Quantification of epicardial fat with cardiac CT angiography and association with cardiovascular risk factors in symptomatic patients: from the ALTER-BIO (Alternative Cardiovascular Bio-Imaging markers) registry

PURPOSE We aimed to assess the association between features of epicardial adipose tissue and demographic, morphometric and clinical data, in a large population of symptomatic patients with clinical indication to cardiac computed tomography (CT) angiography. METHODS Epicardial fat volume (EFV) and adipose CT density of 1379 patients undergoing cardiac CT angiography (918 men, 66.6%; age range, 18-93 years; median age, 64 years) were semi-automatically quantified. Clinical variables were compared between diabetic and nondiabetic patients to assess potential differences in EFV and adipose CT density. Multiple regression models were calculated to find the clinical variables with a significant association with EFV and adipose CT density. RESULTS The median EFV in diabetic patients (112.87 mL) was higher compared with nondiabetic patients (82.62 mL; P < 0.001). The explanatory model of the multivariable analysis showed the strongest associations between EFV and BMI (beta=0.442) and age (beta=0.365). Significant yet minor association was found with sex (beta=0.203), arterial hypertension (beta=0.072), active smoking (beta=0.068), diabetes (beta=0.068), hypercholesterolemia (beta=0.046) and cardiac height (beta=0.118). The mean density of epicardial adipose tissue was associated with BMI (beta=0.384), age (beta=0.105), smoking (beta=0.088), and diabetes (beta=0.085). CONCLUSION In a large population of symptomatic patients, EFV is higher in diabetic patients compared with nondiabetic patients. Clinical variables are associated with quantitative features of epicardial fat.