Pericardial fat volume and coronary risk factors as predictors of non-calcified coronary plaque presence among patients with coronary calcium score = 0.

INTRODUCTION: There is scarce data linking pericardial fat volume (PFV) and classical coronary risk factors with non-calcified plaque presence among patients with CAC = 0 in the literature. MATERIAL AND METHOD: A total of 811 patients with chest pain suggestive of angina underwent CT coronary angiography for the assessment of coronary artery disease were collected. Of these, 417 with CAC = 0 were included in the analysis. RESULT: Patients with non-calcified plaque were older (54 ± 9 versus 50 ± 10, P = 0.01) and had a higher prevalence of diabetes mellitus (31% versus 17%, P = 0.02), high BMI (29.9 versus 28.3, P = 0.04), and increased PFV (123 cm3 versus 99 cm3, P < 0.01) compared to patients without plaque. In multivariate regression analysis, high BMI[OR(CI) = 1.1(1-1.3), P = 0.02] was an independent predictor of non-calcified coronary plaque presence among patients with CAC = 0 after adjustment to variables with P < 0.05 in the univariate analysis. CONCLUSION: In patients with a CAC score of 0, advanced age, diabetes mellitus, increased PFV, and high BMI were all associated with the presence of non-calcified plaque. After multivariate adjustment, increased BMI remained a significant independent predictor for non-calcified plaque presence.

Aortic root diameter, main pulmonary artery diameter/aortic root diameter and pericardial fat volume as predictors of occlusive coronary artery disease.

The clinical relevance of aortic root diameter (ARD) and main pulmonary artery diameter (MPAd) or pericardial fat volume (PFV) in the assessment of coronary artery disease (CAD) is largely unknown. We aimed to assess the relationship of pericardial fat volume (PFV), ARD, MPAd, and MPAd/ARD ratio with occlusive CAD (stenosis>50%).This cross-sectional study included patients who had chest pain suggestive of CAD and underwent a 64-multislice multi-detector CT angiography exam to exclude occlusive CAD presence. A total of 145 patients were enrolled in this study. The mean age was 54±10 years, 51% were males. The mean PFV, ARD, MPAd, and MPAd/ARD ratio in all patients were 155 cm3, 29.9 mm, 23.4 mm and 0.8, respectively. On univariate analysis, PFV (OR (CI)=1.1 (1.01-1.3), P<0.01), ARD (OR (CI)=1.2 (1.1-1.4), P<0.01), and MPAd/ARD ratio (OR (CI)= 0.2 (0.1-0.5), p=0.02) showed significant association with occlusive CAD presence. After adjusting for cardiac risk factors, only PFV (OR (CI)=1.1 (1.02-1.3), p<0.01), but not ARD (OR (CI)=0.9(0.3-2), p=0.85) or MPAd/ARD ratio (OR (CI)=0.1(0.1-2), p=0.69), was independently associated with occlusive CAD. In conclusion, increased PFV, but not ARD or MPAd/ARD ratio, showed a significant and independent association with occlusive CAD presence in patients with chest pain suggestive of CAD.

Relationship of cardiovascular risk factors, pericardial fat, and carotid thickness with coronary plaque type in patients with diabetes mellitus.

Background: There is paucity of data on the potential predictors of coronary plaque types among patients with diabetes mellitus(DM). Aims: To assess the association of cardiovascular risk factors, pericardial fat volume (PFV) assessed by multi-detector CT(MDCT)angiography, and internal carotid intima media thickness with coronary atherosclerotic plaque types in patients with type 2 DM. Patients and methods: Patients with suspected coronary artery disease who underwent 64-slice MDCT angiography were enrolled in this retrospective study. Results: A total of 784 patients were enrolled in this study, 198 of whom had DM and 586 of whom did not. The prevalence of calcified and mixed plaques was significantly higher in the DM group than without DM group, while no significant difference was found in the distribution of non-calcified plaque between groups. There was significant association between smoking [OR(CI) = 4(2-10),P = 0.001] and increased age[OR(CI) = 1.1(1-1.3),P = 0.023] and calcified plaque presence. Regarding mixed and non-calcified plaque, increased PFV[OR(CI) = 1.1(1-1.3),P = 0.001] and positive family history[OR(CI) = 4(2-12),P = 0.049] showed a significant association with coronary mixed plaque presence while no significant association was observed between cardiovascular risk factors, PFV, and internal carotid intima media thickness and non-calcified plaque presence in patients with DM. Conclusion: Increased PFV showed significant and independent association with mixed coronary plaques development, which suggests that PFV may be used as an imaging marker for early detection of increased risk for future coronary events in patients with DM.

Cardiovascular risk factors and pericardial fat volume as predictors of coronary atherosclerosis burden in postmenopausal women: A retrospective, single center study.

Background and Aims: Little is known about the clinical relevance of pericardial fat volume (PFV), compared to other conventional cardiovascular risk factors, as predictors of coronary atherosclerosis severity among postmenopausal women. Our main aim was to assess the association of PFV and cardiovascular risk factors with coronary atherosclerosis burden, including occlusive coronary artery disease (CAD) (luminal stenosis >50%), coronary artery calcium score (CAC) >100, and plaque types in postmenopausal women. Methods: Patients who had chest pain of angina and referred for 64-slice multi-detector CT (MDCT) angiography examination to exclude occlusive CAD presence were enrolled in this retrospective study. Results: A total of 241 women with absence of menses for more than 2 consecutive years and not taking hormone replacement therapy were enrolled in the present study. Increased PFV (OR [CI] = 1.1 [1-1.3], p = 0.004), age (OR [CI] = 1.1 [1-1.4], p = 0.002), and diabetes mellitus (OR [CI] = 2 [1-4], p = 0.025) were significant predictors of occlusive CAD presence. Increased PFV (OR [CI] = 1.1 [1-1.4], p = 0.017) and increased age (OR [CI] = 1.2 [1.1-1.4], p < 0.001) were better predictors of CAC >100 than other cardiovascular risk factors. Regarding coronary plaque types, increased age (OR [CI] = 1.1 [1.1-1.3], p = 0.001) showed a significant association with coronary calcified plaque presence while increased body mass index(OR [CI] = 1.2 [1-1.4], p = 0.018) showed a significant association with coronary non-calcified plaque presence. Conclusion: Higher PFV values showed an independent association with occlusive CAD and significant coronary calcification. This may imply that increased PFV is likely associated with the development of advanced and severe phenotype of coronary atherosclerosis among postmenopausal women with suspected CAD.

Pericardial adiposity versus body adiposity measured by BMI in the assessment of coronary atherosclerosis burden in patients with hypertension.

OBJECTIVES: The link between obesity and hypertension with coronary atherosclerosis is complex. We aimed to assess the association of cardiac fat deposition measured by pericardial fat volume(PFV) using by multi-detector CT(MDCT) and general obesity measured by BMI with subclinical coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary plaque and stenosis) in patients with hypertension and suspected coronary artery disease. METHODS: Among 496 patients presenting with chest pain who underwent 64-slice MDCT angiography to exclude occlusive coronary disease, 261 patients with hypertension (age: 57 ± 8 years, 45% males) enrolled in the present study. RESULTS: PFV showed a significant association with CAC(r = 0.2,P = .001),coronary stenosis severity(PFV median(IQR) 88(63-161) in patients with coronary stenosis<50% compared to PFV median(IQR) 125(85-140) in patients with coronary stenosis ≥ 50%, P = .001) and coronary plaque presence (PFV median (IQR) 89(65-128) in patients without plaque compared to PFV median (IQR) 115(74-150) in patients with plaque presence = 0.03).the significant association of PFV with CAC[odds ratio(95% confidence interval = 0.5(0.19-0.97),P = .001] and coronary stenosis severity [odds ratio(95% confidence interval = 1.1(1.00-1.01),P = .01]persisted after adjustment for conventional cardiac risk. BMI showed a significant association with significant coronary stenosis presence (P = .02).The association of BMI with significant coronary stenosis presence after adjustment for conventional cardiac risk factors (P = .03).BMI showed no significant association with CAC and coronary plaque presence (P > .05). CONCLUSION: PFV showed a significant independent association with coronary calcification and significant coronary stenosis in patients with hypertension rather than BMI.

Sex-Related Differences in the Association of BMI and Pericardial Fat Volume With Coronary Atherosclerotic Markers in Young.

We assessed sex-related differences in the association of pericardial fat volume (PFV) and obesity measured by body mass index (BMI) with coronary atherosclerotic markers (coronary artery calcium score [CAC], coronary luminal stenosis severity, and coronary plaque) in young patients. Patients (n = 174; age <50 years) with suspected coronary artery disease who underwent 64-slice multidetector computed tomography angiography were enrolled. Females tended to have a younger age and increased BMI, normal coronary arteries (free from luminal stenosis), and increased percentage of absent coronary plaque compared with males. There was a significant independent association between PFV with coronary luminal stenosis and between PFV and BMI with coronary noncalcified plaque presence after adjustment for conventional cardiac risk factors. On the other hand, males showed a more increment in PFV, CAC, percentage of calcified plaque, and percentage of significant coronary luminal stenosis compared with females. There was a significant independent association of PFV with CAC, significant coronary stenosis, and calcified plaque presence, while no association was observed between BMI with coronary markers in young males. In conclusion, PFV, but not BMI, showed a significant independent association with advanced coronary atherosclerosis in young male patients.

Pericardial fat volume and coronary atherosclerotic markers among body mass index groups.

BACKGROUND: Increased pericardial fat volume (PFV) is associated with coronary atherosclerosis burden independent of body mass index (BMI) in many clinical studies. However, the association of PFV with markers of coronary atherosclerosis has not yet been assessed by dividing the patients according to BMI categories. HYPOTHESIS: To assess the association of PFV measured by multi-detector CT (MDCT) angiography with coronary atherosclerotic markers (coronary artery calcium score [CAC], plaque type, and luminal stenosis) among BMI categories. METHODS: A total of 496 patients with suspected coronary artery disease who underwent 64-slice MDCT angiography examination were enrolled. Patients divided into obese, overweight, and normal weight groups according to BMI degree. RESULTS: PFV showed a significant association with CAC, non-calcified coronary plaque, and significant coronary stenosis in obese group. After adjusting for cardiac risk factors, the association of PFV with the non-calcified coronary plaque and significant coronary stenosis persisted. There was a significant association between PFV with CAC and significant coronary stenosis in normal weight group. The association between PFV with CAC and significant coronary stenosis in normal weight was persisted afar adjusting for cardiac risk factors. No significant association was noted between PFV with coronary plaque type in normal weight group. There was no significant independent association between PFV with coronary atherosclerotic markers in overweight group. CONCLUSIONS: Increased PFV was associated with advanced stage atherosclerosis in normal weight group, while increased PFV was associated with non-calcified plaque in obese. These results highlight the differential relationship of PFV with coronary atherosclerotic markers among BMI categories.

Pericardial fat versus BMI in the assessment of coronary atherosclerotic burden in patients with diabetes mellitus.

AIMS: To investigate the association of obesity measured by body mass index (BMI) versus pericardial fat volume (PFV) measured by multi-detector computed tomography (MDCT) with coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary stenosis severity and coronary plaque presence) in patients with type 2 diabetes mellitus (DM). METHODS: Among 496 patients with suspected coronary artery disease who underwent 64-slice MDCT angiography to exclude occlusive coronary artery disease, 102 patients with DM were enrolled in the present study. RESULTS: PFV showed a significant association with CAC (r = 0.2, P = 0.01) and significant coronary artery stenosis [PFV median (IQR) = 75 (51-136) in patients with coronary stenosis < 50% versus PFV median (IQR) = 113 (68-140) in patients with coronary stenosis ≥ 50%, P = 0.01] while there was no significant association of PFV with coronary plaque presence (PFV median (IQR) = 84 (56-140) in patients without plaque versus PFV median (IQR) = 109 (70-136) in patients with plaque presence, P = 0.4). The association between PFV with CAC persisted after adjustment for conventional cardiac risk factors. BMI showed no significant association with CAC, coronary stenosis severity and coronary plaque presence (P > 0.05). CONCLUSIONS: PFV was independently associated with CAC in diabetic patients. PFV, rather than obesity measured by BMI, could be used as an imaging biomarker for assessing coronary atherosclerotic burden in patients with DM.

ECG changes and markers of increased risk of arrhythmia in patients with myocardial bridge.

BACKGROUND: The clinical significance and prognosis of myocardial bridge (MB) is still a matter of debate. OBJECTIVES: To assess the novel ECG markers of T peak-to-end (Tp-e) interval, transmural dispersion of repolarization (TDR), is assessed by Tp-e/QT ratio, and index of electrophysiogical index(iCEB),is defined by QT/QRS ratio and changes (ST-T changes) in MB patients. PATIENTS AND METHODS: Forty one patients who were diagnosed as having MB (MB group) and other 41 patients without MB (non-MB group) at multi-detector CT (MDCT) exam matched by age, sex were enrolled in the study. RESULTS: iCEB was significantly increased in MB group in comparison to non-MB group particularly in patients with no coronary atherosclerosis (5.3 Vs 4.5, p = 0.04). Tp-e and TDR values were decreased in MB in comparison to non-MB patients particularly in patients with coronary atherosclerosis (69 Vs 80, p = 0.003 and 0.18 Vs 0.2, p = 0.01 respectively). Isolated T inversion in V1 was observed more in MB compared to non-MB patients (58% Vs 5%, p ≤ 0.0001) particularly in patients without coronary atherosclerosis. CONCLUSION: MB patients have shown decreased Tp-e and TDR markers particularly in MB patients with coronary atherosclerosis.

ECG markers of arrythmogenic risk relationships with pericardial fat volume and BMI in patients with coronary atherosclerosis.

BACKGROUND: Several novel ECG markers are proposed to predict the risk of sudden cardiac death in several clinical conditions in the recent years. However, little is known about the association of pericardial fat or obesity with these markers. OBJECTIVES: To assess the possible relationship between pericardial fat volume (PFV) and body mass index (BMI) with novel ECG markers (Tp-e, Tp-e/QT, Tp-e/QTc*QRS and QTc/QRS) in patients with coronary atherosclerosis. PATIENTS AND METHODS: We enrolled 100 patients with suspected coronary artery disease who underwent 64-slice multi-detector CT angiography. RESULTS: Higher values of Tp-e/QTc*QRS and QTc/QRS were observed among high PFV group in comparison to low PFV group particularly in patient with coronary atherosclerosis and these relationships persisted after adjustment for cardiac risk factors and coronary calcium score (CAC) while no significant differences in QTc, Tp-e, Tp-e/QTc and Tp-e/QRS values were observed between the PFV groups in patients without coronary atherosclerosis. There was no significant difference in QTc, Tp-e/QTc, Tp-e/QRS, Tp-e/QTc*QRS and QTc/QRS observed between the BMI groups either in patients with and without coronary atherosclerosis. CONCLUSION: PFV and not obesity measured by BMI is significantly associated with novel ECG markers of arrhythmia risk in patients with coronary atherosclerosis. These results could suggest the potential role of PFV in cardiac arrhythmogenesis through depolarization-repolarization conduction abnormalities.

Index of cardiac electrophysiological balance and transmural dispersion of the repolarization index relationships with pericardial fat volume and coronary calcification.

AIM: To assess the possible relationship between coronary atherosclerosis markers, pericardial fat volume (PFV) and coronary artery calcification, with ECG markers of index of the cardiac electrophysiological balance (iCEB) and transmural dispersion of the repolarization in patients with suspected coronary artery disease. METHODOLOGY: One hundred patients who underwent 64-slice multidetector computed tomography angiography were found to be eligible and were enrolled in the study. RESULTS: Patients with high iCEB levels tended to have a higher PFV values compared with patients with low iCEB levels (median [interquartile range]) (152 [29-206] vs 96 [14-177]; p = 0.03). No significant differences in coronary artery calcification values were observed between iCEB and transmural dispersion of the repolarization groups. CONCLUSION: A higher PFV value was observed in patients with high iCEB. Larger prospective studies are required to confirm the results.

Aortic Root Calcification: A Possible Imaging Biomarker of Coronary Atherosclerosis.

It has been reported that coronary atherosclerosis risk assessment using coronary artery calcium and thoracic aorta calcium quantification may improve risk stratification as it can lead to the reclassification of persons at increased risk. The aortic root has been characterized by its close anatomical proximity to the ostial origins of the right and left coronary arteries, and it can be evaluated using multi-detector computed tomography without additional radiation exposure and the use of contrast. The correlations between aortic root calcification and coronary atherosclerotic markers as well as cardiac risk factors have been analyzed.

Correlations between aortic root calcification and coronary artery atherosclerotic markers assessed using multidetector computed tomography.

RATIONALE AND OBJECTIVES: Atherosclerosis is a systemic process associated with arterial calcification in multiple vascular beds. This study investigated correlations between aortic root calcification (ARC) quantified using Agatston and volumetric scoring methods with coronary atherosclerotic markers (coronary artery calcification [CAC], calcified plaques, and luminal stenosis). MATERIALS AND METHODS: This cross-sectional study was carried out between January and December 2013. One hundred ninety-six consecutive patients with intermediate pretest probability of ischemic heart disease who underwent 64-slice multidetector computed tomography angiography were recruited, with 175 patients being eligible to enroll in the study. RESULTS: A significant correlation was observed between ARC and total CAC using the Agatston and volumetric scoring methods (r = 0.225; P = .003 and r = 0.243; P = .001, respectively). With regard to individual coronary vessel calcification and ARC, a significant correlation was observed between ARC and left main stem artery calcification calculated using the volumetric and Agatston scoring methods (P < .05). A significant correlation was observed between high ARC and presence of coronary calcified plaque measured using the Agatston and volumetric scoring methods. A strong correlation was also observed between ARC and number of coronary stenotic vessels measured using the Agatston and volumetric scoring methods (r = 0.67; P < .001 and r = 0.63; P < .001, respectively). CONCLUSIONS: ARC can be used as an additional marker to assess coronary atherosclerosis and may have a complementary role with CAC for detection of coronary artery disease.