Is the epicardial adipose tissue area on non-ECG gated low-dose chest CT useful for predicting coronary atherosclerosis in an asymptomatic population considered for lung cancer screening?
The purpose was to determine whether the epicardial adipose tissue (EAT) area on low-dose chest CT (LDCT) could be used to predict coronary atherosclerosis in an asymptomatic population considered for lung cancer screening.
Subjects aged 55-80 years with smoking history who underwent both LDCT and coronary CT angiography (CCTA) were retrospectively enrolled. Correlation between the EAT volume in CCTA and EAT area in LDCT was evaluated. Coronary risk factors including the body surface area (BSA) indexed EAT area were compared between coronary plaque negative and positive groups. Significant factors for predicting coronary atherosclerosis were analyzed with logistic regression analysis. Receiver-operating characteristic curve analysis was performed to determine the cutoff value.
A total of 438 subjects were enrolled, including 299 subjects with coronary atherosclerosis. There was a good correlation between the EAT volume in CCTA and EAT area in LDCT (ρ = 0.712, p < 0.001). There were significant differences in age, systolic blood pressure, all BSA indexed EAT area, sex, and hypertension between plaque negative and positive groups. In multivariate logistic regression for the BSA indexed EAT area in LDCT at the RCA level, sex (OR: 11.168, 95% CI: 2.107-59.201, p = 0.005), systolic blood pressure (OR: 1.021, 95% CI: 1.005-1.036, p = 0.009), hypertension (OR: 1.723, 95% CI: 1.103-2.753, p = 0.017), and EAT area (OR: 1.273, 95% CI: 1.154-1.405, p < 0.001) were significant. The area under the curve of the BSA indexed EAT area in LDCT at the RCA level for coronary atherosclerosis was 0.657, and the cut-off value was 7.66 cm2/m2.
The EAT area in LDCT could be used to predict coronary atherosclerosis in an asymptomatic population considered for lung cancer screening.
• To quantify EAT, the EAT area in LDCT can be used instead of the EAT volume in CCTA.
• The EAT area measured in LDCT can be used as a predictor of coronary artery disease.
• The extensive CAD group tended to have a greater EAT area than the non-extensive CAD group.
KeywordsCoronary artery disease Pericardium Adipose tissue Computed tomography angiography Multidetector computed tomography
Abbreviations and acronyms
EAT area in CCTA
EAT area in LDCT
EAT area in LDCT at LM
EAT area in LDCT at RCA
Area under the curve
Body mass index
Body surface area
Coronary artery disease
Coronary CT angiography
Diastolic blood pressure
Epicardial adipose tissue
Institutional Review Board
Low-dose chest computed tomography
Left main coronary artery
Magnetic resonance imaging
National Lung Screening Trial
Odds ratios (ORs)
Right coronary artery
Systolic blood pressure
US Preventive Services Task Force
EAT volume in CCTA
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Hwan Seok Yong.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• Case-control study
• Performed at one institution
- 2.Şengül C, Özveren O (2013) Epicardial adipose tissue: a review of physiology, pathophysiology, and clinical applications. Anadolu Kardiyol Derg 13:261–265Google Scholar
- 14.Team NLSTR (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011:395–409Google Scholar
- 15.Moyer VA (2014) Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 160:330–338Google Scholar
- 16.Greenland P, Alpert JS, Beller GA et al (2010) 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56:e50–e103CrossRefGoogle Scholar
- 30.Tanami Y, Jinzaki M, Kishi S et al (2015) Lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population. Clin Perspect Circ Cardiovasc Imaging 8:e002676Google Scholar
- 31.Forouzandeh F, Chang SM, Muhyieddeen K et al (2012) Does quantifying epicardial and intrathoracic fat with noncontrast computed tomography improve risk stratification beyond calcium scoring alone? Circ Cardiovasc Imaging: CIRCIMAGING 976316:112Google Scholar