Reference values for epicardial adipose tissue: data from 27,500 CT scans in the general population and symptomatic patients.
Authors
Affiliations (11)
Affiliations (11)
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: [email protected].
- Division of Biomedical Imaging, KTH Royal Institute of Technology, Stockholm, Sweden.
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland; Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland.
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Sahlgrenska Academy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, and CMIV, Linköping University, Linköping, Sweden; Department of Clinical Physiology in Linköping, Region Östergötland, Linköping, Sweden.
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
- Department of Surgical Sciences, Uppsala University, Sweden; Department of Surgical Sciences, SciLifeLab, Uppsala University, Sweden.
- Unit of Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
- Departement of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland; Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
Abstract
Increased epicardial adipose tissue volume (EATV) is a potentially important risk marker for coronary artery disease (CAD) available from cardiac computed tomography (CT) images. Sex differences and effects of age and body size on EATV have been insufficiently explored, and no reliable reference values exist. Consequently, EATV has yet to find its deserved use in clinical practice. To define normal values by sex and age, the best normalization procedure for EATV to neutralize effects of body size, explore the relationship between normalized EATV and cardiac risk, and propose a clinically meaningful cut-off. AI-based automated EATV data from the general population (n = 25,155) and a clinical cohort (n = 2,482) with suspected CAD was normalized to height, BSA and heart volumes. Correlation between EATV and EAT attenuation (EATA) was tested with Spearman's rank correlation and linear regression to find the optimal normalization. Normalized EATV was compared to high-risk by SCORE2 and obstructive CAD in the population cohort. A cut-off including 95% of cases with obstructive CAD was defined in the general population and tested in the clinical cohort. EATV varied with sex and age across cohorts. Normalization of EATV to total heart volume (EATVh) improved correlation with EATA and successfully neutralized sex differences. High-risk by SCORE2 and the prevalence of obstructive CAD increased over quartiles of EATVh in the population cohort, and significantly higher EATVh was seen with obstructive CAD in both cohorts. A cut-off of 0.1 in EATVh had a negative predictive value for obstructive CAD of 97.1% in the general population and 88.9% in the clinical cohort. EATV varies considerably with sex, age and body size. EATVh is largely sex-neutral and likely reflects true EAT expansion better than absolute EATV. EATVh is a potentially useful marker of obstructive CAD in both the general population and symptomatic patients.