Vascular-specific epicardial adipose tissue in predicting functional myocardial ischemia for patients with stable chest
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Vascular‑specific epicardial adipose tissue in predicting functional myocardial ischemia for patients with stable chest pain Dongkai Shan1 · Xi Wang1 · Guanhua Dou1 · Wei Zhang1 · Jing Jing1 · Bai He1 · Yang Li1 · Yundai Chen1 · Junjie Yang1 Accepted: 9 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The relationship between vascular-specific epicardial adipose tissue (vEAT) volume and myocardial ischemia measured by fractional flow reserve (FFR) was not well investigated. Patients with typical and atypical chest pain undergoing coronary computed tomographic angiography scan followed by invasive coronary angiography in combination with FFR examination within one month were retrospectively included. EAT volume and CT attenuation was calculated. The patient with FFR ≤ 0.8 in at least one vessel was referred to as functional ischemia. The mean age of all patients was 61.7 ± 8.9 years and 66.7% of patients were male. There was a significant difference for left anterior descending branch (LAD) vEAT volume between patients with and without functional myocardial ischemia (28.7 ± 10.6 cm3 vs. 23.9 ± 8.7 cm3, p = 0.005). After adjusted by cardiac risk factors and CAD-RADS categories in multivariable logistic regression analysis, LAD-vEAT volume ≥ 24.6 cm3 (OR 3.355, 95% CI 1.546–7.281, p = 0.002) remained an independent predictor of functional ischemia. After adding LAD-vEAT volume ≥ 24.6 cm3 to a prediction model composed with cardiac risk factors and CAD-RADS categories, receiver operating characteristic curve analysis showed significantly improved areas under curve (AUC) for the new model (AUC: 0.795, p = 0.0319) compared with the previous ones. Moreover, the new model revealed significance in net reclassification improvement (NRI: 0.186, p = 0.037). In conclusion, LAD-vEAT volume measurements have incremental predictive performance beyond cardiac risk factors and CAD-RADS categories in identifying significant flow-limit ischemia detected by FFR. Keywords Epicardial adipose tissue · Coronary artery disease · Myocardial ischemia · Diagnostic performance
Highlights • Epicardial adipose tissue (EAT) plays an important role
in the progression of coronary artery disease.
• Vascular specific EAT (vEAT) showed more potential
clinical implication for vessel plaque and stenosis. • There was a significant difference for left anterior descending branch (LAD) vEAT volume between patients with and without functional myocardial ischemia.
* Yundai Chen [email protected] * Junjie Yang [email protected] 1
Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
• LAD-vEAT volume has an incremental value of predic-
tive performance in identifying significant flow-limit myocardial ischemia.
Introduction Epicardial adipose tissue (EAT), a special visceral adipose depot in interventricular and atrioventricular groove, plays an important role in heart thermal metabolism, fat storage, and acts as a buffer to protect from stress. EAT has been r
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