Nappi, Carmela (2018) Relationship between Epicardial Adipose Tissue and Coronary Vascular Function in Patients with Normal Myocardial Perfusion by 82Rb PET/TC. [Tesi di dottorato]


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Item Type: Tesi di dottorato
Lingua: English
Title: Relationship between Epicardial Adipose Tissue and Coronary Vascular Function in Patients with Normal Myocardial Perfusion by 82Rb PET/TC
Date: 30 November 2018
Number of Pages: 40
Institution: Università degli Studi di Napoli Federico II
Department: Scienze Biomediche Avanzate
Dottorato: Scienze biomorfologiche e chirurgiche
Ciclo di dottorato: 31
Coordinatore del Corso di dottorato:
Date: 30 November 2018
Number of Pages: 40
Uncontrolled Keywords: CFR, Perfusion, PET/CT
Settori scientifico-disciplinari del MIUR: Area 06 - Scienze mediche > MED/36 - Diagnostica per immagini e radioterapia
Date Deposited: 21 Dec 2018 08:39
Last Modified: 30 Jun 2020 09:01


Background: Epicardial adipose tissue (EAT) is the visceral fat depot of the heart and it directly influences myocardial homeostasis through vasocrine and paracrine mechanism. A reduced coronary flow reserve (CFR) reflects not only the presence of coronary artery stenosis but also coronary vascular dysfunction. There are a few evidences of a direct correlation between increased EAT and impaired CFR in small patients’ population with suspected or known coronary artery disease (CAD). However, this association has not been not fully investigated. Purpose: We assessed the relationship between EAT and CFR in patients with suspected or known CAD and normal myocardial perfusion imaging. Methods: From a pool of 512 subjects referred for the evaluation of suspected or known CAD to stress-rest 82Rb PET/CT, only 270 patients showing normal MPI were considered. CAC score was measured according to the Agatston method. Using unenhanced CT images for CAC, EAT volume was measured (cm3). The ln (CAC+1) score and ln (EAT) transformation were used to reduce heteroscedasticity. Myocardial perfusion was assessed using standardized segmentation of 17 myocardial regions. Myocardial perfusion was considered normal when the summed stress score was <3. Absolute myocardial blood flow (MBF) was computed (in milliliters per minute per gram) from the dynamic rest and stress imaging series. CFR was defined as the ratio of hyperemic to baseline MBF and CFR < 2 was considered reduced. Results: Among 270 patients with normal MPI, 93 (35%) patients showed reduced CFR and 177 (65%) normal CFR. Compared to patients with normal CFR, those with impaired CFR were older (P<0.001) and showed higher values of ln (CAC+1), (P<0.05), EAT thickness (P<0.01) and ln (EAT) volume (P<0.001). At univariable and multivariable logistic regression analyses, although age, ln (CAC+1) and ln (EAT) volume resulted significant predictors of reduced CFR, only age and ln (EAT) volume were independently associated with reduced CFR (P<0.001 and P<0.05). Accordingly, at incremental analysis, while a model including clinical data and ln (CAC+1) score did not show significant difference as compared to a model including only clinical data (global chi-square from 23.3 to 23.5, P=0.65), the addition of ln (EAT) volume to clinical data significantly increased the global chi-square of the model (from 23.3 to 28.5, P<0.05).In addition, a significant correlation was observed between ln (EAT) volume and CFR (r= −.229, p value <0.05) in patients with CAC score =0 (n=114) while such a relationship was not significant in patients with documented CAC (n=156) (r= −.101, p value N.S.) Conclusion In patients with suspected or known CAD and normal MPI age and EAT are strongly associated with reduced CFR and hyperemic MBF confirming that visceral fat depot may directly influence coronary vascular function. Thus, EAT evaluation may play a major role in the identification of coronary vascular dysfunction even in patients with normal MPI. In particular, it could be useful to consider EAT in patients with to no evidence of coronary calcium burden.


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