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Association between epicardial adipose tissue density and characteristics of coronary plaques assessed by coronary computed tomographic angiography

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To investigate the relationship between the epicardial adipose tissue density (EATD) and the coronary plaque components as assessed by coronary computed tomographic angiography (CCTA). The study cohort included 240 patients with chest pain or precardiac discomfort (mean age 62.01 ± 7.45 years, 55.83% male). Patients were assigned to the high-risk plaque (HRP) group (n = 133) or non-HRP group (n = 107). All patients underwent CCTA to assess plaque composition, and quantitative analysis of EATD and epicardial adipose tissue volume (EATV). Age, gender, EATV, EATD, diabetes history and family history were all correlated with HRP. There was no linear correlation between EATD and EATV among the subjects (R2 = 0.008, p = 0.177), but there was a curvilinear correlation (R2 = 0.102, p < 0.001). After adjusting other traditional factors, and we observed robust associations of EAT volume and density with HRP (all p < 0.05). For per 1 standard deviation increase in EATD, the risk of HRP was 3.120 times the risk than that of non-HRP. For per 1 standard deviation increase in EATV, the risk of HRP was 1.499 times the risk than that of non-HRP. The receiver operating characteristic curve showed that EATD was more predictive of HRP than EATV (AUC = 0.761, 95% CI 0.701–0.822). Our study found that EATD and EATV are both independent factors affecting the presence of HRPs, and EATD had a high predictive value for the presence of HRP.

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  1. Libby P (2021) Inflammation in atherosclerosis-no longer a theory. Clin Chem 67(1):131–142

    Article  Google Scholar 

  2. Tunon J, Badimon L, Bochaton-Piallat ML et al (2019) Identifying the anti-inflammatory response to lipid lowering therapy. A position paper from the working group on atherosclerosis and vascular Biology of the European Society of Cardiology. Cardiovasc Res 115:10–19

    Article  CAS  Google Scholar 

  3. Martelli A, Citi V, Calderone V (2021) Recent efforts in drug discovery on vascular inflammation and consequent atherosclerosis. Expert Opin Drug Discov 16(4):411–427

    Article  CAS  Google Scholar 

  4. Ito H, Wakatsuki T, Yamaguchi K et al (2020) Atherosclerotic coronary plaque is associated with adventitial vasa vasorum and local inflammation in adjacent epicardial adipose tissue in fresh cadavers. Circ J 84(5):769–775

    Article  CAS  Google Scholar 

  5. Conceição G, Martins D, Miranda MI et al (2020) Unraveling the role of epicardial adipose tissue in coronary artery disease: partners in crime? Int J Mol Sci 21(22):8866

    Article  Google Scholar 

  6. Scheja L, Heeren J (2019) The endocrine function of adipose tissues in health and cardiometabolic disease. Nat Rev Endocrinol 15(9):507–524

    Article  CAS  Google Scholar 

  7. Berg G, Miksztowicz V, Morales C et al (2019) Epicardial adipose tissue in cardiovascular disease. Adv Exp Med Biol 1127:131–143

    Article  CAS  Google Scholar 

  8. Goeller M, Tamarappoo BK, Kwan AC et al (2019) Relationship between changes in pericoronary adipose tissue attenuation and coronary plaque burden quantified from coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 20(6):636–643

    Article  Google Scholar 

  9. Uretsky S, Aldaia L (2020) It’s all about the inflammation. J Am Heart Assoc 9(17):e018073

    Article  Google Scholar 

  10. Katus H, Ziegler A, Ekinci O et al (2017) Early diagnosis of acute coronary syndrome. Eur Heart J 38(41):3049–3055

    Article  CAS  Google Scholar 

  11. Knuuti J, Wijns W, Saraste A et al (2020) 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 41(3):407–477

    Article  Google Scholar 

  12. Ferencik M, Mayrhofer T, Bittner DO et al (2018) Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the PROMISE randomized clinical trial. JAMA Cardiol 3(2):144–152

    Article  Google Scholar 

  13. Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U (2014) Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol 11(7):390–402

    Article  Google Scholar 

  14. Maurovich-Horvat P, Schlett CL, Alkadhi H et al (2012) The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. J Am Coll Cardiol Imaging 5:1243–1252

    Article  Google Scholar 

  15. Lin A, Dey D, Wong DTL et al (2019) Perivascular adipose tissue and coronary atherosclerosis: from biology to imaging phenotyping. Curr Atheroscler Rep 21(12):47

    Article  Google Scholar 

  16. Eisenberg E, McElhinney PA, Commandeur F et al (2020) Deep learning-based quantification of epicardial adipose tissue volume and attenuation predicts major adverse cardiovascular events in asymptomatic subjects. Circ Cardiovasc Imaging 13(2):e009829

    Article  Google Scholar 

  17. Senoo A, Kitagawa T, Torimaki S et al (2018) Association between histological features of epicardial adipose tissue and coronary plaque characteristics on computed tomography angiography. Heart Vessels 33(8):827–836

    Article  Google Scholar 

  18. Hwang IC, Park HE, Choi SY (2017) Epicardial adipose tissue contributes to the development of non-calcified coronary plaque: a 5-year computed tomography follow-up study. J Atheroscler Thromb 24(3):262–274

    Article  Google Scholar 

  19. Nerlekar N, Brown AJ, Muthalaly RG et al (2017) Association of epicardial adipose tissue and high-risk plaque characteristics: a systematic review and meta-analysis. J Am Heart Assoc 6(8):e006379

    Article  Google Scholar 

  20. Raggi P, Gadiyaram V, Zhang C et al (2019) Statins reduce epicardial adipose tissue attenuation independent of lipid lowering: a potential pleiotropic effect. J Am Heart Assoc 8(12):e013104

    Article  CAS  Google Scholar 

  21. Oikonomou EK, Marwan M, Desai MY et al (2018) Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 392:929–939

    Article  Google Scholar 

  22. Antonopoulos AS, Sanna F, Sabharwal N et al (2017) Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med 9(398):eaal2658

    Article  Google Scholar 

  23. Mahabadi AA, Rassaf T (2018) Thoracic adipose tissue density as a novel marker of increased cardiovascular risk. Atherosclerosis 279:91–92

    Article  CAS  Google Scholar 

  24. Liu Z, Wang S, Wang Y et al (2019) Association of epicardial adipose tissue attenuation with coronary atherosclerosis in patients with a high risk of coronary artery disease. Atherosclerosis 284:230–236

    Article  CAS  Google Scholar 

  25. Kitagawa T, Nakamoto Y, Fujii Y et al (2020) Relationship between coronary arterial 18F-sodium fluoride uptake and epicardial adipose tissue analyzed using computed tomography. Eur J Nucl Med Mol Imaging 7:1746–1756

    Article  Google Scholar 

  26. Franssens BT, Nathoe HM, Leiner T et al (2017) Relation between cardiovascular disease risk factors and epicardial adipose tissue density on cardiac computed tomography in patients at high risk of cardiovascular events. Eur J Prev Cardiol 24(6):660–670

    Article  Google Scholar 

  27. Goeller M, Achenbach S, Marwan M et al (2018) Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. J Cardiovasc Comput Tomogr 12(1):67–73

    Article  Google Scholar 

  28. Mahabadi AA, Balcer B, Dykun I et al (2017) Cardiac computed tomography-derived epicardial fat volume and attenuation independently distinguish patients with and without myocardial infarction. PLoS ONE 12:e0183514

    Article  Google Scholar 

  29. Aitken-Buck HM, Moharram M, Babakr AA et al (2019) Relationship between epicardial adipose tissue thickness and epicardial adipocyte size with increasing body mass index. Adipocyte 8(1):412–420

    Article  CAS  Google Scholar 

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Correspondence to Huaijun Liu.

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The study protocol was approved by the Ethics Committee of the Second Hospital of Hebei Medical University and conducted in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards for studies involving human participants. Written informed consent was obtained from all patients prior to inclusion in this study.

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Gao, Z., Zuo, Y., Jia, L. et al. Association between epicardial adipose tissue density and characteristics of coronary plaques assessed by coronary computed tomographic angiography. Int J Cardiovasc Imaging 38, 673–681 (2022).

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