Epicardial fat volume, an independent risk factor for major adverse cardiovascular events, had an incremental prognostic value to myocardial perfusion imaging in Chinese populations with suspected or known coronary artery disease with a normal left ventricular ejection fraction

Le Yang; Wenji Yu; Peng Wan; JingWen Wang; Xiaoliang Shao; Feifei Zhang; Xiaoyu Yang; Yongjun Chen; Qi Li; Dan Jiang; Yufeng Wang; Qi Jiang; Jianfeng Wang; Yuetao Wang

doi:10.3389/fcvm.2023.1261215

Epicardial fat volume, an independent risk factor for major adverse cardiovascular events, had an incremental prognostic value to myocardial perfusion imaging in Chinese populations with suspected or known coronary artery disease with a normal left ventricular ejection fraction

Front Cardiovasc Med. 2023 Oct 2:10:1261215. doi: 10.3389/fcvm.2023.1261215. eCollection 2023.

Authors

Le Yang^#^{1

2

3}, Wenji Yu^#^{1

2}, Peng Wan^#⁴, JingWen Wang^{1

2}, Xiaoliang Shao^{1

2}, Feifei Zhang^{1

2}, Xiaoyu Yang⁴, Yongjun Chen⁴, Qi Li^{1

2}, Dan Jiang^{1

2}, Yufeng Wang^{1

2}, Qi Jiang^{1

2}, Jianfeng Wang^{1

2}, Yuetao Wang^{1

2}

Affiliations

¹ Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.
² Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, China.
³ Department of Nuclear Medicine, The first afflicted hospital of Ningbo University, Ningbo, China.
⁴ Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China.

^# Contributed equally.

Abstract

Background: Most coronary artery disease (CAD) patients with a normal left ventricular ejection fraction (LVEF) experience a poor prognosis. Single-photon emission computerized tomography (SPECT)-myocardial perfusion imaging (MPI), a routine examination, is useful in assessing risk and predicting major adverse cardiovascular events (MACEs) in populations with suspected or known CAD. SPECT/CT is a "one-stop shop" examination, which, through non-contrast CT, can produce attenuation correction for MPI and obtain information on coronary artery calcium (CAC) and epicardial fat volume (EFV) simultaneously. This study aims to investigate the predictive and incremental value of EFV to MPI for MACE in Chinese populations with suspected or known CAD with a normal LVEF.

Methods and results: We retrospectively studied 290 suspected or known CAD inpatients with a normal LVEF who underwent SPECT/CT between February 2014 and December 2017. Abnormal MPI was defined as a summed stress score ≥4 or summed difference score ≥2. EFV and CAC were calculated using non-contrast CT. The end date of follow-ups was in February 2022. The follow-up information was obtained from the clinical case notes of the patients or reviews of telephone calls. MACE was defined as cardiac death, late coronary revascularization ≥3 months after MPI, non-fatal myocardial infarction, angina-related rehospitalization, heart failure, and stroke. During the 76-month follow-up, the event rate was 32.0% (93/290). Univariate and multivariate Cox regression analyses concluded that high EFV (>108.3 cm³) [hazard ratio (HR): 3.3, 95% CI: 2.1-5.2, P < 0.000] and abnormal MPI (HR: 1.8, 95% CI: 1.1-2.8, P = 0.010) were independent risk factors for MACE. The event-free survival of patients with high EFV was significantly lower than that of the low EFV group (log-rank test P < 0.001). In the subgroup with normal MPI, high EFV was associated with reduced event-free survival (log-rank P < 0.01), with a higher annualized event rate (8.3% vs. 1.9%). Adding high EFV to MPI could predict MACEs more effectively, with a higher concordance index (0.56-0.69, P < 0.01), higher global chi square (7.2-41.4, P < 0.01), positive integrated discrimination improvement (0.10, P < 0.01), and net reclassification index (0.37, P < 0.01).

Conclusions: In Chinese populations with suspected or known CAD with normal LVEF, high EFV was an independent risk factor for MACE after adjusting for traditional risk factors, CAC and MPI. In subgroups with normal MPI, EFV could also improve risk stratification. Adding EFV to MPI had an incremental value for predicting MACE.

Keywords: EFV; coronary artery calcium; major adverse cardiovascular events (MACEs); myocardial perfusion imaging; non-contrast CT.

Grants and funding

This research was supported by National Natural Science Foundation of China (82272031, 81871381, PI: YW), Key Research and Development Program of Jiangsu Province (Social Development) (Grant NO. BE2021638), Top Talent of Changzhou “The 14th Five-Year Plan” High-Level Health Talents Training Project [(2022)260], Changzhou Clinical Medical Center [(2022)261], Science and technology project for youth talents of Changzhou Health Committee (QN202212, PI: WY), Young Talent Development Plan of Changzhou Health Commission (CZQM2023008, PI: WY.