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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Application of Epicardial Fat Volume for Identifying Hemodynamically Significant Coronary Artery Disease: A
Wenqi Lu1,2, Zhe Zhang2, Ling Wang2
1The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
Insights
Epicardial fat volume (EFV) is a significant independent predictor of hemodynamically significant coronary artery disease (HS-CAD). Adding EFV to clinical risk factors and coronary artery calcium score (CACS) improves HS-CAD risk stratification.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) risk stratification is crucial for patient management.
- Coronary computed tomography angiography (CCTA) is widely used, necessitating advanced imaging biomarkers.
- Current methods like coronary artery calcium score (CACS) may not fully capture plaque activity.
Purpose of the Study:
- To investigate the association between epicardial fat volume (EFV) and hemodynamically significant coronary artery disease (HS-CAD).
- To evaluate the incremental diagnostic value of EFV beyond clinical risk factors and CACS for HS-CAD detection.
Main Methods:
- A retrospective study of 140 patients who underwent both CCTA and SPECT-MPI.
- Quantitative assessment of EFV and CACS.
- Logistic regression analysis to identify independent predictors of HS-CAD.
Main Results:
- EFV and CACS were significantly higher in patients with HS-CAD.
- Smoking history, CACS, and EFV were independent predictors of HS-CAD.
- The combination of smoking history, CACS, and EFV achieved an AUC of 0.90 for HS-CAD prediction, showing significant improvement.
Conclusions:
- EFV is independently associated with HS-CAD.
- EFV offers incremental diagnostic value for HS-CAD risk stratification.
- EFV may serve as a valuable biomarker, requiring prospective validation.
Background:
With the widespread application of coronary computed tomography angiography (CCTA), exploring novel biomarkers in imaging data to optimize the risk stratification of hemodynamically significant coronary artery disease (HS-CAD) has become a research hotspot. HS-CAD was defined as ≥50% stenosis on CCTA with a corresponding reversible perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Although coronary artery calcium score (CACS) is routinely used, it is difficult to fully reflect the biological activity and functional impact of plaques. This single-center retrospective study aimed to investigate the association between epicardial fat volume (EFV) and HS-CAD, and to evaluate its incremental diagnostic value over clinical risk factors and the CACS.
Methods:
A single-center retrospective study included 140 patients who underwent both CCTA and SPECT-MPI. EFV and CACS were quantitatively assessed. Univariable and multivariable logistic regression analyses were performed to identify independent predictors.
Results:
Among the included patients, 50 (35.7%) had HS-CAD. The HS-CAD group had a higher prevalence of smoking and significantly greater EFV and CACS (all P<0.05). Multivariable analysis identified smoking history (OR=5.79;95% CI:2.14-15.66; indicating that smokers had nearly 6-fold higher odds of HS-CAD), CACS (OR=1.91 per 100-unit increase;95% CI:1.35-2.70), and EFV (OR=1.04 per cm3 increase;95% CI:1.02-1.07) as independent predictors (all P<0.01). The optimal EFV cutoff for predicting HS-CAD was 91.98 cm3, with a sensitivity of 0.53 (95% CI: 0.42-0.63) and specificity of 0.96 (95% CI: 0.91-1.00). The area under the curve (AUC) for identifying HS-CAD was 0.78 for EFV alone and 0.79 for CACS alone. The combination of smoking history and CACS yielded an AUC of 0.84, which significantly improved to 0.90 after adding EFV. The combined model also showed good calibration and provided a net clinical benefit.
Conclusion:
EFV is independently associated with HS-CAD and provides incremental diagnostic value over clinical risk factors and CACS in this single-center retrospective study. These findings suggest that EFV may serve as a valuable biomarker for improving non-invasive risk stratification, warranting prospective validation in multicenter studies.
