Radiomic phenotype of epicardial adipose tissue in patients with myocardial infarction with obstructive and non-obstructive coronary artery disease: relationship with myocardial injury biomarkers

Aim. To evaluate the influence of epicardial adipose tissue (EAT) volume and density, based on computed tomography (CT) data, on the severity of myocardial injury assessed using cardiac biomarkers.

Material and methods. The study included patients with newly diagnosed acute myocardial infarction (MI). All patients underwent invasive coronary angiography. Two following groups were formed: 1) MI with obstructive coronary artery disease (MICAD) (stenosis ≥50%); 2) MI with non-obstructive coronary arteries (MINOCA) (stenosis <50%). Cardiac biomarker levels (cardiac troponin I (cTnI), cardiac creatine phosphokinase (CPK-MB)) were determined at admission, 24 hours later, and on days 4 and 7. CT coronary angiography was performed on day 7 hospitalization. EAT volume and density were calculated using CT data.

Results. The study included 31 patients as follows: 21 with MICAD (age 62 (56; 68) years) and 10 with MINOCA (age 68 (57; 79) years). MICAD patients had higher levels of cardiac biomarkers. Significant differences in EAT volume were found between MICAD and MINOCA patients (p<0,05). The median EAT volume in MICAD patients was greater than in MINOCA patients: 125 (69,4; 169) cm3 and 70,9 (62,4; 140) cm3, respectively. EAT density did not differ significantly as follows: MICAD -76,3 (-80; -71,6) HU, MINOCA -77,6 (-82,7; -73) HU. In the total sample, a significant nonparametric correlation was found between EAT volume and left ventricular end-diastolic mass (ρ=0,41; p=0,032), body surface area (ρ=0,55; p=0,002), and body mass index (ρ=0,54; p=0,003). EAT density negatively correlated with left ventricular enddiastolic mass (ρ=-0,39; p=0,041), body surface area (ρ=-0,54; p=0,003), and body mass index (ρ=-0,57; p=0,002). In the MINOCA group, negative correlations were obtained between biomarker levels and EAT volume, as well as significant positive correlations between CPK-MB at 24 h and cTnI on the 7th day with EAT density. EAT density was positively associated with elevated cTnI levels on day 7 (odds ratio (OR) 2,0, 95% confidence interval (CI) 1-3,5, p<0,05), CPK-MB at 24 h (OR 1,3, 95% CI 1-2,0, p<0,05), and CK-MB on day 4 (OR 2,0, 95% CI 1-3,5, p<0,05).

Conclusion. In the acute period after acute MI, in patients with MINOCA, the EAT phenotype, characterized by a smaller volume and higher density, is associated with greater myocardial damage according to biomarker assessment, while in MICAD, the relationship between EAT properties and cardiac biomarkers is predominantly absent.

1. Oyama N, Philimon G, Michael LC, et al. Epicardial fat thickness increases with age, body mass index and male sex: the framingham heart study. Journal of Cardiovascular Magnetic Resonance. 2008;10(Suppl 1). doi:10.1186/1532-429X-10-S1-A105.

2. Napoli G, Pergola V, Basile P, et al. Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes. J. Clin. Med. 2023;12:7212. doi:10.3390/jcm12237212.

3. Bière L, Behaghel V, Mateus V, et al. Relation of Quantity of Subepicardial Adipose Tissue to Infarct Size in Patients With ST-Elevation Myocardial Infarction. Am J Cardiol. 2017;119(12):1972-8. doi:10.1016/j.amjcard.2017.03.024.

4. Gohbara M, Iwahashi N, Akiyama E, et al. Association between epicardial adipose tissue volume and myocardial salvage in patients with a first ST-segment elevation myocardial infarction: An epicardial adipose tissue paradox. J Cardiol. 2016;68(5):399-405. doi:10.1016/j.jjcc.2015.10.018.

5. Doesch C, Haghi D, Suselbeck T, et al. Impact of functional, morphological and clinical parameters on epicardial adipose tissue in patients with coronary artery disease. Circ J. 2012;76(10):2426-34. doi:10.1253/circj.cj-12-0301.

6. Mukherjee AG, Renu K, Gopalakrishnan AV, et al. Epicardial adipose tissue and cardiac lipotoxicity: A review. Life Sci. 2023;328:121913. doi:10.1016/j.lfs.2023.121913.

7. Lacobellis G. Epicardial adipose tissue in contemporary cardiology. Nat. Rev. Cardiol. 2022;19:593-606. doi:10.1038/s41569-022-00679-9.

8. Hendricks S, Dykun I, Balcer B, et al. Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction — a meta-analysis on over 6600 patients and rationale for the EPIC-ACS study. Medicine (Baltimore). 2021;100(52): e28060. doi:10.1097/MD.0000000000028060.

9. Popov EV, Ilyushenkova YN, Repin AN, et al. The potential role of radiochemical analysis of CT images of epicardial adipose tissue in the prognosis of acute myocardial infarction. The Siberian Journal of Clinical and Experimental Medicine. 2023;38(3):143-52. (In Russ.) doi:10.29001/2073-8552-2023-39-3-143-152.

10. Fontes-­Carvalho R, Fontes-­Oliveira M, Sampaio F, et al. Influence of epicardial and visceral fat on left ventricular diastolic and systolic functions in patients after myocardial infarction. Am J Cardiol. 2014;114(11):1663-9. doi:10.1016/j.amjcard.2014.08.037.

11. Fisser C, Colling S, Debl K, et al. The impact of epicardial adipose tissue in patients with acute myocardial infarction. Clin Res Cardiol. 2021;110(10):1637-46. doi:10.1007/s00392-021-01865-4.

12. Krauz K, Kempiński M, Jańczak P, et al. The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-­Infarct Remodeling and Cardiac Regeneration. Int J Mol Sci. 2024;25(7):3583. doi:10.3390/ijms25073583.

13. Goeller M, Achenbach S, Marwan M, et al. Epicardial adipose tissue density and vo­lume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. J Cardiovasc Comput Tomogr. 2018;12(1):67-73. doi:10.1016/j.jcct.2017.11.007.

14. Mahabadi AA, Balcer B, Dykun I, et al. Cardiac computed tomography-­derived epicardial fat volume and attenuation independently distinguish patients with and without myocardial infarction. PLoS One. 2017;12(8): e0183514. doi:10.1371/journal.pone.0183514.

15. Foldyna B, Hadzic I, Zeleznik R, et al. Deep learning analysis of epicardial adipose tissue to predict cardiovascular risk in heavy smokers. Commun Med (Lond). 2024;4(1):44. doi:10.1038/s43856-024-00475-1.