Highlights
- •A small difference in epicardial adipose tissue density has been reported between patients with and without coronary events.
- •However, epicardial adipose tissue is composed of beige fat and its activation may change in response to several stimuli.
- •We show that season, clinical and demographic factors induce a change in epicardial adipose tissue attenuation.
- •We conclude that the numerous confounders influencing adipose tissue attenuation may limit its utility as a marker of risk.
Abstract
Background and aims
A small difference in epicardial adipose tissue (EAT) attenuation measured on computed
tomography (CT) imaging has been reported between patients who suffered coronary events
and event-free patients. EAT consists of beige adipose tissue functionally similar
to brown adipose tissue and its attenuation may be affected by seasonal temperature
variations and clinical factors.
Methods
We retrospectively measured EAT attenuation on cardiac CT in 597 patients submitted
to cardiac CT imaging for coronary artery calcium scoring. All scans were performed
on the same CT scanner during the summer (June, July, August) or winter (December,
January, February) months. EAT attenuation in Hounsfield units (HU) was assessed near
the proximal right coronary artery in an area free of artifacts. For comparison, subcutaneous
adipose tissue (SCAT) attenuation was measure along the midaxillary line.
Results
The clinical and demographic characteristics of patients scanned during the summer
(N = 253) and the winter (N = 344) months were similar. One third of patients were
women, one quarter used statins and anti-hypertensive drugs and 30% were obese. The
EAT attenuation was significantly lower during the summer than the winter months (−98.17 ± 6.94
HUs vs −95.64 ± 7.99 HUs; p<0.001). Sex, white race, body mass index, diabetes status, treatment with statins
and anti-hypertensive agents significantly modulated the seasonal variation in EAT
attenuation. SCAT attenuation was not affected by season or other factors.
Conclusions
The measurement of EAT attenuation is complex and is affected by season, demographic
and clinical factors. These factors may hinder the utilization of EAT attenuation
as a biomarker of cardiovascular risk.
Graphical abstract
Graphical Abstract
Keywords
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Article Info
Publication History
Published online: February 03, 2021
Accepted:
January 29,
2021
Received in revised form:
January 26,
2021
Received:
January 13,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
