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 to check access
We wish to thank Mr. Takeshi Matsumoto, R.T. for his technical support of MDCT procedures.
Compliance with ethical standards
Conflict of interest
There is no conflict of interest.
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.
Mazurek T, Zhang L, Zalewski A et al (2003) Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 108:2460–2466CrossRefPubMedGoogle Scholar
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 29:251–255Google Scholar
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 5:1CrossRefPubMedPubMedCentralGoogle Scholar
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 30:850–856CrossRefPubMedPubMedCentralGoogle Scholar
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 61:1388–1395CrossRefPubMedGoogle Scholar
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 3:352–360CrossRefPubMedPubMedCentralGoogle Scholar
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 16:1264–1269CrossRefPubMedGoogle Scholar
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 102:380–385CrossRefPubMedGoogle Scholar
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 102:1602–1607CrossRefPubMedGoogle Scholar
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:e002676CrossRefPubMedPubMedCentralGoogle Scholar
Taguchi R, Takasu J, Itani Y et al (2001) Pericardial fat accumulation in men as a risk factor for coronary artery disease. Atherosclerosis 157:203–209CrossRefPubMedGoogle Scholar
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 40:97–101CrossRefPubMedGoogle Scholar
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 57:417–422CrossRefGoogle Scholar
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 197:896–903CrossRefPubMedGoogle Scholar
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 15:827–832CrossRefPubMedGoogle Scholar
Motoyama S, Kondo T, Sarai M et al (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50:319–326CrossRefPubMedGoogle Scholar
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 6:448–457CrossRefPubMedGoogle Scholar
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 34:166–171CrossRefPubMedGoogle Scholar
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 32:1012–1024CrossRefPubMedGoogle Scholar
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 64:1641–1654CrossRefPubMedGoogle Scholar
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 117:605–613CrossRefGoogle Scholar
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 29:777–783CrossRefPubMedGoogle Scholar
Bettencourt N, Toschke AM, Leite D et al (2012) Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden. Int J Cardiol 158:26–32CrossRefPubMedGoogle Scholar
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) 21:1056–1063CrossRefGoogle Scholar
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 73:1927–1933CrossRefPubMedGoogle Scholar
Alexopoulos N, McLean DS, Janik M, Arepalli CD, Stillman AE, Raggi P (2010) Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis 210:150–154CrossRefPubMedGoogle Scholar
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 161:45–49CrossRefPubMedGoogle Scholar
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 54:49–57CrossRefPubMedGoogle Scholar
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 7:125–132CrossRefPubMedPubMedCentralGoogle Scholar