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Epicardial Fat Volume as a Good Predictor for Multivessel Coronary Artery Disease

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Epicardial adipose tissue may have an important role in the pathogenesis of coronary artery disease (CAD).


We aimed to study the association between epicardial fat volume (EFV) and presence of obstructive as well as multivessel CAD.


A total of 87 adult subjects with suspected CAD who underwent both quantified by multidetector computerized tomography (MDCT) and Invasive Coronary Angiography (ICA) were enrolled in this observational study. EVF was measured by MDCT by calculating the sum of cross- sectional areas of fat multiplied by slice thickness. EFV measurement and its association with the presence of obstructive CAD (defined as coronary artery stenosis > 70%) was evaluated.


Overall, 89.6% patients had obstructive CAD with higher EFV as compared to 10.3% patients with non-obstructive CAD (57 ± 20.14 cm3 vs. 44 ± 7.4 cm3; P < 0.001). Furthermore, EFV was significantly increased in group II as compared with group I (74 ± 24.3 ml vs. 53 ± 16.2 ml; P < 0.003). On the hand, the coronary calcium score (CAC) was insignificantly increased in group II as compared with group I (486.1 vs. 211.2; P = 0.10). Multivariate analysis revealed that, EFV might be an independent risk factor for not only the presence of obstructive CAD (odds ratio [OR], 1.062; 95% CI 1.018– 1.108; P < 0.005) but also in predicting multivessel disease affection.


Our results demonstrated that, EFV was significantly increased not only with obstructive CAD, independent of other traditional risk factors and CAC score, but also it can be considered a good predictor of multivessel disease occurrence.

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  1. Zheng X, Curtis JP, Hu S, Wang Y, Yang Y, Masoudi FA, et al. Coronary catheterization and percutaneous coronary intervention in China: 10- year results from the China PEACE- retrospective CathPCI study. JAMA Intern Med. 2016;176:512–21.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gabriela B, Miksztowicz V, Morales C, Barchuk M. Epicardial adipose tissue in cardiovascular disease. Adv Exp Med Biol. 2019;1127:131–43.

    Article  Google Scholar 

  3. Monti CB, Codari M, de Cecco CN, Secchi F, Sardanelli F, Stillman AE. Novel imaging biomarkers: epicardial adipose tissue evaluation. Br J Radiol. 2020;93:20190770.

    Article  PubMed  Google Scholar 

  4. Corradi D, Maestri R, Callegari S. The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts. Cardio vasc Pathol. 2004;13(6):313–6.

    Article  Google Scholar 

  5. Moore KL, Persaud TVN. The developing human. Clinically oriented embryology. 7th ed. Philadelphia (PA): WB Saunders; 2003.

    Google Scholar 

  6. Vishal V, Blythe H, Wood EG, Sandhar B, Sarker SJ, Balmforth D, et al. Obesity and diabetes are major risk factors for epicardial adipose tissue inflammation. JCI Insight. 2021;6:16.

    Google Scholar 

  7. McLaughlin T, Schnittger I, Nagy A, Zanley E, Xu Y, Song Y, et al. Relationship between coronary atheroma, epicardial adipose tissue inflammation, and adipocyte differentiation across the human myocardial bridge. J Am Heart Assoc. 2021;10:e021003 [CrossRef].

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Gruzdeva OV, Dyleva YA, Belik EV, Sinitsky MY, Stase AN, Kokov AN, et al. Relationship between epicardial and coronary adipose tissue and the expression of adiponectin, leptin, and interleukin 6 in patients with coronary artery disease. J Pers Med. 2022;12:129 [CrossRef].

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sacks HS, Fain JN. Human epicardial adipose tissue: a review. Am Heart J. 2007;153:907–17.

    Article  CAS  PubMed  Google Scholar 

  10. Sade LE, Eroglu S, Bozbaş H, Ozbiçer S, Hayran M, Haberal A, et al. Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. Atherosclerosis. 2009;204:580–5.

    Article  CAS  PubMed  Google Scholar 

  11. Sacks HS, Fain JN, Cheema P, Bahouth SW, Garrett E, Wolf RY, et al. Inflammatory genes in epicardial fat contiguous with coronary atherosclerosis in the metabolic syndrome and type2 diabetes: changes associated with pioglitazone. Diabetes Care. 2011;34:730–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ayton SL, Gulsin GS, McCann GP, Moss AJ. Epicardial adipose tissue in obesity-related cardiac dysfunction. Heart. 2022;108:339–44 [CrossRef] [PubMed].

    Article  CAS  PubMed  Google Scholar 

  13. Konwerski MG, Asecka A, Opolski G, Grabowski M, Mazurek T. Role of epicardial adipose tissue in cardiovascular diseases: a review. Biology. 2022;11:355 [CrossRef] [PubMed].

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Fitzgibbons TP, Czech MP. Epicardial and perivascular adipose tissues and their influence on cardiovascular disease: basic mechanisms and clinical associations. J Am Heart Assoc. 2014;3:e000582.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hirata Y, Tabata M, Kurobe H, Motoki T, Akaike M, Nishio C, et al. Coronary atherosclerosis is associated with macrophage polarization in epicardial adipose tissue. J Am Coll Cardiol. 2011;58:248–55.

    Article  CAS  PubMed  Google Scholar 

  16. Paolo Raggi S, Zona R, Scaglioni C, Stentarelli G, Ligabue G, Besutti, et al. Epicardial adipose tissue and coronary artery calcium predict incident myocardial infarction and death in HIV-infected patients. J Cardiovasc Comput Tomogr. 2015;9(6):553–8.

    Article  PubMed  Google Scholar 

  17. You S, Sun JS, Park SY, Baek Y, Kang DK. Relationship between indexed epicardial fat volume and coronary plaque volume assessed by cardiac multidetector CT. Med. 2016;95(27):e4164.

    Article  Google Scholar 

  18. Iwasaki K, Urabe N, Kitagawa A, Nagao T. The association of epicardial fat volume with coronary characteristics and clinical outcome. Int J Cardiovasc Imaging. 2018;34(2):301–9.

    Article  PubMed  Google Scholar 

  19. Bettencourt N, Toschke AM, Leite D, Rocha J, Carvalho M, Sampaio F, et al. Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden. Int J Cardiol. 2012;158:26–32.

    Article  CAS  PubMed  Google Scholar 

  20. Guglielmo M, Lin A, Dey D, Baggiano A, Fusini L, Muscogiuri G, Pontone G. Epicardial fat and coronary artery disease: role of cardiac imaging. Atherosclerosis. 2021;321:30–8 [CrossRef].

    Article  CAS  PubMed  Google Scholar 

  21. Ouwens DM, Sell H, Greulich S, Eckel J. The role of epicardial and perivascular adipose tissue in the pathophysiology of cardiovascular disease. J Cell Mol Med. 2010;14:2223–34.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Talman AH, Psaltis PJ, Cameron JD, Meredith IT, Seneviratne SK, Wong DT. Epicardial adipose tissue: far more than a fat depot. Cardiovasc Diagn Ther. 2014;4:416–29.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Oka T, Yamamoto H, Ohashi N, Kitagawa T, Kunita E, Utsunomiya H, et al. Association between epicardial adipose tissue volume and characteristics of non-calcified plaques assessed by coronary computed tomographic angiography. Int J Cardiol. 2012;161:45–9.

    Article  PubMed  Google Scholar 

  24. Ito T, Suzuki Y, Ehara M, Matsuo H, Teramoto T, Terashima M, et al. Impact of epicardial fat volume on coronary artery disease in symptomatic patients with a zero calcium score. Int J Cardiol. 2013;167:2852–8.

    Article  PubMed  Google Scholar 

  25. Huang G, Wang D, Zeb I, Budoff MJ, Harman SM, Miller V, et al. Intra- thoracic fat, cardiometabolic risk factors, and subclinical cardiovascular disease in healthy, recently menopausal women screened for the Kronos early estrogen prevention study (KEEPS). Atherosclerosis. 2012;221:198–205.

    Article  CAS  PubMed  Google Scholar 

  26. Mahaisavariya P, Detrano R, Kang X, Garner D, Vo A, Georgiou D, et al. Quantitation of in vitro coronary artery calcium using ultrafast computed tomography. Cathet Cardiovasc Diagn. 1994;32:387–93.

    Article  CAS  PubMed  Google Scholar 

  27. van Lennep HWOR, Westerveld HT, Zwinderman AH, van Lennep JER, Bruins Slot H, Erkelens DW, et al. Differential effect of female gender on coronary artery disease and peripheral artery disease. Neth Heart J. 2002;10(12):500–5.

    PubMed  PubMed Central  Google Scholar 

  28. Khurana R, Yadav A, Buxi TBS, Sawhney JPS, Rawat KS, Samarjit S, Ghuman. Correlation of epicardial fat quantification with severity of coronary artery disease: a study in indian population. Indian Heart J. 2018;70(Suppl 3):140-S145.

    Article  Google Scholar 

  29. Sinha SK, Thakur R, Jha MJ, Goel A, Kumar V, Kumar A, et al. Epicardial adipose tissue thickness and its association with the presence and severity of coronary artery disease in clinical setting: a cross-sectional observational study. J Clin Med Res. 2016;8:410–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Betancur J, Commandeur F, Motlagh M, Sharir T, Einstein AJ, Bokhari S, et al. Deep learning for prediction of obstructive disease from fast myocardial perfusion SPECT: a multicenter study. JACC Cardiovasc Imaging. 2018;11:1654–63.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Alexopoulos N, McLean DS, Janik M, Arepalli CD, Stillman AE, Raggi P. Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis. 2010;210:150–4.

    Article  CAS  PubMed  Google Scholar 

  32. Rajani R, Haim Shmilovich R, Nakazato R, Nakanishi Y, Otaki VY, Cheng, et al. Features assessed by coronary CT angiography. J Cardiovasc Comput Tomogr. 2013;7(2):125–32.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Aslanabadi N, Salehi R, Tarzamni M, Javadrashid A, et al. Epicardial and pericardial fat volume correlate with the severity of coronary artery stenosis. J Cardiovasc Thorac Res. 2014;6(4):235–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Djaberi R, Schuijf JD, van Werkhoven JM. Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol. 2008;102:1602–7.

    Article  PubMed  Google Scholar 

  35. Tanami Y, Jinzaki M, Kishi S, Matheson M, Vavere AL, Rochitte CE, et al. 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. 2015;8:e002676.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cheng VY, Dey D, Tamarappoo B, Nakazato R, Gransar H, Miranda- Peats R, et al. Pericardial fat burden on ECG- gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events. JACC Cardiovasc Imaging. 2010;3:352–60.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Harada K, Amano T, Uetani T, et al. Cardiac 64-multislice computed tomography reveals increased epicardial fat volume in patients with acute coronary syndrome. Am J Cardiol. 2011;108:1119–23.

    Article  PubMed  Google Scholar 

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Correspondence to Eman S. EL Shahawy.

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EL Shahawy, E.S., Hassan, A.A. & EL Shahawy, M.S. Epicardial Fat Volume as a Good Predictor for Multivessel Coronary Artery Disease. High Blood Press Cardiovasc Prev 30, 427–434 (2023).

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