Optimized Reconstruction Algorithm-Processed CT Image in the Diagnosis of Correlation between Epicardial Fat Volume and Coronary Heart Disease

This study was to analyze the application value of a reconstruction algorithm in CT images of patients with coronary heart disease and analyze the correlation between epicardial fat volume and coronary heart disease. An optimized reconstruction algorithm was constructed based on compressed sensing theory in this study. Then, the optimized algorithm was applied to the image reconstruction of multislice spiral CT image data after testing its sensitivity, accuracy, and specificity. 60 patients with suspected angina pectoris were divided into lesion group (40 cases) and normal group (20 cases) according to whether there were coronary atherosclerotic plaques in cardiac vessels. The results showed that the sensitivity, specificity, and accuracy of the optimized reconstruction algorithm were 91.78%, 84.27%, and 95.32%, and the running time was (12.18 ± 2.49) s. The CT value of the liver and the CT ratio of the liver and spleen in the lesion group were (53.81 ± 5.91) and (3.88 ± 0.67), respectively. There was no significant difference between the two groups ( P > 0.05 ). The body mass index and epicardial fat volume in the lesion group were (31.93 ± 4.54) kg/m2 and (120.09 ± 22.01) cm3, respectively. The body mass index and fat volume in the lesion group were significantly higher than those in the normal group ( P < 0.05 ). The epicardial fat constitution increased with the increase of the number of coronary arteries involved, and there was a positive correlation between them. Among patients with different coronary atherosclerotic plaques, the epicardial fat volume in patients with mixed plaques was the largest ( P < 0.05 ). In summary, optimizing CT images under compressed a sensing reconstruction algorithm could effectively improve the diagnostic accuracy of doctors. Epicardial fat volume was positively correlated with coronary heart disease. Epicardial fat volume could be used as one of the important indexes to predict coronary heart disease.

Relationship Between Epicardial Fat volume on Cardiac CT and Atherosclerosis Severity in Three-Vessel Coronary Artery Disease: A Single-Center Cross-Sectional Study

Background The ideal treatment strategy for stable three-vessel coronary artery disease (CAD) patients are difficult to determine and for patients undergoing conservative treatment, imaging evidence of coronary atherosclerotic severity progression remains limited. Epicardial fat volume (EFV) on coronary CT angiography (CCTA) has been considered to be associated with coronary atherosclerosis. Therefore, this study aims to evaluate the relationship between EFV level and coronary atherosclerosis severity in three-vessel CAD. Methods This retrospective study enrolled 252 consecutive patients with three-vessel CAD and 252 normal control group participants who underwent CCTA between January 2018 and December 2019. A semi-automatic method was developed for EFV quantification on CCTA images, standardized by body surface area. Coronary atherosclerosis severity was evaluated and scored by the number of coronary arteries with ≥ 50% stenosis on coronary angiography. Patients were subdivided into groups on the basis of lesion severity: mild (score = 3 vessels, n = 85), moderate (3.5 vessels ≤ score < 4 vessels, n = 82), and severe (4 vessels ≤ score ≤ 7 vessels, n = 85). The independent sample t-test, analysis of variance, and logistic regression analysis were used to evaluate the associations between EFV level and severity of coronary atherosclerosis. Results Compared with normal controls, three-vessel CAD patients had significantly higher EFV level (65 ± 22 mL/m2 vs. 48 ± 19 mL/m2; P < 0.001). In patients with three-vessel CAD, there was a progressive decline in EFV level as the score of coronary atherosclerosis severity increased, especially in those patients with a body mass index (BMI) ≥ 25 kg/m2 (75 ± 21 mL/m2 vs. 72 ± 22 mL/m2 vs. 62 ± 17 mL/m2; P < 0.05). Multivariable regression analysis showed that both BMI (OR: 3.40, 95%CI: 2.00 - 5.78, P < 0.001) and the score of coronary atherosclerosis severity (OR: 0.49, 95% CI: 0.26 - 0.93, P<0.05) were independently related to the change of EFV level. Conclusion Three-vessel CAD patients do have higher EFV level than the normal controls. While, there may be an inverse relationship between EFV level and the severity of coronary atherosclerosis in patients with three-vessel CAD.

Predictors of Epicardial Fat Volume Decrease after Dapagliflozin Treatment in Patients with Type 2 Diabetes

Background and Objectives: Dapagliflozin treatment proved to reduce the epicardial fat volume (EFV) in patients with type 2 diabetes (T2D). Despite the reduction in EFV being associated with improved diastolic function in patients with T2D, EVF is not routinely evaluated in T2D because it is costly and involves radiation exposure. This study aims to identify biomarkers that predict EFV reduction after dapagliflozin treatment in patients with T2D. Materials and Methods: In a prospective, observational, consecutive-case enrollment scenario, 52 patients with T2D were initiated on dapagliflozin 10 mg q.d. as part of the standard of care. At enrollment and after six months of dapagliflozin treatment, patients were evaluated using cardiac ultrasonography, native computer tomography, transient liver elastography, and metabolic lab tests. In addition, the atherogenic index of plasma (AIP), atherogenic coefficient (AC), triglyceride glucose index (TyG), cardiac risk ratio (CRR), and visceral abdominal index (VAI) were calculated. Results: Higher AIP (r = 0.28; p = 0.04), CRR (r = 0.28; p = 0.04), and TyG (r = 0.32; p = 0.01) are associated with more important reductions in the EFV. A lower conicity index (β = −0.29; p = 0.03), visceral fat volume at the 4th vertebrae (L4VFV) (β = −0.32; p = 0.02), left atrium volume (β = −3.08; p = 0.003), and right ventricle diameter (β = −2.13; p = 0.04) are associated with higher reductions in the EFV after six months of dapagliflozin treatment. A valid performance for predicting clinically relevant decreases in EFV after dapagliflozin treatment was observed for AIP (AUROC = 0.903; Youden = 0.732; p < 0.001), CRR (AUROC = 0.772; Youden = 0.595; p = 0.004), TyG (AUROC = 0.957; Youden = 0.904; p < 0.001), and VAI (AUROC = 0.898; Youden = 0.712; p < 0.001). Conclusion: Higher initial EFV values are associated with more important reductions in EFV in patients with T2D treated for six months with dapagliflozin. TyG values have the best prediction performances for EFV reduction, having the highest sum of sensitivity and specificity at the 0.904 threshold level. AIP, CRR, VAI, conicity index, L4VF, left atrium volume, and right ventricle volume are valid biomarkers for a decrease in EFV after dapagliflozin treatment in diabetes patients.

Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and it’s Relation with the Severity of Coronary Artery Disease

Background Recent studies have suggested that fat disposition in epicardial tissue may be a predictor of the severity of coronary artery disease (CAD). Epicardial adipose tissue (EAT) is defined as the adipose tissue located between the outer wall of the myocardium and the visceral layer of pericardium, surrounding the heart and the coronary vessels. EAT is closely related to the adventitia of the coronary arteries without a barrier that may directly influence the development and progression of atherosclerosis and CAD through pro-inflammatory mediators. Objective The aim of the work is to investigate the relation between epicardial fat volume (EFV) [assessed by multidetector computed tomography (MDCT)] and severity of CAD. Methods This cross sectional study was conducted on 40 patients referred for MDCT coronary angiography to assess their complaint. EFV was quantified during non-contrast phase and severity of CAD was assessed by segment involvement score (SIS) and segment stenosis score (SSS) during contrast phase at Nasr City Police Hospital in the period between August 2018 and April 2019. Results The 40 consecutive subjects consisted of 30 males (75%) and 10 females (25%) with mean age 56 ±10.27 years. Risk factors of atherosclerosis were analyzed among the studied population as followed; the BMI ranged between 24 and 30.9 kg/m2, hypertensive patients were 77.5%, diabetic patients were 55% and smokers were 67.5%. The laboratory finding of the studied group revealed that the serum LDL.C ranged between 70 and 218 mg/dl (Mean±SD =163.88±43.37, Median= 183.5). The serum HDL.C ranged between 30 and 62 mg/dl (Mean±SD = 41.45±9.87, Median= 37). The serum total cholesterol ranged between 136 and 280 mg/dl (Mean±SD = 214.35± 35.51, Median= 224). The serum triglycerides ranged between 110 and 215 mg/dl (Mean±SD = 164.13±27.38, Median= 173).The serum creatinine ranged between 0.8 and 1.8 mg/dl (Mean±SD = 1.12±0.19, Median= 1.1). 17.5% of the studied patients had normal coronaries while 37.5% had single vessel disease and 45% had multi-vessel disease. There was a significant relationship between EFV and CAC score (p = 0.011, r = 0.397), a highly significant relationship between EFV and SSS score (p = 0.001, r = 0.518) and significant relationship between EFV & SIS score (P = 0.003, r = 0.459). Patients with normal coronary arteries were noted to have a lower EFV value than those with coronary lesions (highly significant relationship, p = 0.004) either single vessel disease or multi-vessel disease. There is no significant difference between the effects of EFV on number of diseased coronaries either single vessel disease or multi-vessel disease. Conclusion EFV increased in patients with both significant coronary artery stenosis or coronary calcification. EFV is considered an independent risk factor for CAD.

Relationship between epicardial fat volume measured by multi-detector computed tomography and coronary artery disease

Background The association between epicardial fat thickness and coronary artery disease (CAD) has been evaluated previously using echocardiography. Recently, multidetector computed tomography (MDCT), as a valuable tool in cardiovascular CT imaging, can improve characterization of CAD and give a more accurate volumetric quantitation of EF. The purpose of our study was to evaluate the relationship between the epicardial fat volume and CAD using multi-detector row CT. Results Out of the studied 120 patients, 22 patients were negative for CAD, while 98 patients had positive CAD. There was significant difference between both groups as regard epicardial fat volume (p < 0.001), and good relation was found between the amount of epicardial fat volume and coronary calcium score, number of affected vessel, plaque burden and degree of stenosis (p = < 0.001). Conclusion EAT volume was larger in the presence of obstructive CAD and atheromatous plaques. These data suggest that EAT is associated with the development of coronary atherosclerosis and potentially the most dangerous types of plaques.

Impact of epicardial fat on the duration of radiofrequency energydelivery during catheter ablation of atrial fibrillation

Funding Acknowledgements Type of funding sources: None. Aims This study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF). Methods The volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI. Results From March 2015 to May 2018, 222 patients (45,5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0,0002; p = 0,009 respectively), periatrial (p = 0,003; p = 0,045) and periventricular epicardial fat (p = 0,001; p = 0,012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0,743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35,2 vs 74,5 ± 31,2 ml ; p = 0,192). Conclusion We observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat maybe a marker, but not an independent factor,of ablation complexity.