Association of Epicardial Adipose Tissue Thickness by Echocardiography With Coronary Artery Disease

Background: Epicardial adipose tissue (EAT) mimics visceral fat which is associated with metabolic derangements and coronary artery disease (CAD). EAT volume (EAT-V) measured by CT scan had shown good correlation with CAD. QRISK3 score is a validated risk predictor of future cardiovascular events but has limitations. We assessed whether EAT thickness (EAT-T) measured by echocardiography, a simple and widely available tool, correlated with EAT-V, and whether EAT-T is a predictor of CAD independently of QRISK3 scores. Methods: We enrolled 97 patients who underwent CTA for evaluation of chest pain. EAT-T was measured by 2D-echocardiography in parasternal long axis (PLAX) and parasternal short axis (PSAX) views. We evaluated association of EAT-T with EAT-V and CAD (≥50% stenosis on CTA); and independent predictive value of EAT-T for CAD after adjusting for QRISK 3 scores. Results: EAT-T was significantly more in patients with CAD (PLAX: 4.82 ± 1.31 mm vs. 4.06 ± 1.25 mm, p=0.005). EAT-T correlated strongly with EAT-V (r=0.75, p<0.001). On receiver operating characteristic curve analysis, EAT-T (PLAX) ≥3.9 mm (area-under-curve: 0.68; 95% CI: 0.58-0.79, sensitivity 84%, specificity 55%) predicted the presence of CAD. On multivariate analysis after adjusting for QRISK 3 scores, EAT-T showed significant association with CAD with highest odds ratio for indexed EAT-T (EAT-T/body surface area) (PLAX) ≥2.2 mm/m2 (OR 5.40; 95% CI: 2.17-13.55.; p<0.001). Conclusion: EAT-T is a predictor of CAD independent of QRISK3 scores. An increased EAT-T detected CAD with >80% sensitivity. These findings need to be validated in larger prospective cohort studies.