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Incremental value of epicardial fat volume to coronary artery calcium score and traditional risk factors for predicting myocardial ischemia in patients with suspected coronary artery disease

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Epicardial fat volume (EFV) has been reported to be associated with coronary artery disease (CAD). CAD is the leading cause of myocardial ischemia and myocardial ischemia is closely related to major adverse cardiovascular events. We hypothesized that EFV could provide incremental value to traditional risk factors and coronary artery calcium score (CACS) in predicting myocardial ischemia in Chinese patients with suspected CAD.

Methods

We retrospectively studied 204 Chinese patients with suspected CAD who underwent single-photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) combined with computed tomography (CT). Pericardial contours were manually defined, and EFV was automatically calculated. A reversible perfusion defect with summed difference score (SDS) ≥ 2 was defined as myocardial ischemia.

Results

The myocardial ischemia group had higher EFV than normal MPI group (137.80 ± 34.95cm3 vs. 106.63 ± 29.10 cm3, P < .001). In multivariable logistic regression analysis, high EFV was significantly associated with myocardial ischemia [odds ratio (OR): 8.30, 95% CI: 3.72-18.49, P < .001]. Addition of EFV to CACS and traditional risk factors could predict myocardial ischemia more effectively, with larger AUC .82 (P < .001), positive net reclassification index .14 (P = .04) and integrated discrimination improvement .14 (P < .001). The bootstrap resampling method (times = 500) was used to internally validation and calculate the 95% confidence interval (CI) of the AUC (95% CI .75-.87). The calibration curve for the probability of myocardial ischemia demonstrated good agreement between prediction and observation.

Conclusions

In Chinese patients with suspected CAD, EFV was significantly associated with myocardial ischemia, and improved prediction of myocardial ischemia above traditional risk factors and CACS.

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Abbreviations

EAT:

Epicardial adipose tissue

EFV:

Epicardial fat volume

CACS:

Coronary artery calcium score

99mTc-MIBI:

99MTechnetium-sestamibi

SPECT:

Single-photon emission computerized tomography

MPI:

Myocardial perfusion imaging

CT:

Computed tomography

CAD:

Coronary artery disease

SSS:

Summed stress score

SRS:

Summed rest score

SDS:

Summed difference score

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Disclosure

The authors have indicated they have no financial conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China

    Wenji Yu MD, Feifei Zhang MD, Bao Liu MD, Jianfeng Wang MD, Xiaoliang Shao MD, Yunmei Shi MD, Bing Wang MD, Yiduo Xu MD & Yuetao Wang MD

  2. Changzhou Key Laboratory of Molecular Image, Changzhou, Jiangsu Province, China

    Wenji Yu MD, Feifei Zhang MD, Bao Liu MD, Jianfeng Wang MD, Xiaoliang Shao MD, Yunmei Shi MD, Bing Wang MD, Yiduo Xu MD & Yuetao Wang MD

  3. Department of Nuclear Medicine, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China

    Min-Fu Yang PhD

  4. Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China

    Xiaoyu Yang MD

  5. Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China

    Zhifang Wu PhD & Sijin Li PhD

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  1. Wenji Yu MD
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Correspondence to Yuetao Wang MD.

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Funding

This research was supported by National Natural Science Foundation of China (81871381, PI: Yuetao Wang), key laboratory of Changzhou high-tech research project (CM20193010, PI: Yuetao Wang), Chinese National Natural Science Foundation for Young Scholars (81701737, PI: Jianfeng Wang), Social Development Foundation of Changzhou Science and Technology Bureau, Jiangsu Province, China (CE20175029, PI: Jianfeng Wang), Chinese National Natural Science Foundation for Young Scholars (81701734, PI: Xiaoliang Shao), Chinese National Natural Science Foundation for Young Scholars (81901777, PI: Feifei Zhang), science and technology project for youth talents of Changzhou Health Committee

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Yu, W., Zhang, F., Liu, B. et al. Incremental value of epicardial fat volume to coronary artery calcium score and traditional risk factors for predicting myocardial ischemia in patients with suspected coronary artery disease. J. Nucl. Cardiol. 29, 1583–1592 (2022). https://doi.org/10.1007/s12350-021-02538-5

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