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Epicardial adipose tissue and calcific aortic stenosis – unveiling a long-distance relationship
Session:
Painel 3 - Imagiologia Cardiovascular 2
Speaker:
Catarina Brízido
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Posters
FP Number:
---
Authors:
Catarina Brízido; António Miguel Ferreira; Pedro Freitas; Daniel Nascimento Matos; Sara Guerreiro; João Abecasis; Ana Coutinho Santos; Carla Rodrigues Carvalho; Regina Ribeiras; Maria João Andrade; Rui Campante Teles; Manuel Almeida; Miguel Mendes
Abstract
<p><strong>Introduction: </strong></p> <p>Calcific aortic stenosis (AS) and coronary artery disease share common risk factors, but efforts to retard the progression of AS with anti-atherosclerotic therapies have been unsuccessful, suggesting the existence of unknown links in its pathophysiology. Epicardial adipose tissue (EAT) is also correlated with multiple cardiovascular risk factors and has recently been shown to be an active promoter of vascular inflammation and calcification. We raised the hypothesis that patients with severe AS would have a greater amount of EAT, independently of their atherosclerotic burden.</p> <p><strong>Methods: </strong></p> <p>Within a single-centre cardiac CT registry, we identified 624 patients undergoing cardiac CT for symptomatic severe calcific AS and 1110 patients undergoing cardiac CT for other reasons. After applying exclusion criteria (age <60 years, known coronary disease, left ventricle dysfunction or bicuspid valve), 241 AS patients and 260 non-AS patients were available for analysis. AS patients were paired in a 1:1 ratio with patients from the control group using a propensity score (matched by age, sex, body mass index [BMI], serum creatinine, tobacco use, dyslipidaemia, hypertension, diabetes and coronary calcium Agatston score). Epicardial fat was quantified in a single 3mm slice of non-contrast CT, using a simplified semi-automated method.</p> <p><strong>Results</strong>:</p> <p>A total of 122 patients (67% women, mean age 76±6 years) were matched (61 AS patients and 61 controls). Patients with AS had a mean gradient of 53±12 mmHg and a median aortic valve calcium score of 2219 AU (IQR 1607-3114). Coronary atherosclerotic burden, as measured by coronary calcium Agatston score, was similar in both groups (108 AU [IQR 2-532] vs 172 AU [IQR 26-626]; p=0.414). There were no statistically significant differences between AS patients and controls regarding age, sex, BMI, serum creatinine, and prevalence of classic cardiovascular risk factors.</p> <p>Overall, the median epicardial fat volume was 4.23cm<sup>3</sup>/m<sup>2</sup> (IQR 3.46-5.33) and similar between genders (4.23cm<sup>3</sup>/m<sup>2</sup> [IQR 3.48-6.40] in males vs 4.22cm<sup>3</sup>/m<sup>2</sup> [IQR 3.31-5.15] in females; p=0.332). Even though AS patients had more epicardial fat volume (4.30cm<sup>3</sup>/m<sup>2 </sup>[IQR 3.25-5.62]) when compared to their matched controls (4.11cm<sup>3</sup>/m<sup>2</sup>, [IQR 3.51-4.99]; p for comparison = 0.65), this finding was not statistically significant. Larger studies are necessary to conclude about meaningful differences between AS patients and matched controls.</p> <p><strong>Conclusion:</strong></p> <p>In this cohort, epicardial fat volume was slightly higher (but not statistically significant) in patients with calcific aortic stenosis when compared to a matched control group. It remains to elucidate if inflammatory epicardial fat (vs. noninflammatory fat) could be associated with calcific aortic stenosis.</p>
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