Epicardial fat: a non-invasive, non-contrast imaging biomarker for high-risk plaque monitoring in computed tomography

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INTRODUCTION: Coronary computed tomography angiography (CCTA) is a viable method for monitoring vulnerable plaques; however, noncontrast calcium scoring (CAS) has a limited utility in this context. It is therefore necessary to search for novel noncontrast imaging biomarkers to track high‑risk plaques. OBJECTIVES: We aimed to investigate possible associations between low‑attenuation plaque (LAP) identified on CCTA and noncontrast CAS, pericardial adipose tissue (PAT), and epicardial adipose tissue (EAT) in patients with nonobstructive coronary atherosclerosis undergoing serial CCTA. PATIENTS AND METHODS: We analyzed data from 89 participants (40% women; mean [SD] age, 60 [7.7] y) enrolled in the Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography trial. CCTA was performed at baseline and repeated at mean (SD) follow‑up of 66.8 (13.7) weeks. CAS and cardiac fat were measured on noncontrast reconstructions and analyzed in relation to contrast‑derived LAP. RESULTS: Mean (SD) decrease in LAP burden was 0.23% (1%; P = 0.04), median (interquartile range [IQR]) decrease in PAT volume was 4.2 (-36.9 to 8.3) cm³ (P <0.001), median (IQR) decrease in EAT volume was 2.8 (-12.2 to 6.7) cm³ (P = 0.01), and median (IQR) increase in CAS was 21.2 (1.7-71.7) Agatston units (P <0.001). Positive correlations were found between changes in LAP burden and both PAT and EAT volumes (r = 0.349; P = 0.001 and r = 0.49; P <0.001, respectively), but not with a change in CAS. Multivariable linear regression analysis identified EAT as an independent predictor of LAP regression (95% CI, 0.007-0.032; P = 0.003). CONCLUSIONS: Pericardial and epicardial fat volumes and their dynamics are positively associated with LAP burden, while CAS is not. Monitoring EAT volume on noncontrast CT may facilitate the assessment of high‑risk plaque progression or regression, overcoming the limitations of CAS.

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