Usefulness of epicardial adipose tissue as predictor of cardiovascular events in patients with coronary artery disease

Several studies have suggested that epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD). However, the role of EAT as a potential risk factor for, and predictor of, long-term cardiovascular outcomes in patients with CAD requires additional investigation. We investigated the relation among EAT, cardiovascular events, and measures of adiposity in patients with CAD. The study was a prospective cohort study of 194 consecutive patients with CAD who entered a phase II cardiac rehabilitation program at the Mayo Clinic. EAT was measured using echocardiography. The primary outcome was the long-term recurrence of major adverse cardiovascular events (MACE). The outcomes were assessed using the Mayo Clinic electronic medical records. The mean age was 59.4 ± 10.8 years, the body mass index was 28.7 ± 4.6 kg/m², 80% were men, and 21% of the patients underwent coronary artery bypass grafting. The mean follow-up period was 3.6 ± 1.3 years, and 52 MACE occurred. EAT was not a predictor of MACE (hazard ratio 1.32, 95% confidence interval 0.75 to 2.31; p = 0.33) when used as a continuous variable and correlated poorly with the measures of adiposity. However, a nonsignificant trend was seen for a greater incidence of cardiovascular events when EAT was stratified by tertile (hazard ratio for third tertile 1.77, 95% confidence interval 0.84 to 3.32; p = 0.11), after statistical adjustments for age, gender, body mass index, and other covariates. In conclusion, the results of the present longitudinal study suggest that EAT, as measured using echocardiography, does not strongly predict for MACE and is poorly associated with measures of obesity in patients with CAD.