AI-quantified epicardial adipose tissue and prediction of future myocardial infarction in patients with cardiometabolic disease: a post-hoc analysis from the SCOT-HEART trial.
Jolien Geers, Nipun Manral, Caroline Park, Guadalupe Flores Tomasino, Kajetan Grodecki, Joel Lenell, Mikolaj Buchwald, Aryabod Razipour, Jacek Kwiecinski, Hidenari Matsumoto, Mohamed Marwan, Stephan Achenbach, Daniel S Berman, Marc R Dweck, David E Newby, Piotr J Slomka, Michelle C Williams, Damini Dey
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引用次数: 0
Abstract
Background: Epicardial adipose tissue is gaining increasing interest as a cardiometabolic imaging biomarker, but its exact role in coronary artery disease is not fully understood. This study aimed to investigate the relationship between epicardial adipose tissue, coronary plaque characteristics, and risk of myocardial infarction in patients with suspected coronary artery disease, and in those with concomitant cardiometabolic disease.
Methods: In a post-hoc analysis of the SCOT-HEART trial, epicardial adipose tissue volume and attenuation were quantified automatically from computed tomography (CT) angiography using deep-learning. Quantitative and high-risk coronary plaque characteristics were also assessed. The primary endpoint was fatal or non-fatal myocardial infarction.
Results: The study population consisted of 1770 patients (58 ± 9 years, 56% males) of whom 313 (18%) with cardiometabolic disease. Epicardial adipose tissue volume was higher in patients withcardiometabolic disease (123 ± 44 versus 88 ± 36 mL, p < 0.001), and increased with the coronary calcium score (0: 82 ± 35 mL, 1-400: 97 ± 38 mL, > 400: 113 ± 44 mL; p < 0.001), and low-attenuation plaque burden (burden ≤ 4%: 85 ± 36mL, burden > 4%: 103 ± 41mL; p < 0.001), while there were no interactions between these features and epicardial adipose tissue attenuation (p > 0.05 for all). During a median follow-up of 8.6 years, 82 (4.6%) patients experienced myocardial infarction. In the total study cohort, epicardial adipose tissue volume predicted myocardial infarction both in univariable analysis, and after adjustment for established markers of cardiovascular risk. In patients with cardiometabolic disease, epicardial adipose tissue volume independently predicted myocardial infarction after adjustment for clinical risk factors and plaque features but this relationship was not found in those without cardiometabolic disease.
Conclusions: CT-derived Epicardial adipose tissue volume correlates with quantitative and high-risk plaque features, and independently predicts risk of myocardial infarction in patients with cardiometabolic disease.
背景：心外膜脂肪组织作为一种心脏代谢成像生物标志物越来越受到关注，但其在冠状动脉疾病中的确切作用尚不完全清楚。本研究旨在探讨疑似冠状动脉疾病及合并心脏代谢疾病患者心外膜脂肪组织、冠状动脉斑块特征与心肌梗死风险的关系。方法：在SCOT-HEART试验的事后分析中，使用深度学习技术，通过计算机断层扫描（CT）血管造影自动量化心外膜脂肪组织体积和衰减。定量和高危冠状动脉斑块特征也进行了评估。主要终点为致死性或非致死性心肌梗死。结果：研究人群包括1770例患者（58±9岁，56%男性），其中313例（18%）患有心脏代谢疾病。心脏代谢性疾病患者的心外膜脂肪组织体积更高（123±44 mL vs 88±36 mL, p 400: 113±44 mL; p 4%: 103±41mL; p 0.05）。在8.6年的中位随访期间，82例（4.6%）患者发生心肌梗死。在整个研究队列中，心外膜脂肪组织体积在单变量分析中预测心肌梗死，并在调整心血管风险的既定标记后。在心脏代谢疾病患者中，调整临床危险因素和斑块特征后，心外膜脂肪组织体积独立预测心肌梗死，但在没有心脏代谢疾病的患者中没有发现这种关系。结论：ct来源的心外膜脂肪组织体积与定量和高危斑块特征相关，可独立预测心脏代谢疾病患者发生心肌梗死的风险。
期刊介绍：
Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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