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. 2023 Mar 21:10:1088961.
doi: 10.3389/fcvm.2023.1088961. eCollection 2023.

Impact of epicardial adipose tissue volume on hemodynamically significant coronary artery disease in Chinese patients with known or suspected coronary artery disease

Xiangbo Jin  1 , Beibei Gao  1 , Jiamin Zheng  2 , Xueer Wu  3 , Ning Zhang  1 , Lijun Zhu  4 , Xinyu Zhu  1 , Jianchang Xie  1 , Zhen Wang  5 , Guoxin Tong  1 , Jinyu Huang  1
Affiliations

Impact of epicardial adipose tissue volume on hemodynamically significant coronary artery disease in Chinese patients with known or suspected coronary artery disease

Xiangbo Jin et al. Front Cardiovasc Med. .

Abstract

Background: Epicardial adipose tissue (EAT) is directly related to coronary artery disease (CAD), but little is known about its role in hemodynamically significant CAD. Therefore, our goal is to explore the impact of EAT volume on hemodynamically significant CAD.

Methods: Patients who underwent coronary computed tomography angiography (CCTA) and received coronary angiography within 30 days were retrospectively included. Measurements of EAT volume and coronary artery calcium score (CACs) were performed on a semi-automatic software based on CCTA images, while quantitative flow ratio (QFR) was automatically calculated by the AngioPlus system according to coronary angiographic images.

Results: This study included 277 patients, 112 of whom had hemodynamically significant CAD and showed higher EAT volume. In multivariate analysis, EAT volume was independently and positively correlated with hemodynamically significant CAD [per standard deviation (SD) cm3; odds ratio (OR), 2.78; 95% confidence interval (CI), 1.86-4.15; P < 0.001], but negatively associated with QFRmin (per SD cm3; β coefficient, -0.068; 95% CI, -0.109 to -0.027; P = 0.001) after adjustment for traditional risk factors and CACs. Receiver operating characteristics curve analysis demonstrated a significant improvement in predictive value for hemodynamically significant CAD with the addition of EAT volume to obstructive CAD alone (area under the curve, 0.950 vs. 0.891; P < 0.001).

Conclusion: In this study, we found that EAT volume correlated substantially and positively with the existence and severity of hemodynamically significant CAD in Chinese patients with known or suspected CAD, which was independent of traditional risk factors and CACs. In combination with obstructive CAD, EAT volume significantly improved diagnostic performance for hemodynamically significant CAD, suggesting that EAT could be a reliable noninvasive indicator of hemodynamically significant CAD.

Keywords: coronary artery calcium; epicardial adipose tissue; fractional flow reserve; hemodynamically significant coronary artery disease; obstructive coronary artery disease; quantitative flow ratio.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flowchart of population selection. CABG, coronary artery bypass grafting; CAD, coronary artery disease; CAG, coronary angiography; CCTA, coronary computed tomography angiography; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Case example of CACs calculation, EAT volume quantification and QFR assessment. (A) CACs was calculated by the sum of calcium score of each coronary artery according to the Agatston coronary calcification score. (B) EAT volume was quantified by manually tracing pericardium (pink). (C) QFR assessment in two-dimensional mode derived from CAG (QFR value of 0.43 in the RCA). (D) QFR assessment in three-dimensional mode derived from CAG (QFR value of 0.43 in the RCA). CACs, coronary artery calcium score; CAG, coronary angiography; CX, left circumflex coronary artery; EAT, epicardial adipose tissue; LAD, left anterior descending coronary artery; LM, left main coronary artery; QFR, quantitative flow ratio; RCA, right coronary artery.
Figure 3
Figure 3
Association of EAT volume with BMI, HDL, dSmax and QFRmin. (A) Correlation between EAT volume and BMI. (B) Correlation between EAT volume and HDL. (C) Correlation between EAT volume and DSmax. (D) Correlation between EAT volume and QFRmin. BMI, body mass index; CAD, coronary artery disease; DS, diameter stenosis; EAT, epicardial adipose tissue; HDL, high-density lipoprotein; QFR, quantitative flow ratio.
Figure 4
Figure 4
Association of hemodynamically significant CAD with demographic characteristics, cardiometabolic disease, laboratory and imaging values. (A) Forest plots illustrate the association between hemodynamically significant CAD and demographic characteristics. (B) Forest plots illustrate the association between hemodynamically significant CAD and cardiometabolic disease. (C) Forest plots illustrate the association between hemodynamically significant CAD and laboratory values. (D) Forest plots illustrate the association between hemodynamically significant CAD and imaging values. BMI, body mass index; CACs, coronary artery calcium score; CAD, coronary artery disease; CI, confidence interval; EAT, epicardial adipose tissue; EF, ejection fraction; FBG, fasting blood glucose; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein; OR, odds ratio; TC, total cholesterol.
Figure 5
Figure 5
ROC curve analysis of CACs, EAT volume, obstructive CAD, combined EAT + CACs, combined CACs + obstructive CAD and combined EAT + obstructive CAD for identifying hemodynamically significant CAD. AUC, area under the curve; CACs, coronary artery calcium score; CAD, coronary artery disease; EAT, epicardial adipose tissue; ROC, receiver operating characteristics.
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References

    1. Liyuan M, Zengwu W, Jing F, Shengshou HJCGP. An essential Introduction to the annual report on cardiovascular health and diseases in China. Chin Gen Pract. (2021) 25(27):3331. 10.12114/j.issn.1007-9572.2022.0506 - DOI
    1. Toth GG, Toth B, Johnson NP, De Vroey F, Di Serafino L, Pyxaras S, et al. Revascularization decisions in patients with stable angina and intermediate lesions: results of the international survey on interventional strategy. Circ Cardiovasc Interv. (2014) 7(6):751–9. 10.1161/CIRCINTERVENTIONS.114.001608 - DOI - PubMed
    1. Park S-J, Kang S-J, Ahn J-M, Shim EB, Kim Y-T, Yun S-C, et al. Visual-functional mismatch between coronary angiography and fractional flow reserve. JACC Cardiovasc Interv. (2012) 5(10):1029–36. 10.1016/j.jcin.2012.07.007 - DOI - PubMed
    1. Pijls NH, Van Gelder B, Van der Voort P, Peels K, Bracke FA, Bonnier HJ, et al. Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. (1995) 92(11):3183–93. 10.1161/01.CIR.92.11.3183 - DOI - PubMed
    1. Toth G, Hamilos M, Pyxaras S, Mangiacapra F, Nelis O, De Vroey F, et al. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. (2014) 35(40):2831–8. 10.1093/eurheartj/ehu094 - DOI - PubMed