Case Control Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2015; 7(5): 287-292
Published online May 26, 2015. doi: 10.4330/wjc.v7.i5.287
Quantification of epicardial fat: Which method can predict significant coronary artery disease?
Zizi Saad, Mohamed El-Rawy, Ragab H Donkol, Sami Boghattas
Zizi Saad, Mohamed El-Rawy, Cardiology Department, Aseer Central Hospital, Abha, Saudi Arabia and Faculty of Medicine, Zagazig University, Ash Sharqia Governorate 44516, Egypt
Ragab H Donkol, Radiology Department, Aseer Central Hospital, Abha, Saudi Arabia and Faculty of Medicine, Cairo University, Giza 12411, Egypt
Sami Boghattas, Radiology Department, Aseer Central Hospital, Abha 61321, Saudi Arabia
Author contributions: Saad Z and Donkol RH designed the study, performed CCTA studies, and wrote the manuscript; El-Rawy M and Donkol RH shared selection of cases, clinical and echocardiographic assessment as well as collection of data and interpreted CCTA scans; Boghattas S analyzed the data.
Ethics approval: The study was approved by institutional ethics committee.
Informed consent: All participants provided written informed consent prior to study enrollment.
Conflict-of-interest: Corresponding author with no conflict of interest regarding the study.
Data sharing: Technical appendix, statistical code, and dataset are available. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ragab H Donkol, MD, Radiology Department, Aseer Central Hospital, Abha, Saudi Arabia and Faculty of Medicine, Cairo University, PO Box 34, Giza 12411, Egypt. ragabhani@hotmail.com
Telephone: +966-72291169 Fax: +966-38552244
Received: September 13, 2014
Peer-review started: September 17, 2014
First decision: October 14, 2014
Revised: January 4, 2015
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: May 26, 2015
Processing time: 249 Days and 14 Hours
Abstract

AIM: To compare the predictive value of three methods of epicardial fat (EF) assessment for presence of significant coronary artery disease (CAD) [i.e., epicardial fat volume (EFV), EFV indexed with body surface area (EFV/BSA) and EFV indexed with body mass index (EFV/BMI)].

METHODS: The study was performed on 170 patients (85 women and 85 men) with clinical suspicion of CAD. They aged 26-89 years with a median age of 54 years. The patients were classified into three groups: Group 1: 58 patients with normal coronary arteries; group 2: 48 patients with non-significant CAD and group 3: 64 patients with significant CAD. The three methods for assessment of epicardial fat were retrospectively studied to determine the best method to predict the presence of significant CAD.

RESULTS: The three methods for epicardial fat quantification and measurements, i.e., EFV, EFV/BSA and EFV/BMI with post- hoc analysis showed a significant difference between patients with significant coronary artery disease compared to the normal group. Receiver operating characteristic curve analysis showed no significant difference between the three methods of epicardial fat measurements, the area under curve ranging between 0.6 and 0.62. The optimal cut-off was 80.3 cm3 for EFV, 2.4 cm3/m2 for EFV indexed with BMI and 41.7 cm3/(kg/m2) for EFV indexed with BSA. For this cut-off the sensitivity ranged between 0.92 and 0.94, while specificity varied from 0.31 to 0.35.

CONCLUSION: Any one of the three methods for assessment of epicardial fat can be used to predict significant CAD since all have the same equivalent predictive value.

Keywords: Quantification of epicardial fat; Coronary heart disease; Epicardial fat volume

Core tip: There is a great correlation between the volume of epicardial fat and presence of significant coronary artery disease. There are different methods for quantification of epicardial fat volume (EFV). The aim of the study is to compare the predictive value of the three methods used for quantification of epicardial fat (EFV, EFV indexed with body surface area and EFV indexed with body mass index) for presence of significant coronary artery disease. The study concluded the three methods for assessment of epicardial fat have the same equivalent predictive value for significant coronary artery disease and any one of them can be used as a sensitive predictor for significant coronary artery disease.