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Published in: The International Journal of Cardiovascular Imaging 2/2016

01-02-2016 | Original Paper

Relationship between epicardial fat and quantitative coronary artery plaque progression: insights from computer tomography coronary angiography

Authors: Peter J. Psaltis, Andrew H. Talman, Kiran Munnur, James D. Cameron, Brian S. H. Ko, Ian T. Meredith, Sujith K. Seneviratne, Dennis T. L. Wong

Published in: The International Journal of Cardiovascular Imaging | Issue 2/2016

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Abstract

Epicardial fat volume (EFV) has been suggested to promote atherosclerotic plaque development in coronary arteries, and has been correlated with both coronary stenosis and acute coronary events. Although associated with progression of coronary calcification burden, a relationship with progression of coronary atheroma volume has not been previously tested. We studied patients who had clinically indicated serial 320-row multi-detector computer tomography coronary angiography with a median 25-month interval. EFV was measured at baseline and follow-up. In vessels with coronary stenosis, quantitative analysis was performed to measure atherosclerotic plaque burden, volume and aggregate plaque volume at baseline and follow-up. The study comprised 64 patients (58.4 ± 12.2 years, 27 males, 192 vessels, 193 coronary segments). 79 (41 %) coronary segments had stenosis at baseline. Stenotic segments were associated with greater baseline EFV than those without coronary stenosis (117.4 ± 45.1 vs. 102.3 ± 51.6 cm3, P = 0.046). 46 (24 %) coronary segments displayed either new plaque formation or progression of adjusted plaque burden at follow-up. These were associated with higher baseline EFV than segments without stenosis or those segments that had stenoses that did not progress (128.7 vs. 101.0 vs. 106.7 cm3 respectively, P = 0.006). On multivariate analysis, baseline EFV was the only independent predictor of coronary atherosclerotic plaque progression or new development (P = 0.014). High baseline EFV is associated with the presence of coronary artery stenosis and plaque volume progression. Accumulation of EFV may be implicated in the evolution and progression of coronary atheroma.
Literature
2.
go back to reference Marchington JM, Mattacks CA, Pond CM (1989) Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B Comp Biochem 94(2):225–232CrossRef Marchington JM, Mattacks CA, Pond CM (1989) Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B Comp Biochem 94(2):225–232CrossRef
3.
go back to reference Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G (1984) Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 288(6428):1401–1404CrossRef Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G (1984) Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 288(6428):1401–1404CrossRef
5.
6.
go back to reference Libby P, Ridker PM, Maseri A (2002) Inflammation and atherosclerosis. Circulation 105(9):1135–1143CrossRefPubMed Libby P, Ridker PM, Maseri A (2002) Inflammation and atherosclerosis. Circulation 105(9):1135–1143CrossRefPubMed
7.
go back to reference Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, O’Donnell CJ, Fox CS (2008) Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation 117(5):605–613. doi:10.1161/CIRCULATIONAHA.107.743062 CrossRefPubMed Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, O’Donnell CJ, Fox CS (2008) Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation 117(5):605–613. doi:10.​1161/​CIRCULATIONAHA.​107.​743062 CrossRefPubMed
9.
go back to reference Ahmadi N, Nabavi V, Yang E, Hajsadeghi F, Lakis M, Flores F, Zeb I, Bevinal M, Ebrahimi R, Budoff M (2010) Increased epicardial, pericardial, and subcutaneous adipose tissue is associated with the presence and severity of coronary artery calcium. Acad Radiol 17(12):1518–1524. doi:10.1016/j.acra.2010.08.017 CrossRefPubMed Ahmadi N, Nabavi V, Yang E, Hajsadeghi F, Lakis M, Flores F, Zeb I, Bevinal M, Ebrahimi R, Budoff M (2010) Increased epicardial, pericardial, and subcutaneous adipose tissue is associated with the presence and severity of coronary artery calcium. Acad Radiol 17(12):1518–1524. doi:10.​1016/​j.​acra.​2010.​08.​017 CrossRefPubMed
10.
go back to reference Iwasaki K, Matsumoto T, Aono H, Furukawa H, Samukawa M (2011) Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease. Clin Cardiol 34(3):166–171. doi:10.1002/clc.20840 CrossRefPubMed Iwasaki K, Matsumoto T, Aono H, Furukawa H, Samukawa M (2011) Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease. Clin Cardiol 34(3):166–171. doi:10.​1002/​clc.​20840 CrossRefPubMed
13.
go back to reference Rajani R, Shmilovich H, Nakazato R, Nakanishi R, Otaki Y, Cheng VY, Hayes SW, Thomson LE, Friedman JD, Slomka PJ, Min JK, Berman DS, Dey D (2013) Relationship of epicardial fat volume to coronary plaque, severe coronary stenosis, and high-risk coronary plaque features assessed by coronary CT angiography. J Cardiovasc Comput Tomogr 7(2):125–132. doi:10.1016/j.jcct.2013.02.003 PubMedCentralCrossRefPubMed Rajani R, Shmilovich H, Nakazato R, Nakanishi R, Otaki Y, Cheng VY, Hayes SW, Thomson LE, Friedman JD, Slomka PJ, Min JK, Berman DS, Dey D (2013) Relationship of epicardial fat volume to coronary plaque, severe coronary stenosis, and high-risk coronary plaque features assessed by coronary CT angiography. J Cardiovasc Comput Tomogr 7(2):125–132. doi:10.​1016/​j.​jcct.​2013.​02.​003 PubMedCentralCrossRefPubMed
14.
go back to reference Mahabadi AA, Berg MH, Lehmann N, Kalsch H, Bauer M, Kara K, Dragano N, Moebus S, Jockel KH, Erbel R, Mohlenkamp S (2013) Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol 61(13):1388–1395. doi:10.1016/j.jacc.2012.11.062 CrossRefPubMed Mahabadi AA, Berg MH, Lehmann N, Kalsch H, Bauer M, Kara K, Dragano N, Moebus S, Jockel KH, Erbel R, Mohlenkamp S (2013) Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol 61(13):1388–1395. doi:10.​1016/​j.​jacc.​2012.​11.​062 CrossRefPubMed
15.
go back to reference Ding J, Hsu FC, Harris TB, Liu Y, Kritchevsky SB, Szklo M, Ouyang P, Espeland MA, Lohman KK, Criqui MH, Allison M, Bluemke DA, Carr JJ (2009) The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 90(3):499–504. doi:10.3945/ajcn.2008.27358 PubMedCentralCrossRefPubMed Ding J, Hsu FC, Harris TB, Liu Y, Kritchevsky SB, Szklo M, Ouyang P, Espeland MA, Lohman KK, Criqui MH, Allison M, Bluemke DA, Carr JJ (2009) The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 90(3):499–504. doi:10.​3945/​ajcn.​2008.​27358 PubMedCentralCrossRefPubMed
18.
go back to reference Konishi M, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Matsubara J, Matsuzawa Y, Sumida H, Nagayoshi Y, Nakaura T, Awai K, Yamashita Y, Jinnouchi H, Matsui K, Kimura K, Umemura S, Ogawa H (2010) Association of pericardial fat accumulation rather than abdominal obesity with coronary atherosclerotic plaque formation in patients with suspected coronary artery disease. Atherosclerosis 209(2):573–578. doi:10.1016/j.atherosclerosis.2009.10.008 CrossRefPubMed Konishi M, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Matsubara J, Matsuzawa Y, Sumida H, Nagayoshi Y, Nakaura T, Awai K, Yamashita Y, Jinnouchi H, Matsui K, Kimura K, Umemura S, Ogawa H (2010) Association of pericardial fat accumulation rather than abdominal obesity with coronary atherosclerotic plaque formation in patients with suspected coronary artery disease. Atherosclerosis 209(2):573–578. doi:10.​1016/​j.​atherosclerosis.​2009.​10.​008 CrossRefPubMed
20.
go back to reference Wong DT, Soh SY, Ko BS, Cameron JD, Crossett M, Nasis A, Troupis J, Meredith IT, Seneviratne SK (2014) Superior CT coronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: a comparison with first generation 320-detector row CT. Cardiovasc Diagn Ther 4(4):299–306. doi:10.3978/j.issn.2223-3652.2014.08.05 PubMedCentralPubMed Wong DT, Soh SY, Ko BS, Cameron JD, Crossett M, Nasis A, Troupis J, Meredith IT, Seneviratne SK (2014) Superior CT coronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: a comparison with first generation 320-detector row CT. Cardiovasc Diagn Ther 4(4):299–306. doi:10.​3978/​j.​issn.​2223-3652.​2014.​08.​05 PubMedCentralPubMed
23.
go back to reference Nakanishi K, Fukuda S, Tanaka A, Otsuka K, Jissho S, Taguchi H, Yoshikawa J, Shimada K (2014) Persistent epicardial adipose tissue accumulation is associated with coronary plaque vulnerability and future acute coronary syndrome in non-obese subjects with coronary artery disease. Atherosclerosis 237(1):353–360. doi:10.1016/j.atherosclerosis.2014.09.015 CrossRefPubMed Nakanishi K, Fukuda S, Tanaka A, Otsuka K, Jissho S, Taguchi H, Yoshikawa J, Shimada K (2014) Persistent epicardial adipose tissue accumulation is associated with coronary plaque vulnerability and future acute coronary syndrome in non-obese subjects with coronary artery disease. Atherosclerosis 237(1):353–360. doi:10.​1016/​j.​atherosclerosis.​2014.​09.​015 CrossRefPubMed
24.
go back to reference Oikawa M, Owada T, Yamauchi H, Misaka T, Machii H, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y (2015) Epicardial adipose tissue reflects the presence of coronary artery disease: comparison with abdominal visceral adipose tissue. BioMed Res Int 2015:483982. doi:10.1155/2015/483982 PubMedCentralCrossRefPubMed Oikawa M, Owada T, Yamauchi H, Misaka T, Machii H, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh S, Takeishi Y (2015) Epicardial adipose tissue reflects the presence of coronary artery disease: comparison with abdominal visceral adipose tissue. BioMed Res Int 2015:483982. doi:10.​1155/​2015/​483982 PubMedCentralCrossRefPubMed
26.
go back to reference Nelson AJ, Worthley MI, Psaltis PJ, Carbone A, Dundon BK, Duncan RF, Piantadosi C, Lau DH, Sanders P, Wittert GA, Worthley SG (2009) Validation of cardiovascular magnetic resonance assessment of pericardial adipose tissue volume. J Cardiovasc Magn Reson 11:15. doi:10.1186/1532-429X-11-15 PubMedCentralCrossRefPubMed Nelson AJ, Worthley MI, Psaltis PJ, Carbone A, Dundon BK, Duncan RF, Piantadosi C, Lau DH, Sanders P, Wittert GA, Worthley SG (2009) Validation of cardiovascular magnetic resonance assessment of pericardial adipose tissue volume. J Cardiovasc Magn Reson 11:15. doi:10.​1186/​1532-429X-11-15 PubMedCentralCrossRefPubMed
27.
go back to reference Bastarrika G, Broncano J, Schoepf UJ, Schwarz F, Lee YS, Abro JA, Costello P, Zwerner PL (2010) Relationship between coronary artery disease and epicardial adipose tissue quantification at cardiac CT: comparison between automatic volumetric measurement and manual bidimensional estimation. Acad Radiol 17(6):727–734. doi:10.1016/j.acra.2010.01.015 CrossRefPubMed Bastarrika G, Broncano J, Schoepf UJ, Schwarz F, Lee YS, Abro JA, Costello P, Zwerner PL (2010) Relationship between coronary artery disease and epicardial adipose tissue quantification at cardiac CT: comparison between automatic volumetric measurement and manual bidimensional estimation. Acad Radiol 17(6):727–734. doi:10.​1016/​j.​acra.​2010.​01.​015 CrossRefPubMed
31.
32.
go back to reference Inoue K, Motoyama S, Sarai M, Sato T, Harigaya H, Hara T, Sanda Y, Anno H, Kondo T, Wong ND, Narula J, Ozaki Y (2010) Serial coronary CT angiography-verified changes in plaque characteristics as an end point: evaluation of effect of statin intervention. JACC Cardiovasc Imaging 3(7):691–698. doi:10.1016/j.jcmg.2010.04.011 CrossRefPubMed Inoue K, Motoyama S, Sarai M, Sato T, Harigaya H, Hara T, Sanda Y, Anno H, Kondo T, Wong ND, Narula J, Ozaki Y (2010) Serial coronary CT angiography-verified changes in plaque characteristics as an end point: evaluation of effect of statin intervention. JACC Cardiovasc Imaging 3(7):691–698. doi:10.​1016/​j.​jcmg.​2010.​04.​011 CrossRefPubMed
34.
go back to reference Voros S, Rinehart S, Qian Z, Joshi P, Vazquez G, Fischer C, Belur P, Hulten E, Villines TC (2011) Coronary atherosclerosis imaging by coronary CT angiography: current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging 4(5):537–548. doi:10.1016/j.jcmg.2011.03.006 CrossRefPubMed Voros S, Rinehart S, Qian Z, Joshi P, Vazquez G, Fischer C, Belur P, Hulten E, Villines TC (2011) Coronary atherosclerosis imaging by coronary CT angiography: current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging 4(5):537–548. doi:10.​1016/​j.​jcmg.​2011.​03.​006 CrossRefPubMed
35.
go back to reference Leber AW, Becker A, Knez A, von Ziegler F, Sirol M, Nikolaou K, Ohnesorge B, Fayad ZA, Becker CR, Reiser M, Steinbeck G, Boekstegers P (2006) Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 47(3):672–677. doi:10.1016/j.jacc.2005.10.058 CrossRefPubMed Leber AW, Becker A, Knez A, von Ziegler F, Sirol M, Nikolaou K, Ohnesorge B, Fayad ZA, Becker CR, Reiser M, Steinbeck G, Boekstegers P (2006) Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 47(3):672–677. doi:10.​1016/​j.​jacc.​2005.​10.​058 CrossRefPubMed
36.
go back to reference Schmid M, Achenbach S, Ropers D, Komatsu S, Ropers U, Daniel WG, Pflederer T (2008) Assessment of changes in non-calcified atherosclerotic plaque volume in the left main and left anterior descending coronary arteries over time by 64-slice computed tomography. Am J Cardiol 101(5):579–584. doi:10.1016/j.amjcard.2007.10.016 CrossRefPubMed Schmid M, Achenbach S, Ropers D, Komatsu S, Ropers U, Daniel WG, Pflederer T (2008) Assessment of changes in non-calcified atherosclerotic plaque volume in the left main and left anterior descending coronary arteries over time by 64-slice computed tomography. Am J Cardiol 101(5):579–584. doi:10.​1016/​j.​amjcard.​2007.​10.​016 CrossRefPubMed
37.
go back to reference Burgstahler C, Reimann A, Beck T, Kuettner A, Baumann D, Heuschmid M, Brodoefel H, Claussen CD, Kopp AF, Schroeder S (2007) Influence of a lipid-lowering therapy on calcified and noncalcified coronary plaques monitored by multislice detector computed tomography: results of the New Age II Pilot Study. Invest Radiol 42(3):189–195. doi:10.1097/01.rli.0000254408.96355.85 CrossRefPubMed Burgstahler C, Reimann A, Beck T, Kuettner A, Baumann D, Heuschmid M, Brodoefel H, Claussen CD, Kopp AF, Schroeder S (2007) Influence of a lipid-lowering therapy on calcified and noncalcified coronary plaques monitored by multislice detector computed tomography: results of the New Age II Pilot Study. Invest Radiol 42(3):189–195. doi:10.​1097/​01.​rli.​0000254408.​96355.​85 CrossRefPubMed
38.
go back to reference Ito H, Motoyama S, Sarai M, Kawai H, Harigaya H, Kan S, Kato S, Anno H, Takahashi H, Naruse H, Ishii J, Narula J, Ozaki Y (2014) Characteristics of plaque progression detected by serial coronary computed tomography angiography. Heart Vessels 29(6):743–749. doi:10.1007/s00380-013-0420-4 CrossRefPubMed Ito H, Motoyama S, Sarai M, Kawai H, Harigaya H, Kan S, Kato S, Anno H, Takahashi H, Naruse H, Ishii J, Narula J, Ozaki Y (2014) Characteristics of plaque progression detected by serial coronary computed tomography angiography. Heart Vessels 29(6):743–749. doi:10.​1007/​s00380-013-0420-4 CrossRefPubMed
39.
go back to reference Voros S, Rinehart S, Qian Z, Vazquez G, Anderson H, Murrieta L, Wilmer C, Carlson H, Taylor K, Ballard W, Karmpaliotis D, Kalynych A, Brown C 3rd (2011) Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: results from the ATLANTA (assessment of tissue characteristics, lesion morphology, and hemodynamics by angiography with fractional flow reserve, intravascular ultrasound and virtual histology, and noninvasive computed tomography in atherosclerotic plaques) I study. JACC Cardiovasc Interv 4(2):198–208. doi:10.1016/j.jcin.2010.10.008 CrossRefPubMed Voros S, Rinehart S, Qian Z, Vazquez G, Anderson H, Murrieta L, Wilmer C, Carlson H, Taylor K, Ballard W, Karmpaliotis D, Kalynych A, Brown C 3rd (2011) Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: results from the ATLANTA (assessment of tissue characteristics, lesion morphology, and hemodynamics by angiography with fractional flow reserve, intravascular ultrasound and virtual histology, and noninvasive computed tomography in atherosclerotic plaques) I study. JACC Cardiovasc Interv 4(2):198–208. doi:10.​1016/​j.​jcin.​2010.​10.​008 CrossRefPubMed
41.
go back to reference Okura K, Maeno K, Okura S, Takemori H, Toya D, Tanaka N, Miyayama S (2015) Pericardial fat volume is an independent risk factor for the severity of coronary artery disease in patients with preserved ejection fraction. J Cardiol 65(1):37–41. doi:10.1016/j.jjcc.2014.03.015 CrossRefPubMed Okura K, Maeno K, Okura S, Takemori H, Toya D, Tanaka N, Miyayama S (2015) Pericardial fat volume is an independent risk factor for the severity of coronary artery disease in patients with preserved ejection fraction. J Cardiol 65(1):37–41. doi:10.​1016/​j.​jjcc.​2014.​03.​015 CrossRefPubMed
42.
go back to reference Greif M, Becker A, von Ziegler F, Lebherz C, Lehrke M, Broedl UC, Tittus J, Parhofer K, Becker C, Reiser M, Knez A, Leber AW (2009) Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis. Arterioscler Thromb Vasc Biol 29(5):781–786. doi:10.1161/ATVBAHA.108.180653 CrossRefPubMed Greif M, Becker A, von Ziegler F, Lebherz C, Lehrke M, Broedl UC, Tittus J, Parhofer K, Becker C, Reiser M, Knez A, Leber AW (2009) Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis. Arterioscler Thromb Vasc Biol 29(5):781–786. doi:10.​1161/​ATVBAHA.​108.​180653 CrossRefPubMed
43.
go back to reference Ito T, Suzuki Y, Ehara M, Matsuo H, Teramoto T, Terashima M, Nasu K, Kinoshita Y, Tsuchikane E, Suzuki T, Kimura G (2013) Impact of epicardial fat volume on coronary artery disease in symptomatic patients with a zero calcium score. Int J Cardiol 167(6):2852–2858. doi:10.1016/j.ijcard.2012.07.026 CrossRefPubMed Ito T, Suzuki Y, Ehara M, Matsuo H, Teramoto T, Terashima M, Nasu K, Kinoshita Y, Tsuchikane E, Suzuki T, Kimura G (2013) Impact of epicardial fat volume on coronary artery disease in symptomatic patients with a zero calcium score. Int J Cardiol 167(6):2852–2858. doi:10.​1016/​j.​ijcard.​2012.​07.​026 CrossRefPubMed
44.
go back to reference Park JH, Park YS, Kim YJ, Lee IS, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW (2010) Effects of statins on the epicardial fat thickness in patients with coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatin/ezetimibe. J Cardiovasc Ultrasound 18(4):121–126. doi:10.4250/jcu.2010.18.4.121 PubMedCentralCrossRefPubMed Park JH, Park YS, Kim YJ, Lee IS, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW (2010) Effects of statins on the epicardial fat thickness in patients with coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatin/ezetimibe. J Cardiovasc Ultrasound 18(4):121–126. doi:10.​4250/​jcu.​2010.​18.​4.​121 PubMedCentralCrossRefPubMed
45.
go back to reference Gaborit B, Jacquier A, Kober F, Abdesselam I, Cuisset T, Boullu-Ciocca S, Emungania O, Alessi MC, Clement K, Bernard M, Dutour A (2012) Effects of bariatric surgery on cardiac ectopic fat: lesser decrease in epicardial fat compared to visceral fat loss and no change in myocardial triglyceride content. J Am Coll Cardiol 60(15):1381–1389. doi:10.1016/j.jacc.2012.06.016 CrossRefPubMed Gaborit B, Jacquier A, Kober F, Abdesselam I, Cuisset T, Boullu-Ciocca S, Emungania O, Alessi MC, Clement K, Bernard M, Dutour A (2012) Effects of bariatric surgery on cardiac ectopic fat: lesser decrease in epicardial fat compared to visceral fat loss and no change in myocardial triglyceride content. J Am Coll Cardiol 60(15):1381–1389. doi:10.​1016/​j.​jacc.​2012.​06.​016 CrossRefPubMed
Metadata
Title
Relationship between epicardial fat and quantitative coronary artery plaque progression: insights from computer tomography coronary angiography
Authors
Peter J. Psaltis
Andrew H. Talman
Kiran Munnur
James D. Cameron
Brian S. H. Ko
Ian T. Meredith
Sujith K. Seneviratne
Dennis T. L. Wong
Publication date
01-02-2016
Publisher
Springer Netherlands
Published in
The International Journal of Cardiovascular Imaging / Issue 2/2016
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-015-0762-3

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