Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and it’s Relation with the Severity of Coronary Artery Disease

Abstract Background Recent studies have suggested that fat disposition in epicardial tissue may be a predictor of the severity of coronary artery disease (CAD). Epicardial adipose tissue (EAT) is defined as the adipose tissue located between the outer wall of the myocardium and the visceral layer of pericardium, surrounding the heart and the coronary vessels. EAT is closely related to the adventitia of the coronary arteries without a barrier that may directly influence the development and progression of atherosclerosis and CAD through pro-inflammatory mediators. Objective The aim of the work is to investigate the relation between epicardial fat volume (EFV) [assessed by multidetector computed tomography (MDCT)] and severity of CAD. Methods This cross sectional study was conducted on 40 patients referred for MDCT coronary angiography to assess their complaint. EFV was quantified during non-contrast phase and severity of CAD was assessed by segment involvement score (SIS) and segment stenosis score (SSS) during contrast phase at Nasr City Police Hospital in the period between August 2018 and April 2019. Results The 40 consecutive subjects consisted of 30 males (75%) and 10 females (25%) with mean age 56 ±10.27 years. Risk factors of atherosclerosis were analyzed among the studied population as followed; the BMI ranged between 24 and 30.9 kg/m2, hypertensive patients were 77.5%, diabetic patients were 55% and smokers were 67.5%. The laboratory finding of the studied group revealed that the serum LDL.C ranged between 70 and 218 mg/dl (Mean±SD =163.88±43.37, Median= 183.5). The serum HDL.C ranged between 30 and 62 mg/dl (Mean±SD = 41.45±9.87, Median= 37). The serum total cholesterol ranged between 136 and 280 mg/dl (Mean±SD = 214.35± 35.51, Median= 224). The serum triglycerides ranged between 110 and 215 mg/dl (Mean±SD = 164.13±27.38, Median= 173).The serum creatinine ranged between 0.8 and 1.8 mg/dl (Mean±SD = 1.12±0.19, Median= 1.1). 17.5% of the studied patients had normal coronaries while 37.5% had single vessel disease and 45% had multi-vessel disease. There was a significant relationship between EFV and CAC score (p = 0.011, r = 0.397), a highly significant relationship between EFV and SSS score (p = 0.001, r = 0.518) and significant relationship between EFV & SIS score (P = 0.003, r = 0.459). Patients with normal coronary arteries were noted to have a lower EFV value than those with coronary lesions (highly significant relationship, p = 0.004) either single vessel disease or multi-vessel disease. There is no significant difference between the effects of EFV on number of diseased coronaries either single vessel disease or multi-vessel disease. Conclusion EFV increased in patients with both significant coronary artery stenosis or coronary calcification. EFV is considered an independent risk factor for CAD.