The relationship between epicardial adipose tissue volume on coronary computed tomography angiography and idiopathic ventricular tachycardia: a propensity score matching case-control study in Chinese population

Abstract

Background: Large epicardial adipose tissue (EAT) volume is associated with the incidence of premature ventricular beats. The relationship between EAT volume and idiopathic ventricular tachycardia (IVT) is not yet clear. We aimed to investigate the effect of EAT volume on the risk of IVT.

Methods: This is a retrospective consecutive case-control study from January 2020 to September 2022. IVT patients (n=81) and control patients (n=162) undergoing coronary computed tomography angiography (CCTA) were retrospectively recruited. The patients in the control group were all hospitalized patients for different reasons, such as chest tightness, shortness of breath, chest pain, and so on. Demographic parameters and clinical characteristics of each individual were collected from the patient's medical records. We selected evaluation criteria for the conduct of a 1:1 propensity score (PS)-adjusted analysis. Multivariable logistic analysis was used to investigate risk factors for IVT. Furthermore, the impact of EAT volume on cardiac repolarization indices was assessed in IVT patients.

Results: Patients with IVT had a larger EAT volume than control group patients in the unadjusted cohort. Variables with P<0.10 in the univariable analysis and important factors were included in the multivariable analysis model, including body mass index (BMI), left ventricular ejection fraction (LVEF), early peak/artial peak (E/A) ratios <1, EAT attenuation, and EAT volume (per increase 10 mL). The multivariable logistic analysis found that EAT volume [per increase 10 mL, odds ratio (OR): 1.29, 95% confidence interval (CI): 1.17-1.41, P<0.001] was an independent risk factor for IVT. EAT volume (per increase 10 mL, OR: 1.43, 95% CI: 1.25-1.64, P<0.001) independent effect was demonstrated in the PS adjusted cohort (n=57 in both groups). The area under the curve of EAT volume to predict the risk of IVT patients in the PS adjusted cohort was 0.859. The sensitivity and specificity were 86.0%, and 75.4%, respectively. Furthermore, A large EAT volume of IVT patients had a longer time in Tp-e, and Tp-e/QTc, compared with low EAT volume.

Conclusions: Patients with IVT had increased EAT volume compared to control subjects. Our study revealed that large EAT volume is associated with an extended repolarization process in IVT patients. These insights are essential for understanding the mechanisms linking EAT with IVT.

Keywords: Idiopathic ventricular tachycardia (IVT); computed tomography (CT); electrocardiogram (ECG); epicardial adipose tissue (EAT).

Figure 1

Semi-automated EAT volume on CCTA. The red areas represent the distribution of EAT. EAT, epicardial adipose tissue; CCTA, coronary computed tomography angiography.

Figure 2

The flowchart of the IVT patients’ study cohort. IVT, idiopathic ventricular tachycardia; CCTA, coronary computed tomography angiography; RFCA, radiofrequency catheter ablation; CT, computed tomography; PS, propensity score.

Figure 3

Distribution of EAT volume. (A) EAT volume in the unadjusted cohort; (B) EAT volume in the propensity score-adjusted cohort. Different color dots represent measured EAT volume; top of the box horizontal line, 75th percentile; 50th percentile (median); bottom of the box, 25th percentile; whiskers, maximum and minimum EAT volume except for outliers, respectively. EAT, epicardial adipose tissue; IVT, idiopathic ventricular tachycardia; PS, propensity score.

Figure 4

Receiver operating curve illustrating the accuracy of EAT volume for predicting IVT risk in the propensity score-adjusted cohort. EAT, epicardial adipose tissue; IVT, idiopathic ventricular tachycardia.

Figure 5

Electrocardiogram parameters according to the median EAT volume in IVT patients. (A) Comparison of Tp-e based on EAT volume; (B) comparison of QTc based on EAT volume; (C) comparison of Tp-e/QTc based on EAT volume. The cut-off EAT volume was 147.3 mL according to the median. EAT, epicardial adipose tissue; IVT, idiopathic ventricular tachycardia.