Relación del volumen de grasa epicárdica con los factores de riesgo cardiovascular clásicos, la presencia de enfermedad arterial coronaria y los eventos clínicos

Abstract

Introduction and objectives: The epicardial adipose tissue is a metabolically active fat depot that has shown to be implicated in the development of coronary artery disease and the prediction of cardiovascular events. However, the way both factors interact is controversial, and these findings might be influenced by body size since previous studies have demonstrated a strong correlation between the amount of epicardial fat and anthropometric measurements. Our objective was to assess the association between indexed epicardial adipose tissue volume and the presence of coronary artery disease, cardiovascular events and the cardiovascular risk profile in a cohort of symptomatic patients. Methods: Patients referred for cardiac computed tomography from March 2010 to April 2017 were included. Coronary artery disease was defined as the presence of obstructive coronary stenosis or a high amount of coronary calcium. Epicardial adipose tissue volume was assessed using a semiautomatic software and indexed to body surface area. A regression analysis was performed to determine the relationship between relevant coronary artery disease and indexed epicardial adipose tissue, age, sex, cardiovascular risk factors, and comorbidities. The association between indexed epicardial adipose tissue and cardiovascular events was analyzed with Cox regression models. Results: A total of 179 patients were recruited (56 ± 12 years, 57.5% male). Indexed epicardial adipose tissue (p = 0.003), age (p <0.001) and male sex (p < 0.001) were significantly and independently associated with coronary artery disease. During follow-up (5.5 years, 2.4 – 6.4) patients with elevated indexed epicardial adipose tissue showed an increased risk of events (HR 2.44; 95% CI, 1.07 - 5.56; p = 0.033). Furthermore, this volume is higher in subjects with hypertension (p < 0.001), diabetes (p < 0.001) and dyslipidemia (p = 0.008). Conclusions: In symptomatic patients, an increased volume of indexed epicardial fat was associated with obstructive coronary artery disease as well as with cardiovascular events. Patients with cardiovascular risk factors show a high amount of epicardial adipose tissue.