Prognostic impact of epicardial fat volume, anatomical and functional imaging across the cardiovascular risk spectrum in patients with suspected coronary artery disease: a single-center retrospective cohort study.
Higher epicardial fat volume independently predicted long-term major cardiac events.
Prognostic impact of epicardial fat volume, anatomical and functional imaging across the cardiovascular risk spectrum in patients with suspected coronary artery disease: a single-center retrospective cohort study.
Epicardial adipose tissue (epicardial adipose tissue) is associated with coronary artery disease (coronary artery disease) and adverse cardiovascular outcomes; however, its prognostic relevance across different cardiovascular risk scores remains uncertain.
This study evaluated the long-term prognostic significance of epicardial adipose tissue, coronary anatomical findings, and functional ischemia in patients with suspected coronary artery disease stratified by Framingham risk score (framingham risk score) categories.
A consecutive retrospective cohort of 361 symptomatic patients who underwent both single-photon emission computed tomography/computed tomography myocardial perfusion imaging (SPECT/computed tomography MPI) and coronary angiography (coronary angiography) or coronary computed tomography angiography (coronary computed tomography angiography) at baseline was analyzed.
higher epicardial fat volume more than doubled the risk of major cardiac events
Epicardial fat volume improved risk discrimination over framingham risk score, calcium score, obstructive coronary artery disease, and ischemia burden (all P<0.05).
In the stratified analyses, calcium score (aHR =2.88; P=0.017) and obstructive coronary artery disease (aHR =3.69; P=0.005) predicted major adverse cardiovascular events in low-to-intermediate framingham risk score patients, whereas epicardial fat volume (aHR =3.13; P=0.020) and ischemia burden (aHR =4.67; P=0.005) were only associated with major adverse cardiovascular events in high-risk framingham risk score patients.
Epicardial fat volume independently predicted long-term major adverse cardiovascular events and improved prognostic discrimination beyond clinical risk, anatomical imaging, and functional ischemia.
Prognostic determinants varied by cardiovascular risk level, with anatomical markers being more informative in lower-risk patients, while epicardial fat volume and functional ischemia were more informative in high-risk and diabetic patients.
These findings support a risk-adapted strategy for the use of quantitative imaging biomarkers in patients with suspected coronary artery disease.