Introduction: Recent studies have shown the relationship between the epicardial adipose tissue (EAT) and an enhanced systemic inflammation. In recent years, EAT has been intensely studied due to its possible role as a marker of cardiovascular risk. Despite this, there are still unanswered questions regarding its role in the pathophysiology of acute coronary syndromes.
Objective: To evaluate the relationship between an increased epicardial adipose tissue volume, measured via computed tomography angiography (CTA) and the presence of CT coronary plaque vulnerability markers in patients with unstable angina pectoris.
Methods: The study enrolled 100 patients with unsta-ble angina (UA), for which the following data were collected: clinical and laboratory parameters, medical his-tory, the presence of cardiovascular risk factors and comorbidities. For all study subjects, 128-slice CTA was performed, followed by calculation of the EAT volume and assessment of vulnerability markers in the culprit coronary lesion: plaque burden (PB) >70%, presence of low attenuation plaque (LAP) with <30 HU density, positive remodeling (PR), spotty calcifications (SC) and remodeling index (RI). Study population was cate-gorized into 2 groups: group 1: patients with ≥2 vulnerability markers (n=55), and group 2: patients with <2 vulnerability markers in the culprit lesion (n=45).
Results: Mean age of the study lot was 65.8±11.1 years, and there were no differences between the two groups in relation to cardiovascular risk factors (smo-king: p=0.68; hypertension: p=1.00; diabetes mellitus: p=0.89; obesity: p=1.00). Median EAT volume was 108.0 ml for the overall population, and the compara-tive analysis between groups revealed that gr. 1 presen-ted a significantly higher EAT volume as compared to group 2 (118.2±15.0 ml versus 85.8±12 ml, p=0.001). Patients with an EAT volume larger than 100 ml pre-sented a significantly higher number of vulnerability features compared to subjects with an EAT of <100 ml: PB: 64.2% vs. 42%, p=0.04; LAP: 78.2% vs. 43%, p=0.009; SC: 75.2% vs. 48.5%, p=0.007; RI: 68.4% vs. 43%, p=0.009).
Conclusions: The volume of epicardial adipose tissue was shown to be significantly more increased in pati-ents who present more than two CT features of plaque vulnerability. Moreover, patients with increased volu-mes of EAT (larger than 100 ml) present significantly higher number of vulnerability markers compared to those with low EAT volumes. Epicardial adipose tissue could become a new predictor for coronary vulnerabi-lity in patients with coronary artery disease.