Subcutaneous, Paracardiac, and Epicardial Fat CT Density Before/After Contrast Injection: Any Correlation with CAD?

Adipose tissue, in particular epicardial adipose tissue, has been identified as a potential biomarker of cardiovascular pathologies such as coronary artery disease (CAD) in the light of its metabolic activity and close anatomic and pathophysiologic relationship to the heart. Our purpose was to evaluate epicardial adipose tissue density at both unenhanced and contrast-enhanced computed tomography (CT), along with CT densities of paracardiac and subcutaneous adipose tissue, as well as the relations of such densities with CAD. We retrospectively reviewed patients who underwent cardiac CT at our institution for CAD assessment. We segmented regions of interest on epicardial, paracardiac, and subcutaneous adipose tissue on unenhanced and contrast-enhanced scans. A total of 480 patients were included, 164 of them presenting with CAD. Median epicardial adipose tissue density measured on contrast-enhanced scans (−81.5 HU; interquartile range −84.9 to −78.0) was higher than that measured on unenhanced scans (−73.4 HU; −76.9 to −69.4) (p < 0.001), whereas paracardiac and subcutaneous adipose tissue densities were not (p ≥ 0.055). Patients with or without CAD, did not show significant differences in density of epicardial, paracardiac, and subcutaneous adipose tissue either on unenhanced or contrast-enhanced scans (p ≥ 0.092). CAD patients may experience different phenomena (inflammation, fibrosis, increase in adipose depots) leading to rises or drops in epicardial adipose tissue density, resulting in variations that are difficult to detect.

[1]  F. Sardanelli,et al.  Epicardial Fat Inflammation in Severe COVID‐19 , 2020, Obesity.

[2]  P. Rossing,et al.  Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes? , 2020, Therapeutic advances in endocrinology and metabolism.

[3]  The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study , 2020, Scientific Reports.

[4]  J. González-Juanatey,et al.  Myocardium Metabolism in Physiological and Pathophysiological States: Implications of Epicardial Adipose Tissue and Potential Therapeutic Targets , 2020, International journal of molecular sciences.

[5]  Francesco Sardanelli,et al.  Statistical significance: p value, 0.05 threshold, and applications to radiomics—reasons for a conservative approach , 2020, European Radiology Experimental.

[6]  A. Stillman,et al.  Novel imaging biomarkers: epicardial adipose tissue evaluation. , 2019, The British journal of radiology.

[7]  O. Barbarash,et al.  Adipocytes Directly Affect Coronary Artery Disease Pathogenesis via Induction of Adipokine and Cytokine Imbalances , 2019, Front. Immunol..

[8]  M. Jensen,et al.  Epicardial adipose tissue predicts incident cardiovascular disease and mortality in patients with type 2 diabetes , 2019, Cardiovascular Diabetology.

[9]  C. Stamm,et al.  Association of epicardial adipose tissue attenuation with coronary atherosclerosis in patients with a high risk of coronary artery disease. , 2019, Atherosclerosis.

[10]  Filippo Cademartiri,et al.  Quantification of epicardial fat with cardiac CT angiography and association with cardiovascular risk factors in symptomatic patients: from the ALTER-BIO (Alternative Cardiovascular Bio-Imaging markers) registry. , 2019, Diagnostic and interventional radiology.

[11]  F. Sardanelli,et al.  Epicardial adipose tissue volume in patients with coronary artery disease or non-ischaemic dilated cardiomyopathy: evaluation with cardiac magnetic resonance imaging. , 2019, Clinical radiology.

[12]  Massimo Bellomi,et al.  Radiomics: the facts and the challenges of image analysis , 2018, European Radiology Experimental.

[13]  P. Sanders,et al.  Unique role of epicardial adipose tissue in atrial fibrosis: "Atrial remodeling of a new sort". , 2018, Heart rhythm.

[14]  M. Forsting,et al.  Pericoronary fat volume but not attenuation differentiates culprit lesions in patients with myocardial infarction. , 2018, Atherosclerosis.

[15]  S. Kajimura,et al.  The Common and Distinct Features of Brown and Beige Adipocytes , 2018, Trends in Endocrinology & Metabolism.

[16]  Xi Chen,et al.  Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. , 2017, Journal of cardiovascular computed tomography.

[17]  M. Forsting,et al.  Cardiac computed tomography-derived epicardial fat volume and attenuation independently distinguish patients with and without myocardial infarction , 2017, PloS one.

[18]  Relation of Epicardial Adipose Tissue Radiodensity to Coronary Artery Calcium on Cardiac Computed Tomography in Patients at High Risk for Cardiovascular Disease. , 2017, The American journal of cardiology.

[19]  H. Sacks,et al.  ‘Browning’ the cardiac and peri-vascular adipose tissues to modulate cardiovascular risk , 2017, International journal of cardiology.

[20]  Michael T. Lu,et al.  Epicardial and paracardial adipose tissue volume and attenuation - Association with high-risk coronary plaque on computed tomographic angiography in the ROMICAT II trial. , 2016, Atherosclerosis.

[21]  Filippo Cademartiri,et al.  Quantification of epicardial adipose tissue in coronary calcium score and CT coronary angiography image data sets: comparison of attenuation values, thickness and volumes. , 2016, The British journal of radiology.

[22]  Demetri Terzopoulos,et al.  Epicardial adipose tissue volume but not density is an independent predictor for myocardial ischemia. , 2016, Journal of cardiovascular computed tomography.

[23]  Peter J. Psaltis,et al.  Epicardial adipose tissue: far more than a fat depot. , 2014, Cardiovascular diagnosis and therapy.

[24]  C. Fox,et al.  Association of Fat Density With Subclinical Atherosclerosis , 2014, Journal of the American Heart Association.

[25]  Russell S. Kirby,et al.  Designing Clinical Research , 2014 .

[26]  M. Szklo,et al.  Pericardial adipose tissue and coronary artery calcification in The Multi-Ethnic Study of Atherosclerosis (MESA) , 2012, Obesity.

[27]  G. Iacobellis,et al.  [Epicardial adipose tissue: more than a simple fat deposit?]. , 2013, Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion.

[28]  Milan Sonka,et al.  3D Slicer as an image computing platform for the Quantitative Imaging Network. , 2012, Magnetic resonance imaging.