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Original article
Available online 18 January 2022
Relationship of epicardial adipose tissue with coronary artery disease, cardiovascular risk factors and patient outcomes
Tejido adiposo epicárdico: su relación con la enfermedad arterial coronaria, los factores de riesgo cardiovascular y los eventos clínicos
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Marta Merelo-Nicolása,
Corresponding author
marta.merelo.n@gmail.com

Corresponding author.
, Luciano Consuegra-Sáncheza, Eduardo Pinar-Bermúdezb, Samantha Wasniewskia, Rafael A. León-Alloccaa, Pablo Ramos-Ruiza, José Abellán-Huertaa, José C. López-Clementea, Juan A. Castillo-Morenoa, Federico Soria-Arcosa
a Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
b Servicio de Cardiología, Hospital Central Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Received 09 November 2021. Accepted 20 December 2021
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Table 1. Baseline Characteristics of the total cohort and stratified by cardiovascular events during follow-up.
Table 2. Cox regression for predictors of cardiovascular events.
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Abstract
Introduction and objectives

The epicardial adipose tissue (EAT) is a metabolically active fat depot that has shown to be implicated in the development of coronary artery disease (CAD) and the prediction of cardiovascular events. However, these findings might be influenced by body size since previous studies have demonstrated a strong correlation between the amount of epicardial fat and anthropometric measurements. Our objective was to assess the association between indexed-EAT (EAT-i) volume and the presence of CAD and cardiovascular events in a cohort of symptomatic patients.

Methods

Patients referred for cardiac computed tomography from March 2010 to April 2017 were included. CAD was defined as the presence of obstructive coronary stenosis or a high amount of coronary calcium. EAT was assessed using a semiautomatic software and indexed to body surface area. A regression analysis was performed to determine the relationship between relevant CAD and EAT-i, age, sex, cardiovascular risk factors, and comorbidities. The association between EAT-i and cardiovascular events was analyzed with Cox regression models.

Results

A total of 179 patients were recruited (56±12 years, 57.5% male). EAT-i (P=.003), age (P<.001) and male sex (P<.001) were significantly and independently associated with CAD. During follow-up (5.5 years, 2.4–6.4) patients with elevated EAT-i showed an increased risk of events (HR, 2.44; 95%CI, 1.07–5.56; P=.033).

Conclusions

In symptomatic patients, an increased volume of indexed epicardial fat was associated with obstructive CAD as well as with cardiovascular events.

Keywords:
Epicardial adipose tissue
Computed tomography
Cardiovascular risk factors
Coronary artery disease
Major adverse cardiovascular events
Abbreviations:
AU
CAD
Cardiac CT
EAT
EAT-i
Resumen
Introducción y objetivos

El tejido adiposo epicárdico (TAE) es un depósito metabólicamente activo que ha demostrado estar implicado en el desarrollo de enfermedad arterial coronaria (EAC) y en la predicción de eventos cardiovasculares. Sin embargo, estos hallazgos podrían estar influidos por el tamaño corporal, ya que existe correlación entre la cantidad de grasa epicárdica y las medidas antropométricas. Nuestro objetivo fue analizar la asociación entre el TAE indexado (TAE-i) con la EAC y los eventos en una cohorte de pacientes sintomáticos.

Métodos

Se incluyeron pacientes derivados para la realización de tomografía computarizada coronaria entre marzo de 2010 y abril de 2017. Se definió EAC por la presencia de estenosis coronarias obstructivas o una cantidad elevada de calcio coronario. Se cuantificó el TAE mediante un programa informático semiautomático y se indexó el volumen al área de superficie corporal. Se realizó un análisis de regresión para determinar la relación entre la presencia de EAC y TAE-i, edad, género, factores de riesgo cardiovascular y comorbilidades. La asociación entre TAE-i y eventos se analizó con modelos de regresión de Cox.

Resultados

Se incluyeron 179 pacientes (56±12 años, 57,5% varones). El TAE-i (p=0,003), la edad p<0,001) y el sexo masculino (p<0,001) se asociaron de forma independiente con la presencia de EAC. Los pacientes con mayor TAE-i mostraron un mayor riesgo de eventos cardiovasculares durante el seguimiento (5,5 años, 2,4-6,4) (HR=2,44; IC95%, 1,07-5,56; p=0,033).

Conclusiones

En pacientes sintomáticos un mayor volumen de TAE-i se asocia con EAC obstructiva, así como con eventos cardiovasculares.

Palabras clave:
Tejido adiposo epicárdico
Tomografía computarizada
Factores de riesgo cardiovascular
Enfermedad arterial coronaria
Eventos adversos cardiovasculares mayores

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