Epicardial adipose tissue: relationship between measurement location and metabolic syndrome

Epicardial adipose tissue (EAT) is a contributing factor of metabolic syndrome (MS) and coronary artery disease (CAD). However, it is still unclear which measurement location of EAT area best reflects its cardiometabolic risk. The purpose of our study was to investigate the distribution of EAT and its relationship to the total EAT volume and MS. To assess volume and cross-sectional areas of EAT, coronary CT angiography were obtained in 256 asymptomatic subjects. The EAT areas within the threshold range of -190 to -30 Hounsfield units were measured at six representative slices. Correlations between single slice EAT areas and total EAT volumes were high across all measurement locations (correlation coefficient r > 0.80). The receiver-operator characteristic curves demonstrated EAT area at left main coronary artery (LMCA) was well discriminative for MS (AUC 0.82, p < 0.001) and CAD (AUC 0.76, p < 0.001). EAT areas across all measurement locations were significantly increased linearly with increasing number of MS components. EAT areas were significantly associated with MS at all measurement locations; the highest odds ratio (OR) between EAT area and MS was at the LMCA level (OR 5.86, p < 0.001). The OR between EAT area and coronary artery calcium was also significant in LMCA locations (OR 1.56, p = 0.042). We demonstrated that the single-slice EAT area measurement is a simple and reliable method compared with time-consuming volumetric measurements. The EAT area at LMCA level was the best single slice representing the risk of metabolic syndrome and coronary atherosclerosis.