CT EVALUATION OF ASSOCIATION BETWEEN PERICARDIAL FAT VOLUME AND CORONARY ARTERY DISEASE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 72
Abstract
BACKGROUND Pericardial fat is the adipose tissue surrounding the heart. It releases inflammatory cytokines in a local fashion and affect only the adjacent structures, which are coronary arteries. Multiple studies have tried to establish the association of pericardial fat volume and calcium scoring with the incidence of coronary artery disease with contradicting results. We hope to provide additional evidence towards this already existing dispute and to comment whether pericardial fat volume measurement should be done as a routine diagnostic tool and consider it as a marker for ischaemic heart disease. The objective of this study is to evaluate the association between pericardial fat volume and coronary artery disease using dual source computed tomography (DSCT), to evaluate the pericardial fat volume differences between patients with coronary artery disease and normal controls, to assess the relationship between pericardial fat volume and coronary calcium score and between different degrees of coronary artery stenosis. MATERIALS AND METHODS We included 117 DSCT coronary angiography studies, of which 62 cases were males and 55 were females; 74 scans showed positive findings of coronary artery disease and 43 cases were normal. Both the presence of coronary calcium score and/or coronary artery stenosis was taken into consideration as positive radiological findings of coronary artery disease. The scans were taken using Siemens Somatom definition flash DSCT with 100 kVp, 0.75 mm slice thickness and mAs according to the patient’s BMI. The scans were obtained in diastolic phase with the patient in supine position. Contrast agent used was Visipaque. Pericardial fat volume was measured in Siemens Somatom Syngo volume analysis software. The area of interest was taken as the areas of pericardial fat around the main coronary arteries and the threshold HU was kept between -30 and -190 HU. Coronary artery stenosis was assessed visually by two experienced radiologists and categorised to mild (< 50%), moderate (50% - 75%) and severe (>75%). Coronary artery calcium score (Agatston score) was calculated using Siemens calcium score analysis software by an experienced radiologist. Each coronary artery was selected and the sum of all the calcium score of all the arteries were taken as total coronary calcium score. The data was written in excel format. All the statistics was done in SPSS 16.0 software. RESULTS The retrospective analysis of 117 CT coronary angiography scans revealed 74 (63.24%) cases with positive findings for coronary artery disease either having coronary calcification or coronary artery stenosis. The mean of pericardial fat volume for normal cases was 76.84 ± 35.79 cm3 and the positive cases with the evidence of coronary artery disease were 92.95 ± 35.84 cm3. Significant differences were observed between the pericardial fat volume of normal subjects and subjects with the evidence of coronary artery disease in student t-test (P= 0.023). Pericardial fat volume was observed to have no significant difference between males and females (p= 0.191). Strong correlation was also revealed between age and pericardial fat volume (r= 0.275, p < 0.05). Mean calcium score was 318.2 ± 719.57 in males and 104.92 ± 261.78 in females. Males were found to have more calcified plaques than females (p= 0.04). The statistical studies revealed that there is a strict correlation between pericardial fat volume and coronary calcium score (r= 0.210, p= 0.023). There was positive but insignificant correlation between pericardial fat volume and stenosis in total (r=0.161, p=0.083); however, for different arteries showed significant associations between the pericardial fat volume and stenosis in right coronary artery (r= 0.264, p= 0.004), left anterior descending artery (r= 0.177, p= 0.056) and circumflex artery (r= 0.105, p= 0.262). Coronary artery stenosis was found to have a strong correlation with coronary calcium score (r= 0.452, p < 0.001). A significant linear increase was seen in coronary calcium score with age (p < 0.05). Out of all the positive cases, left anterior descending artery was found to have the most calcified plaques as well as non-calcified soft plaques (89%) causing stenosis. Right coronary artery (63.51%) was the second to be affected, following it the circumflex arteries (40.54%) and finally the left main coronary artery was involved. CONCLUSION Pericardial fat volume is strongly associated with coronary artery calcification and coronary artery stenosis, and thereby can be considered as a predictor or a risk factor for the development of coronary artery disease in the high-risk population. Further studies in this field are warranted, so that assessment of pericardial fat volume can be added as a routine diagnostic tool in cardiac CT.
Authors and Affiliations
Sajay Alias, Sholy K Vareed, Don Paul Mathew, Justine Antony
Keywords
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- EP ID EP265558
- DOI 10.14260/jemds/2017/1112
- Views 102
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