CT-derived epicardial adipose tissue volume predicted major adverse cardiovascular events with HR 2.76 overall and HR 6.31 in contrast-enhanced CT (p<0.001).
Does higher CT-derived epicardial adipose tissue volume predict incident MACE in asymptomatic and suspected/known CAD cohorts?
CT-derived epicardial adipose tissue volume is strongly associated with MACE across both non-contrast and contrast-enhanced imaging, suggesting its potential as an opportunistic imaging biomarker for cardiovascular risk stratification.
Abstract Background Epicardial adipose tissue volume (EATv), quantified on computed tomography (CT), is associated with coronary artery disease (CAD). Cardiac CT is used for CAD risk screening, however non-contrast and non-electrocardiogram gated CT, which can quantify EAT, have limited value for quantitative CAD assessment. Therefore, EATv measurement represents an opportunity for CAD risk assessment from any chest CT imaging. While EATv measurement is not part of standard reporting workflow, if independently associated with major adverse cardiovascular events (MACE), this may strengthen its role for opportunistic measurement. Purpose This systematic review and meta-analysis aimed to evaluate the association between EATv (measured on CT) and MACE across various imaging techniques and asymptomatic vs symptomatic populations. Methods We performed a literature search for studies examining the association between CT-derived EATv and study-defined incident MACE. Pooled associations of MACE risk were determined from unadjusted hazard ratios (HR), and subsequent meta-regression performed to identify any independent predictors. Sub-group analysis was performed to evaluate differences in clinical and technical study variables. Results are presented as point estimate with 95% confidence intervals. Results Twenty-two studies were included in final analysis, including 22,529 participants. Across 10 studies presenting unadjusted hazards ratios, EATv was higher in patients with MACE (weighted mean difference 25.110.8-39.3, p0.001 and significantly predictive of MACE (HR 2.761.73-4.42, p0.001) (Figure 1). The association was stronger in contrast-enhanced CT (HR 6.313.22-12.39, p0.001) compared to non-contrast CT (HR 2.181.35-3.52, p=0.002), (p(interaction)=0.011) (Figure 2). No difference was observed between asymptomatic cohorts and suspected/known CAD cohorts (p(interaction)=0.489). All included studies showed significant positive associations between EATv and MACE regardless of different technical factors including ECG-gating and categorical vs continuous analysis of EATv. Conclusions EATv is strongly associated with MACE when measured from either non-contrast or contrast-enhanced CT, with no significant difference in association between asymptomatic and suspected/known CAD cohorts. Standardised reporting of EATv may opportunistically facilitate future clinical implementation of this imaging biomarker, to enhance cardiovascular risk stratification and risk factor management in any chest CT imaging.
Aldous et al. (2025) studied this question. CT-derived epicardial adipose tissue volume predicted major adverse cardiovascular events with HR 2.76 overall and HR 6.31 in contrast-enhanced CT (p<0.001).