly improved areas under curve (AUC) for the new model (AUC: 0.795, p = 0.0319) compared with the previous ones. Moreover, the new model revealed significance in net reclassification improvement (NRI: 0.186, p = 0.037). In conclusion, LAD-vEAT volume measurements have incremental predictive performance beyond cardiac risk factors and CAD-RADS categories in identifying significant flow-limit ischemia detected by FFR.
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Du Y, Yang L, Liu Y, Yang B, Lv S, Hu C, Zhu Y, Zhang H, Ma Q, Wang Z, Liu Y, Shi D, Zhao Y, Xu L, Zhou Y. Relation between quantity and quality of peri-coronary epicardial adipose tissue and its underlying hemodynamically significant coronary stenosis. BMC Cardiovasc Disord 2020; 20:226. [PMID: 32414371 PMCID: PMC7227353 DOI: 10.1186/s12872-020-01499-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia. METHODS We enrolled 45 patients (55 lesions) with known or suspected coronary artery disease who underwent coronary computed tomography angiography (CTA) followed by invasive fractional flow reserve (FFR) assessment within 30 days. EAT volume (index) and density in patient-, vessel- and lesion-level were measured on CTA images. Lesion-specific ischemia was defined as a lesion with stenosis diameter > 90% or FFR ≤0.80. Multivariate analysis determined the independent association of EAT parameters with lesion-specific ischemia. RESULTS Mean age of the patients was 60 years, and 75% were male. Overall, 55.6% of patients had ischemic lesions and a mean FFR baseline value of 0.82 ± 0.10. Total EAT volume index was significantly higher in patients with functionally or anatomically significant stenosis. Specifically, peri-lesion EAT volume index, not the density, was positively correlated with lesion-specific ischemia independent of luminal stenosis and plaque characteristics (hazard ratio 1.56, 95% confidence interval 1.04-2.33, P = 0.032; per 0.1 ml/m2 increase). Moreover, peri-lesion EAT volume was negatively correlated with lesion FFR values, whereas total EAT volume was positively correlated with fat accumulation and glucose metabolism. In addition, there was no association of EAT volume or density with myocardial ischemia in vessel-level analysis. CONCLUSIONS Lesion-specific EAT volume index, but not density, seems positively and independently associated with myocardial ischemia, while its incremental diagnostic value of lesion-specific ischemia should be further investigated.
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Affiliation(s)
- Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Lin Yang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, 100029, China
| | - Yan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Bangguo Yang
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, Yunnan, 650000, China
| | - Sai Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Chenping Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yong Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, 100029, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yuyang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China.
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Nerlekar N, Thakur U, Lin A, Koh JQS, Potter E, Liu D, Muthalaly RG, Rashid HN, Cameron JD, Dey D, Wong DTL. The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study. Sci Rep 2020; 10:7109. [PMID: 32346001 PMCID: PMC7188860 DOI: 10.1038/s41598-020-63135-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/04/2020] [Indexed: 12/11/2022] Open
Abstract
Epicardial adipose tissue (EAT) is associated with cardiovascular risk. The longitudinal change in EAT volume (EATv) and density (EATd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (CTCA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (CVRF) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline −76 ± 6 HU vs. −86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. In this select group of patients, EATv consistently increased and EATd consistently decreased at long-term follow-up and these changes were independent of CVRF, age and statin use. Together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that EAT is an independent parameter rather than a surrogate for cardiovascular risk.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Ji Quan Samuel Koh
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Elizabeth Potter
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - David Liu
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul N Rashid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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Madonna R, Massaro M, Scoditti E, Pescetelli I, De Caterina R. The epicardial adipose tissue and the coronary arteries: dangerous liaisons. Cardiovasc Res 2019; 115:1013-1025. [DOI: 10.1093/cvr/cvz062] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/23/2019] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rosalinda Madonna
- Center of Excellence on Aging (CeSI-Met), Institute of Cardiology, ‘G. d’Annunzio’ University, Via L. Polacchi, Chieti Scalo (Chieti), Italy
| | - Marika Massaro
- National Research Council (CNR), Department of Biomedical sciences, Institute of Clinical Physiology, Via Monteroni, Lecce, Italy
| | - Egeria Scoditti
- National Research Council (CNR), Department of Biomedical sciences, Institute of Clinical Physiology, Via Monteroni, Lecce, Italy
| | - Irene Pescetelli
- Center of Excellence on Aging (CeSI-Met), Institute of Cardiology, ‘G. d’Annunzio’ University, Via L. Polacchi, Chieti Scalo (Chieti), Italy
| | - Raffaele De Caterina
- Institute of Cardiology, University of Pisa, C/o Ospedale di Cisanello, Via Paradisa, 2, Pisa, Italy
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16
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Beecy A, Hartaigh BÓ, Schulman-Marcus J, Anchouche K, Gransar H, Al'Aref S, Elmore K, Lin FY, Min JK, Peña JM. Association between epicardial fat volume and fractional flow reserve: An analysis of the determination of fractional flow reserve (DeFACTO) study. Clin Imaging 2018; 51:30-34. [DOI: 10.1016/j.clinimag.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/20/2017] [Accepted: 01/11/2018] [Indexed: 01/01/2023]
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Xu L, Xu Y, Coulden R, Sonnex E, Hrybouski S, Paterson I, Butler C. Comparison of epicardial adipose tissue radiodensity threshold between contrast and non-contrast enhanced computed tomography scans: A cohort study of derivation and validation. Atherosclerosis 2018; 275:74-79. [PMID: 29864608 DOI: 10.1016/j.atherosclerosis.2018.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/19/2018] [Accepted: 05/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Epicardial adipose tissue (EAT) volume derived from contrast enhanced (CE) computed tomography (CT) scans is not well validated. We aim to establish a reliable threshold to accurately quantify EAT volume from CE datasets. METHODS We analyzed EAT volume on paired non-contrast (NC) and CE datasets from 25 patients to derive appropriate Hounsfield (HU) cutpoints to equalize two EAT volume estimates. The gold standard threshold (-190HU, -30HU) was used to assess EAT volume on NC datasets. For CE datasets, EAT volumes were estimated using three previously reported thresholds: (-190HU, -30HU), (-190HU, -15HU), (-175HU, -15HU) and were analyzed by a semi-automated 3D Fat analysis software. Subsequently, we applied a threshold correction to (-190HU, -30HU) based on mean differences in radiodensity between NC and CE images (ΔEATrd = CE radiodensity - NC radiodensity). We then validated our findings on EAT threshold in 21 additional patients with paired CT datasets. RESULTS EAT volume from CE datasets using previously published thresholds consistently underestimated EAT volume from NC dataset standard by a magnitude of 8.2%-19.1%. Using our corrected threshold (-190HU, -3HU) in CE datasets yielded statistically identical EAT volume to NC EAT volume in the validation cohort (186.1 ± 80.3 vs. 185.5 ± 80.1 cm3, Δ = 0.6 cm3, 0.3%, p = 0.374). CONCLUSIONS Estimating EAT volume from contrast enhanced CT scans using a corrected threshold of -190HU, -3HU provided excellent agreement with EAT volume from non-contrast CT scans using a standard threshold of -190HU, -30HU.
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Affiliation(s)
- Lingyu Xu
- Department of Cardiology, Mackenzie Health Science Centre, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada; The second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Yuancheng Xu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Richard Coulden
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Emer Sonnex
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Stanislau Hrybouski
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Paterson
- Department of Cardiology, Mackenzie Health Science Centre, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Craig Butler
- Department of Cardiology, Mackenzie Health Science Centre, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Nerlekar N, Brown AJ, Muthalaly RG, Talman A, Hettige T, Cameron JD, Wong DTL. Association of Epicardial Adipose Tissue and High-Risk Plaque Characteristics: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.117.006379. [PMID: 28838916 PMCID: PMC5586465 DOI: 10.1161/jaha.117.006379] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Epicardial adipose tissue (EAT) is hypothesized to alter atherosclerotic plaque composition, with potential development of high‐risk plaque (HRP). EAT can be measured by volumetric assessment (EAT‐v) or linear thickness (EAT‐t). We performed a systematic review and random‐effects meta‐analysis to assess the association of EAT with HRP and whether this association is dependent on the measurement method used. Methods and Results Electronic databases were systematically searched up to October 2016. Studies reporting HRP by computed tomography or intracoronary imaging and studies measuring EAT‐v or EAT‐t were included. Odds ratios were extracted from multivariable models reporting the association of EAT with HRP and described as pooled estimates with 95% confidence intervals (CIs). Analysis was stratified by EAT measurement method. Nine studies (n=3772 patients) were included with 7 measuring EAT‐v and 2 measuring EAT‐t. Increasing EAT was significantly associated with the presence of HRP (odds ratio: 1.26 [95% CI, 1.11–1.43]; P<0.001). Patients with HRP had higher EAT‐v than those without (weighted mean difference: 28.3 mL [95% CI, 18.8–37.8 mL]; P<0.001). EAT‐v was associated with HRP (odds ratio: 1.19 [95% CI, 1.06–1.33]; P<0.001); however, EAT‐t was not (odds ratio: 3.09 [95% CI, 0.56–17]; P=0.2). Estimates remained significant when adjusted for small‐study effect bias (odds ratio: 1.13 [95% CI, 1.03–1.28]; P=0.04). Conclusions Increasing EAT is associated with the presence of HRP, and patients with HRP have higher quantified EAT‐v. The association of EAT‐v with HRP is significant compared with EAT‐t; however, a larger scale study is still required, and further evaluation is needed to assess whether EAT may be a potential therapeutic target for novel pharmaceutical agents. Clinical Trial Registration URL: https://www.crd.york.ac.uk/. Unique identifier: CRD42017055473.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Andrew Talman
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Thushan Hettige
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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