Key result
Higher EATVh linked to ~89% higher MI risk per IQR in women under 55.
Why the study?
Increased epicardial adipose tissue volume is a risk marker for future myocardial infarction, but its incremental predictive value beyond SCORE2, coronary artery calcium score, and coronary artery segment involvement score remained poorly studied.
Does adding epicardial adipose tissue volume normalized to heart volume (EATVh) to SCORE2, CACS, and SIS improve the prediction of future myocardial infarction in a general population cohort of adults aged 50-64?
Cohort (n=25,155)
Does adding epicardial adipose tissue volume normalized to heart volume (EATVh) to SCORE2, CACS, and SIS improve the prediction of future myocardial infarction in a general population cohort of adults aged 50-64?
Epicardial adipose tissue volume normalized to heart volume provides modest, independent incremental predictive value for future myocardial infarction in women beyond SCORE2, coronary artery calcium score, and plaque burden, though not in men.
Answers are grounded in this paper and cite their sources.
EATVh assessment warrants caution before clinical adoption for MI prediction; leaves open its incremental utility beyond SCORE2, CACS, and SIS in larger cohorts.
BACKGROUND: Increased epicardial adipose tissue volume (EATV) is a risk marker for future myocardial infarction (MI), but its value beyond SCORE2 (Systemic Coronary Risk Evaluation 2), the coronary artery calcium score (CACS) and the coronary artery segment involvement score (SIS) remains poorly studied. OBJECTIVES: To determine the incremental value of EATV normalized to heart volume (EATVh) on top of SCORE2, CACS and SIS in predicting future MI. METHODS: We studied associations between EATVh, SCORE2, CACS, SIS and the risk of MI in a general population cohort of 25,155 participants (age 50-64, 50.7% women). Sex-stratified multivariable Cox-regression estimated hazard ratios (HR) and ROC-analysis with variables dichotomized at their 75th percentile assessed incremental predictive value. RESULTS: A total of 304 MI (71 in women) occurred during follow-up (median: 7.8 years). In adjusted analysis, EATVh and SCORE2 were independently associated with MI in women, but only SIS and SCORE2 in men. The highest HR per EATVh IQR was found in women <55 years (1.89). ROC-analysis showed that adding EATVh to SCORE2, CACS and SIS improved MI prediction in women but not men (AUC: 0.681 vs. 0.667; p < 0.05 for both). CONCLUSIONS: EATVh provides independent, modest incremental information on the risk of future MI in women on top of CACS and SIS, but not in men. Further studies in more diverse population segments including younger and symptomatic individuals are warranted.
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Molnár et al. (2026) conducted a cohort in Myocardial infarction risk in the general population (n=25,155). Epicardial adipose tissue volume normalized to heart volume (EATVh) on top of SCORE2, CACS, and SIS vs. SCORE2, CACS, and SIS alone was evaluated on Myocardial infarction (MI) (HR 1.89 (per EATVh IQR in women <55 years); AUC 0.681 vs. 0.667 in women, p=<0.05). Adding EATVh to SCORE2, CACS, and SIS modestly improved MI prediction in women (AUC 0.681 vs. 0.667, p<0.05), with an HR of 1.89 per IQR in women <55 years, but not in men.
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