Djaberi Roxana, Schuijf Joanne D, van Werkhoven Jacob M, Nucifora Gaetano, Jukema J Wouter, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2008 Dec 15;102(12):1602-7. doi: 10.1016/j.amjcard.2008.08.010. Epub 2008 Oct 14.
Adipose tissue surrounding the coronary arteries has been suggested to induce development of atherosclerosis. We explored the relation between epicardial adipose tissue (EAT) volume and coronary atherosclerosis using multislice computed tomography. The study population consisted of 190 patients who had undergone multislice computed tomographic coronary angiography. Coronary artery calcium score was assessed. In addition, patients were classified as having (1) no atherosclerosis, (2) nonobstructive atherosclerosis (luminal narrowing <50%), (3) obstructive atherosclerosis (luminal narrowing >or=50%) in a single vessel, or (4) obstructive atherosclerosis in the left main coronary artery and/or multiple vessels. Cross-sectional tomographic cardiac slices (3.00-mm thickness, range 35 to 40 slices per heart) were traced semiautomatically from the border of EAT below the apex to a point at the center of the left atrium. Tissue with values from -250 to -30 HU was assigned as EAT. EAT volume within the traced area was then automatically quantified. Mean EAT volume was 84 +/- 41 ml. Patients with a coronary artery calcium score >10 had significantly larger average EAT volume (100 +/- 40 ml) compared with patients with calcium scores <or=10 (59 +/- 27 ml, p <0.001). Sensitivity and specificity for prediction of a calcium score >10 were 77% and 70% with a cut-off EAT value of 73 ml. In patients with normal coronaries mean EAT volume (63 +/- 31 ml) was significantly smaller than in patients with atherosclerosis (99 +/- 40 ml, p <0.001). Using a cut-off EAT volume of 75 ml, the sensitivity and specificity for presence of atherosclerosis were 72% and 70%. Interestingly, quantity of EAT did not significantly increase with increasing extent or severity of atherosclerosis. After adjustments for risk factors EAT volume remained a significant predictor of coronary atherosclerosis (p = 0.001). In conclusion, a significant relation was shown between EAT volume and presence of coronary atherosclerosis. Quantification of EAT may be useful to identify patients at risk for coronary artery disease.
冠状动脉周围的脂肪组织被认为会诱发动脉粥样硬化的发展。我们使用多层计算机断层扫描技术探究了心外膜脂肪组织（EAT）体积与冠状动脉粥样硬化之间的关系。研究人群包括190例接受过多层计算机断层扫描冠状动脉造影的患者。评估了冠状动脉钙化积分。此外，患者被分类为：（1）无动脉粥样硬化；（2）非阻塞性动脉粥样硬化（管腔狭窄<50%）；（3）单支血管的阻塞性动脉粥样硬化（管腔狭窄≥50%）；或（4）左主干冠状动脉和/或多支血管的阻塞性动脉粥样硬化。从心尖下方的EAT边界到左心房中心的一点，半自动追踪横断面心脏切片（厚度3.00毫米，每个心脏范围35至40层）。值在-250至-30 HU之间的组织被指定为EAT。然后自动定量追踪区域内的EAT体积。平均EAT体积为84±41毫升。冠状动脉钙化积分>10的患者平均EAT体积（100±40毫升）显著大于钙化积分≤10的患者（59±27毫升，p<0.001）。当EAT值截断为73毫升时，预测钙化积分>10的敏感性和特异性分别为77%和70%。在冠状动脉正常的患者中，平均EAT体积（63±31毫升）显著小于患有动脉粥样硬化的患者（99±40毫升，p<0.001）。当EAT体积截断为75毫升时，动脉粥样硬化存在的敏感性和特异性分别为
