Epicardial Fat Volume Is Correlated With Coronary Lesion And Its Severity

Backgro and Objective:Coronary heart disease is the major cardiovascular disease that threatens the health of elderly population, new research suggests that EAT(Epicardial adipose tissue) may be an important risk factor for coronary heart disease, which can be used as a non-invasive prediction indicators. EAT is the fat tissue fibers between cardiac pericardium and fibrous pericardium, also known as pericardial fat, and it has a close relation with myocardium functionally and anatomically, both blood-supply by coronary artery. Therefore, epicardial adipose tissue plays a vital role in the pathophysiological process of myocardium and coronary artery; EAT, also called "adipokines", can produce various biologically active molecules. EAT inflammation may cause coronary artery intima inflammation, leading to progression of coronary atherosclerosis and making a real difference to the occurrence and development of coronary heart disease, which would become a potential target for the treatment of coronary heart disease. In this study, by using 256-slice spiral CT coronary angiography(CTA) to measure epicardial fat volume(EATV), and exploring the correlation between EATV size and coronary heart disease attack, risk factors, coronary artery lesions and its lesion severity, thus to provide guide to the clinical applications. METHODS: Select those in patients who have been primarily diagnosed with coronary heart lesion stable angina pectoris between Feb 2013 and Aug 2014 as objectives of study. Collect the general clinical data of all cases and make routine inspections to the biochemical markers such as high-sensitivity C-reactive protein(Hs-CRP), triglyceride(TG), fasting blood glucose, creatinine(CREA), total cholesterol, low density lipoprotein cholesterol(LDL–C) and high-density lipoprotein cholesterol(HDL-C), blood urea nitrogen, uric acid(UA), white blood cells(WBC), platelets(PLT). For the patients that coronary artery CTA inspection shows coronary artery lesion, take further inspection by coronary arteriography(CAG) during hospitalization to identify the situation of coronary artery lesion, and use Gensini integration system to assess the severity of coronary artery lesion, then divide coronary artery lesions into one-, two- and three-vessel lesion. Organize the data and make statistical analysis. If P <0.05, it can be defined as statistically significant. RESULTS: Collect 208 qualified cases for the study, including 133 males and 75 females, the mean age is 58.5±9.52. They are divided into two groups: one is non coronary heart disease(CHD) group on the basis of the CTA inspection that shows no coronary artery stenosis, total of 48 cases; the other one is coronary heart disease(CHD) group, total of 160 cases. Compare a number of indicators such as age, gender, TG, TC, history of hypertension, history of diabetes, HDL-C, LDL-C, smoking, body height, body mass index(BMI), waist circumference, body weight, CREA, fasting blood glucose, UA, WBC, PLT and hs-CRP, the difference has no statistical significance(P>0.05). The average EATV of CHD group is 192.57±30.32 cm3, significantly greater than in non CHD group(138.56±23.18 cm3), the difference two compared groups has a great statistical significance(P<0.01). Using single factor Logistic regression analysis method to analyze the main risk factors of coronary heart disease and EATV, result shows that EATV and waist are the independent risk factors of coronary heart disease; using multi factor Logistic regression model to correct other confounding factors, result shows that EATV is still a risk factor of coronary artery disease(OR=1.023, P=0.013). The result of CTA in CHD group shows that there are 68 cases of mild stenosis(mild stenosis group), total of 305 lesions, Gensini score is 9.6±5.9; 47 cases of moderate stenosis(moderate stenosis group), total of 192 lesions, Gensini score is 28.9±8.1; 45 cases of severe stenosis(stenosis group), total of 136 lesions, Gensini score is 51.3±15.4. There is a positive correlation between the Gensini integral of coronary artery stenosis severity and the size of EATV(r=0.285, P=0.000). 63 cases of patients with single vessel lesion, 56 cases of patients with double vessel lesion, 21 cases of patients with three vessel lesion, the EATV of those patients with three vessel lesion is the biggest. Comparing the EATV of those patients with two and three vessel lesion, the difference is statistically significant(one vessel vs. two vessel P<0.001; three vessel vs. one vessel P<0.001). There is no statistically significant difference between the EATV of those patients with two and three vessel lesion(P=0.305). CONCLUSION: There is a significant correlation between the size of EATV and the severity of coronary artery lesion; the bigger the size of EATV is, the more severe coronary artery disease and the higher Gensini score will be. The size of EATV is correlated with the number of coronary artery disease lesion(number of vascular lesions), the EATV of those patients with three vessel lesion is the biggest. EATV is the independent risk factor of coronary heart disease, which can be used as a non-invasive prediction index of coronary heart disease.