Epicardial adipose tissue is associated with high-risk plaque feature progression in non-culprit lesions

Several studies have suggested a link between epicardial adipose tissue (EAT) volume and high-risk plaques (HRPs); however, little is known about the association between EAT volume and HRP progression in non-culprit lesions (NCLs). Therefore, we evaluated whether EAT can independently predict HRP characteristic progression in NCLs by coronary computed tomography angiography (CCTA). In this single-centre trial, we analysed 131 consecutive patients (median age 61 years, male 72.52%) undergoing CCTA with percutaneous coronary intervention (PCI) for culprit lesions. All patients were scheduled to undergo follow-up CCTA 12 months after PCI. HRP features, including positive remodelling, low attenuation plaque, spotty calcification, and napkin-ring sign, along with EAT volume, were assessed by CCTA. The numbers of HRP features were compared between baseline and follow-up CCTA to detect HRP progression in NCLs, and patients were classified into two groups based on HRP progression. Logistic regression analysis was used to evaluate whether EAT volume was independently associated with HRP progression in NCLs. Overall, 23 of 131 patients who underwent two CCTAs exhibited HRP progression in NCLs (17.6%). Logistic regression analysis showed that a higher baseline EAT volume was associated with NCL HRP progression (odds ratio 1.019, 95% confidence interval 1.009–1.029, P < 0.001). The cut-off value for baseline EAT volume for NCL HRP progression was 107 ml based on receiver-operator characteristic curve analyses, and the area under the curve was 0.66. Baseline EAT volume was identified as an independent predictor of NCL HRP progression.