Abstract 534: Pericardial Adipose Tissue Increases the Prognostic Value of Coronary Artery Calcium
Objectives: Coronary artery calcium (CAC) is a well established predictor of future cardiovascular events. As demonstrated before pericardial adipose tissue (PAT) is associated with coronary artery plaque burden. We evaluated the possible incremental prognostic value of PAT over CAC in long term prognosis and survival of patients with stable coronary artery disease (CAD).
Methods: 145 patients (94 men, age 60 ± 10) with stable CAD, defined by the criterion of at least one coronary artery stenosis >50 % in coronary angiography and/or prior myocardial infarction underwent CAC scanning. CAC scanning was performed by a multislice CT (Somatron Sensation 4 or 16, Siemens AG, Forchheim, Germany) using a standard protocol. The same images were used to measure pericardial adipose tissue. The volume of pericardial fat was measured in cm3 using the Volume Analysis software tool of our cardiac workstation (Siemens, Leonardo). After segmentation of the heart and surrounding adipose tissue from the remainder of the thorax, a threshold of −250 to −30 HU was applied to isolate the adipose tissue containing voxels. Over a median follow-up time of 5.4 years severe cardiac events (SE, cardiac death, nonfatal myocardial infarction and coronary angioplasty) were registered in 145 patients with stable CAD.
Results: 34 patients suffered from a severe cardiac event. The CAC of these patients was significantly higher compared to those without coronary events (1708 ± 2269 vs. 538 ± 1150, p < 0.001). The calcium score showed a high correlation with the relative risk of a future cardiac event: 1.4 for patients with scores from 100–400, 3.1 for scores 401–1000, and 5.9 for scores above 1001. In these subgroups the events rate and relative risk for cardiovascular events increased significantly ( p < 0.01) if additionally a PAT volume above 200ml was determined. In these patients a relative risk of 1.8 for scores 100–400, 4.7 for scores 401 to 1000, and 6.8 for scores above 1000 was calculated.
Conclusion: The additional determination of PAT increases the predictive power of CAC for future cardiovascular events. PAT might therefore be a further parameter for risk stratification.