Epicardial Adipose Tissue Volume Is Associated with High Risk Plaque Profiles in Suspect CAD Patients

Abstract

Objective: To explore the association between EAT volume and plaque precise composition and high risk plaque detected by coronary computed tomography angiography (CCTA).

Methods: 101 patients with suspected coronary artery disease (CAD) underwent CCTA examination from March to July 2019 were enrolled, including 70 cases acute coronary syndrome (ACS) and 31 cases stable angina pectoris (SAP). Based on CCTA image, atherosclerotic plaque precise compositions were analyzed using dedicated quantitative software. High risk plaque was defined as plaque with more than 2 high risk features (spotty calcium, positive remolding, low attenuation plaque, napkin-ring sign) on CCTA image. The association between EAT volume and plaque composition was assessed as well as the different of correlation between ACS and SAP was analyzed. Multivariable logistic regression analysis was used to explore whether EAT volume was independent risk factors of high risk plaque (HRP).

Results: EAT volume in the ACS group was significantly higher than that of the SAP group (143.7 ± 49.8 cm³ vs. 123.3 ± 39.2 cm³, P = 0.046). EAT volume demonstrated a significant positive correlation with total plaque burden (r = 0.298, P = 0.003), noncalcified plaque burden (r = 0.245, P = 0.013), lipid plaque burden (r = 0.250, P = 0.012), and homocysteine (r = 0.413, P ≤ 0.001). In ACS, EAT volume was positively correlated with total plaque burden (r = 0.309, P = 0.009), noncalcified plaque burden (r = 0.242, P = 0.044), and lipid plaque burden (r = 0.240, P = 0.045); however, no correlation was observed in SAP. Patients with HRP have larger EAT volume than those without HRP (169 ± 6.2 cm³ vs. 130.6 ± 5.3 cm³, P = 0.002). After adjustment by traditional risk factors and coronary artery calcium score (CACS), EAT volume was an independent risk predictor of presence of HRP (OR: 1.018 (95% CI: 1.006-1.030), P = 0.004).

Conclusions: With the increasing EAT volume, more dangerous plaque composition burdens increase significantly. EAT volume is a risk predictor of HRP independent of convention cardiovascular risk factors and CACS, which supports the potential impact of EAT on progression of coronary atherosclerotic plaque.

Figure 1

EAT volume quantitative method based on CT scan sequence. EAT volume was measured automatically from pulmonary artery bifurcation to diaphragm after drawing the contour of pericardium. The parts in purple represented the range and distribution of EAT.

Figure 2

Precise quantitative analysis method for plaque composition based on CCTA images. The vessel and lumen contour were depicted manually. After automatic recognition specific composition CT attenuation, the volume of each composition was calculated. Above case showed a quantitative process of noncalcified plaque located at the proximal segment of left anterior descending branch. The lesion length was 12.6 mm, the lumen volume was 93.91 mm³, the total plaque volume was 140.02 mm³, the calcified volume was 6.47 mm³, the noncalcified volume was 133.55 mm³, the lipid volume was 24.27 mm³, and the fibrous volume was 109.28 mm³.

Figure 3

Correlation between EAT volume and plaque composition burden, serum LDL-C, and homocysteine. (a–c) EAT volume was positively correlated with total plaque, noncalcified plaque, and lipid plaque burden. (d) EAT volume was not correlation with fibrous plaque burden. (e) EAT volume was not correlation with LDL-C level. (f) EAT volume was positively correlated with homocysteine.

Figure 4

Distribution of HRP features according to quartiles of EAT volume: (a) NRS number; (b) positive remodeling; (c) low attenuation plaque; (d) spotty calcium.

Figure 5

The difference of EAT volume between patients with and without HRP. ^∗P < 0.05 was regarded as significant.