Int J Gen Med. 2026 Sep 2;19:634061. doi: 10.2147/IJGM.S634061. eCollection 2026.
ABSTRACT
OBJECTIVE: To investigate whether epicardial adipose tissue (EAT) volume correlates with coronary microvascular dysfunction (CMD) identified via invasive physiological evaluation, in comparison with EAT attenuation.
MATERIALS AND METHODS: This retrospective study included 158 consecutive patients (mean age 65.40±9.76 years, 51.90% male) who underwent both coronary computed tomography angiography (CCTA) and invasive coronary function testing. CMD was defined as coronary flow reserve (CFR) <2.0 and/or index of microcirculatory resistance (IMR) ≥25. Total EAT volume, left atrial (LA)-EAT volume, and right atrial (RA)-EAT volume, EAT attenuation, and coronary fat attenuation index (FAI) were quantified from CCTA images. Multivariable logistic regression analyses were performed to screen variables associated with CMD.
RESULTS: CMD was diagnosed in 59 patients (37.34%). Patients with CMD had significantly higher total EAT volume, LA-EAT volume, and RA-EAT volume (all P <0.001) compared with patients without CMD. After adjustment for age, sex, BMI, and cardiovascular risk factors, total EAT volume (OR=1.134, 95% CI 1.089-1.181, P <0.001), LA-EAT volume (OR=1.006, 95% CI 1.004-1.008, P <0.001) and RA-EAT volume (OR=1.003, 95% CI 1.002-1.005, P <0.001) were independently associated with CMD. The FAI of the three major coronary arteries showed no significant association with CMD (all P >0.05). LA-EAT volume demonstrated excellent discriminative ability for CMD (AUC=0.917), which was superior to total EAT volume (AUC=0.824) and RA-EAT volume (AUC=0.846). DeLong test analysis confirmed that the AUC of LA-EAT volume was significantly higher than that of total EAT volume (P=0.003) and of RA-EAT volume (P=0.029). No significant difference was observed between the AUCs of total EAT volume and RA-EAT volume (P =0.547).
CONCLUSION: Total and atrial-specific EAT volumes, particularly LA-EAT volume, are strongly and independently associated with CMD, whereas FAI shows no association with coronary microvascular dysfunction. EAT volume measurements acquired from routine CCTA may act as a valuable imaging biomarker for CMD-related risk stratification. LA-EAT measurement obtained from routine CCTA is promising for convenient clinical screening of coronary microvascular dysfunction.
PMID:42703394 | PMC:PMC13546685 | DOI:10.2147/IJGM.S634061