CT-based Epicardial Adipose Tissue Change as a Promising Biomarker of Obstructive Coronary Artery Disease Progression: A Longitudinal Observational Study

OBJECTIVES: To evaluate the association between CT-based longitudinal changes in epicardial adipose tissue (EAT) volume and obstructive coronary artery disease (CAD) progression. METHODS: We included 583 suspected CAD patients (median age, 60 years; 348 men) who underwent coronary CT angiography (CCTA) between June 2010 and June 2017, and received follow-up CCTA at an interval of ≥ 2 years (median interval, 3.33 years; IQR, 2.67 to 4.33 years). 107 patients progressed to obstructive CAD. EAT volume and coronary artery calcium score (CACS) were measured on non-contrast CCTA. Annualised EAT volume change was calculated as the difference between follow-up and baseline scans divided by the follow-up duration. Obstructive CAD progression was defined as new-onset ≥50% stenosis in initially non-obstructive patients. The association of EAT with obstructive CAD progression was evaluated by univariate and multivariate logistic regression. RESULTS: Annualised EAT volume change was 3.47 cm³ in the obstructive progression group and 2.07 cm³ in the no obstructive progression group (P = 0.006). In univariate analysis, only age, CACS, baseline largest luminal diameter stenosis and annualised EAT volume change were significantly associated with obstructive CAD progression. Annualised EAT volume change remained independently associated with obstructive CAD progression (adjusted OR = 1.06, P = 0.007) after adjustment for variables significant in univariate analysis. CONCLUSIONS: Annualised EAT volume change was independently associated with obstructive CAD progression. ADVANCES IN KNOWLEDGE: Annualised EAT volume change may represent a CT-based imaging marker of obstructive CAD progression.