Epicardial fat images aid in heart disease prediction

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According to a new study carried out at Emory University School of Medicine, cardiology professionals say that Adiposeimages of epicardial adipose tissue, the fat layer surrounding the heart, would offer more information about heart disease in comparison to other diagnostic techniques such as coronary artery calcium scoring. The size of that fatty layer is estimated by using X-ray imaging techniques like CT or MRI. Paolo Raggi, MD, professor of medicine (cardiology) and radiology and director of Emory's cardiac imaging center, said "This information may be used as a 'gate keeper', in that it could help a cardiologist decide whether a patient should go on to have a nuclear stress test,"

Two studies were carried out assessing the indication of fat layer imaging; both were discussed at the American College of Cardiology meeting in Atlanta. Cardiology fellow Nikolaos Alexopoulos, MD, now at the University of Athens, Greece, presented the first one. The study showed that patients with a higher volume of epicardial fat tissue usually develop more dangerous types of atherosclerotic plaques, the non-calcified plaques. Dr. Raggi said that Atherosclerotic plaques are built mainly by calcium. Although heart's coronary calcium burden is considered a good predictor of cardiac disease, calcium in an individual plaque doesn't necessarily predict imminent disease. Researchers understood that non-calcified plaques mean active buildup in that coronary artery. Studies suggest that the fat layer surrounding the heart is producing more inflammatory hormones, in comparison to the sub-coetaneous fat under the skin. "Release of inflammatory factors from epicardial adipose tissue may be promoting an active atherosclerotic process, and this is indicated by the presence of non-calcified plaques," Raggi says.

The Emory researchers checked 214 patients using cardiac CT, and carried out coronary artery scoring to assess the patients' epicardial fat tissue volume along with the plaques in their coronary arteries. The volume of the epicardial fat tissue was the higher in the patients having non-calcified plaques. Emory cardiology fellow Matthew Janik, MD, presented the second study; that one measured epicardial fat in patients undergoing nuclear stress tests. 382 patients expressed chest pain while not having known cardiovascular disease. The nuclear stress test shows signs of inducible ischemia, which is deficiency in blood flow nourishing the heart muscle.

In the second study, the researchers reported the presence of ischemia to correlate increasingly with epicardial fat tissue volume more than the coronary calcium score.

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