Abstract
Objective
To evaluate the frequency and common locations of myocardial fat and its associated factors using coronary CT angiography (CCTA) in patients without cardiac disease.
Methods
Using CCTA findings for 298 consecutive patients without cardiac disease, we categorized the myocardium into nine locations, scored fat in those locations, and correlated the fat score with the thickness of the right ventricular (RV) free wall and factors including gender, age, and body mass index (BMI) as well as history of diabetes mellitus, hypertension (HT), and dyslipidemia.
Results
We observed myocardial fat in 68.5 % of patients, most commonly in the RV outflow tract (RVOT, 64.1 %), followed by the base (42.3 %) and middle (28.9 %) of the RV free wall, RV trabeculations (22.5 %), and the left ventricular apex (11.4 %). The RV free wall thickened significantly with increasing fat score. Dependent variables for myocardial fat were female gender (P < 0.0001), age ≥65 years (P = 0.0043), BMI ≥25 (P = 0.0050), and HT (P = 0.0139).
Conclusion
Myocardial fat is a common finding on CCTA in patients without cardiac disease, is often observed in the RVOT, and is more frequent in female patients, those older than 65 years, those with BMI ≥25, and those with HT.
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References
Hamada S, Takamiya M, Ohe T, Ueda H. Arrhythmogenic right ventricular dysplasia: evaluation with electron-beam CT. Radiology. 1993;187:723–7.
Winkens MH, Snoep G, Bekkers SC. Images in cardiovascular medicine: imaging of arrhythmogenic right ventricular cardiomyopathy. Circulation. 2008;118:e158–9.
Kimura F, Sakai F, Sakomura Y, et al. Helical CT features of arrhythmogenic right ventricular cardiomyopathy. Radiographics. 2002;22:1111–24.
Tandri H, Bomma C, Calkins H, Bluemke DA. Magnetic resonance and computed tomography imaging of arrhythmogenic right ventricular dysplasia. J Magn Reson Imaging. 2004;19:848–58.
Corrado D, Basso C, Thiene G, et al. Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol. 1997;30:1512–20.
d’Amati G, Leone O, di Gioia CR, et al. Arrhythmogenic right ventricular cardiomyopathy: clinicopathologic correlation based on a revised definition of pathologic patterns. Hum Pathol. 2001;32:1078–86.
Winer-Muram HT, Tann M, Aisen AM, Ford L, Jennings SG, Bretz R. Computed tomography demonstration of lipomatous metaplasia of the left ventricle following myocardial infarction. J Comput Assist Tomogr. 2004;28:455–8.
Ahn SS, Kim YJ, Hur J, et al. CT detection of subendocardial fat in myocardial infarction. AJR Am J Roentgenol. 2009;192:532–7.
Ichikawa Y, Kitagawa K, Chino S, et al. Adipose tissue detected by multislice computed tomography in patients after myocardial infarction. JACC Cardiovasc Imaging. 2009;2:548–55.
Zafar HM, Litt HI, Torigian DA. CT imaging features and frequency of left ventricular myocardial fat in patients with CT findings of chronic left ventricular myocardial infarction. Clin Radiol. 2008;63:256–62.
Baroldi G, Silver MD, De Maria R, Parodi O, Pellegrini A. Lipomatous metaplasia in left ventricular scar. Can J Cardiol. 1997;13:65–71.
Sanal HT, Kocaoğlu M, Yildirim D, Ors F. Multiple cardiac lipomas and pericardial lipomatosis: multidetector-row computer tomography findings. Int J Cardiovasc Imaging. 2007;23:655–8.
Sparrow PJ, Kurian JB, Jones TR, Sivananthan MU. MR imaging of cardiac tumors. Radiographics. 2005;25:1255–76.
Meaney JF, Kazerooni EA, Jamadar DA, Korobkin M. CT appearance of lipomatous hypertrophy of the interatrial septum. AJR Am J Roentgenol. 1997;168:1081–4.
Adriaensen ME, Schaefer-Prokop CM, Duyndam DA, Zonnenberg BA, Prokop M. Fatty foci in the myocardium in patients with tuberous sclerosis complex: common finding at CT. Radiology. 2009;253:359–63.
Perloff JK, de Leon AC, O’Doherty D Jr. The cardiomyopathy of progressive muscular dystrophy. Circulation. 1966;33:625–48.
Hunter S. The heart in muscular dystrophy. Br Med Bull. 1980;36:133–4.
Kaminaga T, Naito H, Takamiya M, Hamada S, Nishimura T. Myocardial damage in patients with dilated cardiomyopathy: CT evaluation. J Comput Assist Tomogr. 1994;18:393–7.
Rakar S, Sinagra G, Di Lenarda A, et al. Epidemiology of dilated cardiomyopathy: a prospective post-mortem study of 5252 necropsies. The Heart Muscle Disease Study Group. Eur Heart J. 1997;18:117–23.
Tansey DK, Aly Z, Sheppard MN. Fat in the right ventricle of the normal heart. Histopathology. 2005;46:98–104.
Lorin de la Grandmaison G, Le Bihan C, Durigon M. Assessment of right ventricular lipomatosis by histomorphometry in control adult autopsy cases. Int J Legal Med. 2001;115:105–8.
Basso C, Thiene G. Adipositascordis, fatty infiltration of the right ventricle, and arrhythmogenic right ventricular cardiomyopathy: Just a matter of fat? Cardiovasc Pathol. 2005;14:37–41.
Burke AP, Farb A, Tashko G, Virmani R. Arrhythmogenic right ventricular cardiomyopathy and fatty replacement of the right ventricular myocardium: are they different diseases? Circulation. 1998;97:1571–80.
Kim E, Choe YH, Han BK, et al. Right ventricular fat infiltration in asymptomatic subjects: observations from ECG-gated 16-slice multidetector CT. J Comput Assist Tomogr. 2007;31:22–8.
Imada M, Funabashi N, Asano M, et al. Epidemiology of fat replacement of the right ventricular myocardium determined by multislice computed tomography using a logistic regression model. Int J Cardiol. 2007;119:410–3.
Kirsch J, Williamson EE, Glockner JF. Focal macroscopic fat deposition within the right ventricular wall in asymptomatic patients undergoing screening EBCT coronary calcium scoring examinations. Int J Cardiovasc Imaging. 2008;24:223–7.
Abbara S, Arbab-Zadeh A, Callister TQ, et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2009;3:190–204.
Jacobi AH, Gohari A, Zalta B, Stein MW, Haramati LB. Ventricular myocardial fat: CT findings and clinical correlates. J Thorac Imaging. 2007;22:130–5.
Kimura F, Matsuo Y, Nakajima T, et al. Myocardial fat at cardiac CT: how can we differentiate pathologic from physiologic fatty infiltration? Radiographics. 2010;30:1587–602.
Su L, Siegel JE, Fishbein MC. Adipose tissue in myocardial infarction. Cardiovasc Pathol. 2004;13:98–102.
Goldfarb JW, Roth M, Han J. Myocardial fat deposition after left ventricular myocardial infarction: assessment by using MR water-fat separation imaging. Radiology. 2009;253:65–73.
Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56:1864–94.
Acknowledgments
We thank Mr. Shin Takahashi for his assistance with statistical analysis and Ms. Rosalyn Uhrig for her English proofreading.
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The authors declare that they have no conflict of interest.
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Matsuo, Y., Kimura, F., Nakajima, T. et al. CT features of myocardial fat and correlation with clinical background in patients without cardiac disease. Jpn J Radiol 31, 444–454 (2013). https://doi.org/10.1007/s11604-013-0212-x
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DOI: https://doi.org/10.1007/s11604-013-0212-x