Can epicardial fat tissue thickness help determine the need for coronary angiography before heart valve surgery?

Epicardial adipose tissue (EAT) is proposed to be a marker of cardiovascular risk. We aimed to evaluate the association of EAT with the presence of coronary artery disease (CAD) in patients with valvular heart disease.

A total of 72 patients scheduled for heart valve surgery were included in this prospective study. EAT was measured by transthoracic echocardiography (TTE) preoperatively. EAT thickness with positive coronary angiography (CAG) results were compared with the negative ones. The Mann-Whitney U test and Spearman Correlation was used to analyse in terms of non-normally distributed variables. The diagnostic decision-making characteristics of the presence of coronary lesions in the prediction of EAT were examined by ROC analysis.

Patients with concomitant hypertension (HT) disease had higher EAT thickness than without HT disease (4.11 mm vs 3.57 mm, p = 0.02). Median values were 4.10 (IQR 1.50) and 3.60 (IQR 0.80) respectively. Patient with CAD had significantly higher EAT thickness than without CAD (4.87 mm vs 3.50 mm; p < 0.001). Median values were 4.80 (IQR 0.80) and 3.50 (IQR 0.85), respectively. Smoking habit (Rho = 0.414, p = 0.013), ascending aortic diameter (Rho = 0.24, p = 0.043) and body/mass index (Rho = 0.360, p = 0.002) had positive correlation with EAT thickness. To define diagnostic value of EAT in predicting coronary lesion, UAC was calculated 0.929 in ROC analysis (p < 0.001). When the cut-off point was selected as 4.3 mm, EAT strongly predicts presence of any coronary lesion (sensitivity 78%, specificity 92%).

EAT thickness > 4.3 mm is a strong predictor of suspected CAD and may help determine the need for CAG in patients undergoing heart valve surgery.