Correlation of Pericoronary and Epicardial Fat Attenuation With Severity of Coronary Artery Disease: A Retrospective Study

Q: What are the key findings of this study?

Epicardial and LAD pericoronary fat attenuation were significantly more negative in CAD-RADS 3-5 vs 0-2 (-94.0 vs -64.5 HU and -90.0 vs -57.0 HU; both p<0.001, AUC 1.000).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary artery disease (n=100). Intervention: High CAD-RADS (3-5) obstructive coronary artery disease vs. Low CAD-RADS (0-2) non-obstructive or absent coronary artery disease. Primary outcome: Median epicardial fat attenuation (Hounsfield Units, HU) (p=<0.001).

Q: What does this research mean for the field?

Epicardial and pericoronary fat attenuation values on CT angiography are significantly more negative in patients with obstructive coronary artery disease compared to those with non-obstructive disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the correlation between epicardial and peri-coronary fat attenuation and the severity of coronary artery disease using coronary computed tomography angiography.

Shibani Mehra; Shraddha Joshi; Himanshi Batra; Munish Guleria; Ajay Kumar Sharma

doi:10.36106/paripex/9002874

October 15, 2026PARIPEX-INDIAN JOURNAL OF RESEARCHOpen Access

Correlation of Pericoronary and Epicardial Fat Attenuation With Severity of Coronary Artery Disease: A Retrospective Study

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Key result

More negative epicardial fat attenuation links to higher CAD-RADS severity, shifting ~30 HU in CAD-RADS 3-5.

P<0.001
n=100

Why the study?

Regional fat deposits such as epicardial fat are strong predictors of coronary artery disease. This study evaluated the association between the severity of coronary artery disease and epicardial and peri-coronary fat attenuation on computed tomography angiography.

Does epicardial and peri-coronary fat attenuation on non-contrast cardiac CT correlate with and discriminate the severity of coronary artery disease (high vs. low CAD-RADS) in patients undergoing coronary CT angiography?

Key Points

To evaluate the correlation between epicardial and peri-coronary fat attenuation and the severity of coronary artery disease using coronary computed tomography angiography.
Conducted a retrospective cross-sectional study of 100 patients referred for coronary CT angiography.
Stratified patients into low CAD-RADS (0–2) and high CAD-RADS (3–5) categories to evaluate epicardial and peri-coronary fat attenuation in negative Hounsfield units.
Compared groups using the Mann-Whitney U test or independent t-test, evaluated relationships with Spearman rank correlation, and assessed diagnostic performance via receiver operating characteristic curve analysis.
Median attenuation of epicardial fat was -64.5 HU (IQR -67.75 to -57.25) in CAD-RADS 0–2 versus -94.0 HU (IQR -98.0 to -87.0) in CAD-RADS 3–5 (p < 0.001).
Median peri-coronary fat attenuation around both the left anterior descending and right coronary arteries was -57.0 HU in CAD-RADS 0–2 versus -90.0 HU in CAD-RADS 3–5 (p < 0.001 for both).
Epicardial fat and left anterior descending peri-coronary fat attenuation both showed an area under the curve of 1.000 for high CAD-RADS at a cut-off of -79.0 HU, displaying significant negative correlations with disease severity (ρ = -0.742 and ρ = -0.772, respectively; p < 0.001).

Study Design

Type

Cross-Sectional (n=100)

Multicenter

No

Structured PICO

Does epicardial and peri-coronary fat attenuation on non-contrast cardiac CT correlate with and discriminate the severity of coronary artery disease (high vs. low CAD-RADS) in patients undergoing coronary CT angiography?

P

Population

100 patients (mean age 62.9 years, range 32-90) referred for coronary CT angiography at a single center in India, stratified into low CAD-RADS (0-2, n=50) and high CAD-RADS (3-5, n=50).

E

Exposure

Prospective gated cardiac CT angiography on a 128-slice dual-source CT scanner with evaluation of epicardial fat attenuation (at the apex) and peri-coronary fat attenuation (within 0.5 cm from the origin of the LAD and RCA) using a 1 cm² region of interest on non-contrast CT calcium scoring window in the axial plane (with prior 5 mg sublingual isosorbide to all patients and oral propranolol to those not in normal sinus rhythm).

C

Comparator

Comparison between patients with high CAD-RADS (categories 3, 4a, 4b, and 5; n=50) and low CAD-RADS (categories 0, 1, and 2; n=50).

O

Outcome

Association between epicardial and peri-coronary (LAD and RCA) fat attenuation (in Hounsfield Units) and severity of coronary artery disease (CAD-RADS category).surrogate

Main Result

Absolute Event Rate: -94% vs -64.5%

p-value: p=<0.001

More negative epicardial and peri-coronary fat attenuation values on non-contrast cardiac CT strongly correlate with higher CAD-RADS scores and may serve as a non-invasive imaging biomarker for obstructive coronary artery disease.

Limitations

Study population was not entirely uniform, which may have influenced the assessment of subepicardial adipose tissue
Retrospective single-center cross-sectional design with small sample size (N=100) and missing age data for 29 patients
Use of epicardial and pericoronary adipose tissue attenuation as a screening modality in non-cardiac chest scans requires further study and validation
The study population was not entirely uniform, which may have influenced the assessment of subepicardial adipose tissue.
The use of EAT and PCAT attenuation as a screening modality in non-cardiac chest scans requires further study and validation for use as an effective screening modality.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Should not yet change CAD assessment on CT; leaves open prospective validation of fat attenuation as severity biomarker.

Abstract

Background and Purpose.Cardiovascular disease is among the foremost causes of death worldwide.Regional fat deposits, especially the epicardial fat, have emerged as a strong predictor of coronary artery disease.Computed tomography angiography is currently the only modality allowing for characterization of morphological changes in epicardial and peri-coronary adipose tissue and simultaneous assessment of coronary atherosclerosis.The aim of this study was to evaluate the association between severity of coronary artery disease and epicardial and peri-coronary fat attenuation.This was a retrospective cross-sectional study conducted in the department of Radiodiagnosis, Methods.which included 100 patients referred to the department for coronary CT angiography.The patients were stratified into low CAD-RADS (0-2) and high CAD-RADS (3-5) and epicardial and peri-coronary fat attenuation evaluated.Quantitative data were assessed for normality using the Shapiro-Wilk test and compared between groups using the Mann-Whitney U test or independent t-test as appropriate.Associations with CAD-RADS severity were examined using Spearman rank correlation, and discriminatory performance was assessed using receiver operating characteristic (ROC) curve analysis.Our study found a statistically significant difference in epicardial and peri-coronary fat attenuation Results.between the two groups of patients, with a p-value of less than 0.001.Fat attenuation values were corrected to their physiological negative HU range for this analysis.The median attenuation of epicardial fat in the CAD-RADS 0-2 category was -64.5 HU and in the CAD-RADS 3-5 category was -94.0 HU.The median attenuation of peri-coronary fat around the left anterior descending artery was -57.0 HU in CAD-RADS category 0-2 and -90.0 HU in CAD-RADS category 3-5.For peri-coronary fat around the right coronary artery, median attenuation was -57.0 HU in CAD-RADS category 0-2 and -90.0 HU in CAD-RADS category 3-5.Epicardial fat and LAD peri-coronary fat attenuation showed excellent discrimination between the two groups (area under the curve = 1.000), with RCA attenuation and LV thickness also performing strongly.. There is a statistically significant association between epicardial and peri-coronary Conclusions fat attenuation and CAD severity, with more negative attenuation values seen in patients with higher CAD-RADS (3-5) compared to patients with lower CAD-RADS (0-2).It may serve as a non-invasive imaging biomarker for risk stratification and prognostication of obstructive CAD.

Discussion

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Cite This Study

Mehra et al. (2026) conducted a cross-sectional in Coronary artery disease (n=100). High CAD-RADS (3-5) obstructive coronary artery disease vs. Low CAD-RADS (0-2) non-obstructive or absent coronary artery disease was evaluated on Median epicardial fat attenuation (Hounsfield Units, HU) (p=<0.001). Epicardial and LAD pericoronary fat attenuation were significantly more negative in CAD-RADS 3-5 vs 0-2 (-94.0 vs -64.5 HU and -90.0 vs -57.0 HU; both p<0.001, AUC 1.000).

synapsesocial.com/papers/6aebc8ba3e63ca1b6c315e68 https://doi.org/10.36106/paripex/9002874

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Correlation of Pericoronary and Epicardial Fat Attenuation With Severity of Coronary Artery Disease: A Retrospective Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Correlation of Pericoronary and Epicardial Fat Attenuation With Severity of Coronary Artery Disease: A Retrospective Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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