Intrapericardial, But Not Extrapericardial, Fat Is an Independent Predictor of Impaired Hyperemic Coronary Perfusion in Coronary Artery Disease

• Published in: Arteriosclerosis, thrombosis, and vascular biology Vol. 31; no. 1; pp. 211 - 218
• Main Authors: Bucci, Marco, Joutsiniemi, Esa, Saraste, Antti, Kajander, Sami, Ukkonen, Heikki, Saraste, Markku, Pietilä, Mikko, Sipilä, Hannu T, Teräs, Mika, Mäki, Maija, Airaksinen, K.E. Juhani, Hartiala, Jaakko, Knuuti, Juhani, Iozzo, Patricia
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.01.2011; Lippincott Williams & Wilkins
• Subjects: Adenosine; Adiposity; Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Calcinosis - physiopathology; Cardiology. Vascular system; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary Circulation; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Finland; Fractional Flow Reserve, Myocardial; Heart; Humans; Hyperemia - physiopathology; Linear Models; Male; Medical sciences; Middle Aged; Myocardial Perfusion Imaging; Pericardium - physiopathology; Positron-Emission Tomography; Prospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Sex Factors; Tomography, X-Ray Computed; Vasodilator Agents; Finland; coronary artery calcium; Calcium; Coronary artery; Cardiovascular disease; intrapericardial fat; Inorganic element; Coronary heart disease; Vascular disease; multidetector CT; Multidetector scanner; Perfusion imaging; Atherosclerosis; Positron emission tomography; Emission tomography
• ISSN: 1079-5642; 1524-4636
• DOI: 10.1161/ATVBAHA.110.213827

OBJECTIVE—To measure intrapericardial fat (IPF), extrapericardial fat (EPF), and myocardial perfusion (MBF) in patients with and without coronary artery disease (CAD), hypothesizing that perfusion is more strongly associated with IPF because it is in direct anatomic contiguity with the myocardium or coronary arteries. METHODS AND RESULTS—Fat surrounding the heart may increase the risk of CAD and calcification, but little is known about the role of MBF in this relationship. The study included 107 patients with an intermediate likelihood of CAD. Positron emission tomography/computed tomography was used to measure IPF and EPF volumes and coronary artery calcium level, together with MBF at rest and during adenosine-induced hyperemia. Subsequently, all subjects underwent coronary angiography and were grouped for presence/absence of CAD and severity of myocardial hypoperfusion. IPF and EPF levels were higher in men and in patients with CAD (n=85) than in those without CAD (n=22) (P<0.001). EPF was increased regardless of the degree of stenoses (n=45), whereas IPF was selectively increased in subjects with obstructive stenoses (n=40). IPF and EPF levels were both associated with coronary artery calcium scores (R=0.25 and R=0.26, respectively; P<0.02), coronary flow reserve (R=−0.37 and R=−0.38, respectively; P<0.001), and hyperemic MBF (R=−0.36 and R=−0.44, respectively; P<0.0005). Male sex was a strong negative predictor of MBF. After discounting for confounders, myocardial hyperemic perfusion was predicted independently by sex, coronary artery calcium score, and IPF, but not EPF. CONCLUSION—CAD is accompanied by augmented fat depots surrounding the heart, which are negatively related to coronary flow hyperemia. Among fat depots, IPF was the only independent predictor of hyperemic MBF, supporting the hypothesis of a direct paracrine/vasocrine effect.