Determination of Pericardial Adipose Tissue Increases the Prognostic Accuracy of Coronary Artery Calcification for Future Cardiovascular Events

Objectives: Pericardial adipose tissue (PAT) is associated with coronary artery plaque accumulation and the incidence of coronary heart disease. We evaluated the possible incremental prognostic value of PAT for future cardiovascular events. Methods: 145 patients (94 males, age 60 ± 10 years) with stable coronary artery disease underwent coronary artery calcification (CAC) scanning in a multislice CT scanner, and the volume of pericardial fat was measured. Mean observation time was 5.4 years. Results: 34 patients experienced a severe cardiac event. They had a significantly higher CAC score (1,708 ± 2,269 vs. 538 ± 1,150, p < 0.01), and the CAC score was highly correlated with the relative risk of a future cardiac event: 2.4 (1.8–3.7; p = 0.01) for scores >400, 3.5 (1.9–5.4; p = 0.007) for scores >800 and 5.9 (3.7–7.8; p = 0.005) for scores >1,600. When additionally a PAT volume >200 cm3 was determined, there was a significant increase in the event rate and relative risk. We calculated a relative risk of 2.9 (1.9–4.2; p = 0.01) for scores >400, 4.0 (2.1–5.0; p = 0.006) for scores >800 and 7.1 (4.1–10.2; p = 0.005) for scores >1,600. Conclusions: The additional determination of PAT increases the predictive power of CAC for future cardiovascular events. PAT might therefore be used as a further parameter for risk stratification.