Epicardial Adipose Tissue Thickness and Coronary Artery Disease: Role of Cardiac Magnetic Resonance Imaging
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-9.14209Keywords:
Adipose Tissue; Coronary Artery Disease; Magnetic Resonance Imaging; PericardiumAbstract
Objective: To determine mean epicardial adipose tissue (EAT) thickness using cardiac MRI in individuals with coronary artery disease (CAD) compared to controls.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, Pakistan; from July to September 2025.
Methodology: Eighty-four adults were recruited through consecutive sampling and allocated equally to CAD-Group (n = 42) and non-CAD-Group (n = 42). Greater than 50% luminal stenosis was used to identify CAD on CT coronary angiography (CTCA). Inclusion criteria included adults aged 25–55 years with either CTCA-confirmed CAD or normal coronary anatomy. Exclusion criteria comprised MRI contraindications (such as pacemakers, cochlear implants, or severe claustrophobia), nondiagnostic CMR images, prior PCI or CABG, previous valve surgery, known cardiomyopathies, eGFR <30 mL/min/1.73m², and active malignancy or recent chemotherapy or radiotherapy. All participants underwent non-contrast 3.0T cardiac MRI, and EAT thickness was measured at the left atrioventricular groove during end-diastole.
Results: Mean EAT thickness was significantly higher in CAD participants (13.24±3.32 mm) than in controls (11.49±2.15 mm) (p-value=0.005). Logistic regression demonstrated that each 1 mm increase in EAT thickness was independently associated with CAD (adjusted OR 1.256; 95% CI 1.061–1.487; p-value = 0.008).
Conclusion: EAT thickness assessed on non-contrast CMR was significantly elevated in CAD patients and independently associated with disease presence, supporting its potential as a noninvasive imaging biomarker for CAD risk assessment.
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References
1. Merelo-Nicolás M, Consuegra-Sánchez L, Pinar-Bermúdez E, Wasniewski S, León-Allocca RA, Ramos-Ruiz P, et al. Relationship of epicardial adipose tissue with coronary artery disease, cardiovascular risk factors and patient outcomes. REC Cardio Clin 2022; 57(3): 165-171.
https://doi.org/10.1016/j.rccl.2021.12.003
2. Guglielmo M, Penso M, Carerj ML, Giacari CM, Fusini L, Baggiano A, et al. Deep learning-based quantification of epicardial adipose tissue volume in cardiac magnetic resonance predicts major adverse cardiovascular events in patients with known or suspected CAD. Eur Heart J Cardiovasc Imaging 2023; 24(Suppl 1): jead119.038.
https://doi.org/10.1093/ehjci/jead119.038
3. Jehn S, Roggel A, Dykun I, Balcer B, Al-Rashid F, Totzeck M, et al. Epicardial adipose tissue and obstructive coronary artery disease in acute chest pain: the EPIC-ACS study. Eur Heart J Open 2023; 3(3): oead0410.https://doi.org/10.1093/ehjopen/oead041
4. Konwerski M, Gąsecka A, Opolski G, Grabowski M, Mazurek T. Role of epicardial adipose tissue in cardiovascular diseases: a review. Biology 2022; 11(3): 355.
https://doi.org/10.3390/biology11030355
5. Ding Y, Lin F, Liu Z, Zhou X, Liang X. Targeting epicardial/pericardial adipose tissue in cardiovascular diseases: a novel therapeutic strategy. Rev Cardiovasc Med 2025; 26(3): 26128. https://doi.org/10.31083/RCM26128
6. Shaheen S, Khan RN, Rehman A, Raza I, Fatima S, Mukhtar S. Coronary artery disease severity has a strong association with epicardial adipose tissue thickness. Pak J Med Health Sci 2022; 16(7): 249-251. https://doi.org/10.53350/pjmhs22167249
7. Guglielmo M, Lin A, Dey D, Baggiano A, Fusini L, Muscogiuri G, et al. Epicardial fat and coronary artery disease: role of cardiac imaging. Atherosclerosis 2021; 321: 30-38.
https://doi.org/10.1016/j.atherosclerosis.2021.02.008
8. Nakamura H, Masuda T, Yui N, Amano T, Naoto T. Comparison of epicardial adipose tissue volume of normal and coronary artery disease patients during diastolic and systolic phases of retrospective electrocardiogram-gated volume scan. Radiography 2025; 31(1): 220-223.https://doi.org/10.1016/j.radi.2024.11.018
9. Kim HM, Kim KJ, Lee HJ, Yu HT, Moon JH, Kang ES, et al. Epicardial adipose tissue thickness is an indicator for coronary artery stenosis in asymptomatic type 2 diabetic patients: its assessment by cardiac magnetic resonance. Cardiovasc Diabetol 2012; 11: 83. https://doi.org/10.1186/1475-2840-11-83
10. Khidr SS, Bakeer BM, Helmy HAR, Mahmoud AM, Abdalla AM, Hassan ME, et al. Cardiac magnetic resonance-quantified epicardial fat volume is associated with complex coronary artery disease among diabetics. Cardiovasc Diabetol 2025; 24(1): 64.
https://doi.org/10.1186/s12933-025-02606-x
11. Dell'Aversana F, Tuccillo R, Monfregola A, Celentano E, Sironi S, Caiani EG, et al. Epicardial adipose tissue volume assessment in the general population and CAD RADS 2.0 score correlation using dual source cardiac CT. Diagnostics 2025; 15(6): 681.
https://doi.org/10.3390/diagnostics15060681
12. Wang Q, Chi J, Wang C, Wang Y, Zhao H, Li Y, et al. Epicardial adipose tissue in patients with coronary artery disease: a meta-analysis. J Cardiovasc Dev Dis 2022; 9(8): 253.
https://doi.org/10.3390/jcdd9080253
13. Guglielmo M, Lin A, Dey D, Baggiano A, Fusini L, Muscogiuri G, et al. Pericoronary adipose tissue and coronary atherosclerosis: pathophysiology and imaging insights. Curr Atheroscler Rep 2021; 23(10): 62.
https://doi.org/10.1007/s11886-021-01589-9
14. Iacobellis G, Villasante Fricke AC. Epicardial fat: a novel cardiovascular risk marker. Int J Cardiol 2019; 278: 13-19.
https://doi.org/10.1016/j.ijcard.2018.11.115
15. Wang C, Yu W, Yang X, Sun F, Tian Y, Zhang J, et al. Association of epicardial fat volume index with coronary artery disease phenotypes based on anatomical and functional imaging: a linkage with the severity of coronary artery disease. Cardiovasc Diabetol 2025; 24(1): 289.
https://doi.org/10.1186/s12933-025-02897-0
16. Yu W, Chen Y, Zhang F, Wang Y, Liu X, Sun Z, et al. Association of epicardial adipose tissue volume with increased risk of hemodynamically significant coronary artery disease. Quant Imaging Med Surg 2023; 13(4): 2582-2593.
https://doi.org/10.21037/qims-22-709
17. Sun Y, Li X, Xu K, Zhang W, Wang H, Liu Y, et al. Relationship between epicardial fat volume on cardiac CT and atherosclerosis severity in three-vessel coronary artery disease. BMC Cardiovasc Disord 2022; 22(1): 76.
https://doi.org/10.1186/s12872-022-02527-7
18. Yang CD, Quan JW, Tay GP, Tan VH, Ooi CC, Chin CT, et al. Epicardial adipose tissue volume and density are associated with heart failure with improved ejection fraction. Cardiovasc Diabetol 2024; 23(1): 283.
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Copyright (c) 2026 Ali Abbas, Ayaz Ahmed, Sana Afnanzai, Muhammad Waleed Ghous, Muhammad Ayaz
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