Epicardial adipose tissue volumes improve prediction of myocardial infarction in women on top of SCORE2, CACS and plaque burden: Long-term follow-up of 25,000 individuals.

Abstract

Background: Increased epicardial adipose tissue volume (EATV) is a risk marker for future myocardial infarction (MI), but its value beyond SCORE2 (Systemic Coronary Risk Evaluation 2), the coronary artery calcium score (CACS) and the coronary artery segment involvement score (SIS) remains poorly studied.

Objectives: To determine the incremental value of EATV normalized to heart volume (EATVh) on top of SCORE2, CACS and SIS in predicting future MI.

Methods: We studied associations between EATVh, SCORE2, CACS, SIS and the risk of MI in a general population cohort of 25,155 participants (age 50-64, 50.7% women). Sex-stratified multivariable Cox-regression estimated hazard ratios (HR) and ROC-analysis with variables dichotomized at their 75th percentile assessed incremental predictive value.

Results: A total of 304 MI (71 in women) occurred during follow-up (median: 7.8 years). In adjusted analysis, EATVh and SCORE2 were independently associated with MI in women, but only SIS and SCORE2 in men. The highest HR per EATVh IQR was found in women <55 years (1.89). ROC-analysis showed that adding EATVh to SCORE2, CACS and SIS improved MI prediction in women but not men (AUC: 0.681 vs. 0.667; p < 0.05 for both).

Conclusions: EATVh provides independent, modest incremental information on the risk of future MI in women on top of CACS and SIS, but not in men. Further studies in more diverse population segments including younger and symptomatic individuals are warranted.