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Increased Epicardial Fat Volume Is Independently Associated with the Presence and Severity of Systemic Sclerosis

Posted Nov 30, 2017 Updated Apr 10, 2023
By Benjamin D. Long BS , Jadranka Stojanovska MD MS , Richard K.J. Brown MD FACR , Anil K. Attili MD , Eizabeth A. Jackson MD MPH , Vladimir Ognenovski MD
13 min read

Highlights

  • Epicardial fat volume is independently associated with the presence and severity of systemic sclerosis.

  • Extrapericardial fat volume is only associated with the presence of systemic sclerosis.

  • Coronary artery calcification is not independently associated with systemic sclerosis.

Rationale and Objectives

The study aimed to determine if intrathoracic fat volumes are associated with the presence and severity of systemic sclerosis (SSc), defined by the presence of pulmonary arterial hypertension (PAH).

Materials and Methods

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Results

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Conclusion

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Introduction

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Materials and Methods

Study Design

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Study Population

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Figure 1, Flowchart summary of the patient enrollment process. Total of 265 patients were enrolled in our study, 202 of whom were diagnosed with systemic sclerosis and 63 patients represented healthy controls with no history of cardiovascular disease (CVD). Sixty-eight patients with systemic sclerosis had systemic sclerosis-associated pulmonary arterial hypertension (PAH).

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CT Technique

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CT Image Reconstruction, Fat Measurement Technique, and Postprocessing

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Figure 2, A 67-year-old patient with systemic sclerosis and pulmonary arterial hypertension. Axial high-resolution computed tomography image delineates pericardium (arrowhead). The pericardium divides the intrathoracic fat into two fat depots. The fat on the inner side of the pericardium and around the heart is epicardial fat and the fat outside of the pericardium is extrapericardial fat. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

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Statistical Analysis

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Results

Baseline Characteristics

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TABLE 1

(a) Baseline Characteristics of Controls and Patients with Systemic Sclerosis and (b) Baseline Characteristics of Systemic Sclerosis Patients with and without Systemic Sclerosis-Associated Pulmonary Arterial Hypertension

(a) Controls ( N = 63) Systemic Sclerosis ( N = 202)P Value Age (years) 49 ± 11 55 ± 13 0.0004 § Heart rate \* (bpm) 62 ± 11 79 ± 15 <0.0001 § Weight (kg) 82 ± 16 74 ± 19 0.0004 § Height (cm) 172 ± 12 164 ± 10 <0.0001 § BMI (kg/m 2 ) 29 ± 5 27 ± 6 0.0467 § BSA (m 2 ) 1.9 ± 0.2 1.8 ± 0.2 0.0005 § Women, % (n) 52 (33) 79 (159) <0.0001 § CAD, % (n) 0 (0) 10 (21) 0.0055 § ILD, % (n) 0 (0) 63 (124) <0.0001 § Hyperlipidemia, % (n) 0 (0) 23 (46) <0.0001 § Ever smoker † , % (n) 1.6 (1) 42 (80) <0.0001 § CAC 0 (0) 61 (124) <0.0001 § Epicardial fat (cm 3 ) 59 (30–81) 154 (120–202) <0.0001 § Extrapericardial fat (cm 3 ) 79 (48–96) 95 (68–141) <0.0001 § Intrathoracic fat (cm 3 ) 139 (79–179) 268 (199–341) <0.0001 §

(b) Systemic Sclerosis, No PAH ( N = 134) Systemic Sclerosis-Associated PAH ( N = 68)P Value Age (years) 51 ± 14 63 ± 10 <0.0001 § Heart rate (bpm) 80 ± 15 78 ± 15 0.34 Weight (kg) 75 ± 19 71 ± 18 0.17 Height (cm) 165 ± 10 162 ± 9 0.02 § BMI (kg/m 2 ) 27 ± 6 27 ± 6 0.89 BSA (m 2 ) 1.8 ± 0.2 1.8 ± 0.2 0.08 Women, % (n) 77 (103) 82 (56) 0.37 CAD, % (n) 4 (6) 22 (15) 0.0001 § ILD, % (n) 55 (74) 78 (50) 0.002 § Hyperlipidemia, % (n) 15 (20) 38 (26) 0.0002 § Ever Smoker ‡ , % (n) 41 (51) 44 (29) 0.67 CAC 51 (68) 82 (56) <0.0001 § Epicardial fat (cm 3 ) 145 (112–195) 178 (143–225) 0.0003 § Extrapericardial fat (cm 3 ) 90 (65–128) 113 (77–160) 0.002 § Intrathoracic fat (cm 3 ) 243 (171–314) 307 (224–384) 0.0003 §

BMI, body mass index; bpm, beats per minute; BSA, body surface area; CAC, coronary arterial calcification; CAD, coronary artery disease; ILD, interstitial lung disease; PAH, pulmonary arterial hypertension; SSc, systemic sclerosis.

Fat volumes are presented as medians and interquartile range (IQR). Other continuous variables are presented as means and standard deviations when appropriate. Categorical variables are presented as a percentage (%).

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ITFV and Clinical Characteristics in Patients with SSc

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TABLE 2

Associations Between Epicardial Fat Volume and Clinical Variables in Patients with Systemic Sclerosis Using General Linear Model

Fat Volumes (cm 3 ) Epicardial Fat Volume Extrapericardial Fat Volume Estimate difference ± SE_P_ Value Estimate difference ± SE_P_ Value Age 1.39 ± 0.3 <0.0001 1.8 ± 0.3 <0.0001 ‡ Multivariate \* 1.1 ± 0.3 0.001 1.67 ± 0.3 <0.0001 ‡ Gender 31.6 ± 10.3 0.002 ‡ 62.1 ± 10.3 <0.0001 ‡ Multivariate \* 34.3 ± 9.9 0.0007 ‡ 64.3 ± 10.1 <0.0001 ‡ BMI 4.1 ± 0.7 <0.0001 ‡ 4.4 ± 0.7 <0.0001 ‡ Multivariate \* 4.2 ± 0.6 <0.0001 ‡ 4.4 ± 0.7 <0.0001 ‡ Ever-smoker 15.2 ± 8.7 0.08 15.9 ± 9.2 0.08 Multivariate \* 14.3 ± 8.4 0.09 15.2 ± 9.06 0.09 ILD 22.6 ± 8.9 0.01 ‡ 18.3 ± 9.1 0.05 ‡ Multivariate † 4.6 ± 7.8 0.55 ‡ −0.3 ± 7.0 0.96 Diabetes 60.1 ± 21.7 0.0063 35.9 ± 23.5 0.13 Multivariate † 38.2 ± 18.5 0.04 ‡ 12.6 ± 18.0 0.48 Hyperlipidemia 24.6 ± 10.2 0.02 ‡ 41.9 ± 10.5 <0.0001 ‡ Multivariate † -2.5 ± 9.3 0.78 10.03 ± 8.9 0.26 CAC 27.1 ± 8.7 0.0020 ‡ 32.11 ± 9.2 0.0006 Multivariate † 9.4 ± 8.5 0.27 8.7 ± 8.15 0.29

BMI, body mass index; CAC, coronary artery calcium; ILD, interstitial lung disease; SE, standard error.

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ITFV and Presence of SSc

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Figure 3, Column graph showing intrathoracic fat volumes and body mass index (BMI) in controls and systemic sclerosis (SSc) patients without and with associated pulmonary arterial hypertension (PAH). Intrathoracic fat volumes (epicardial fat volume [EFV], extrapericardial fat volume [EPFV], and intrathoracic fat volume [ITFV] are scaled to the left y-axis, and BMI is scaled to the right y-axis). This graph demonstrates significant difference of epicardial fat volume across the groups, whereas BMI demonstrates no difference across the groups. Note that patients with SSc-associated PAH have the most extensive epicardial fat volume than patients with SSc alone and controls.

Figure 4, Box-and-whisker plot showing epicardial fat volume (EFV) in controls, systemic sclerosis (SSc) alone, and SSc-associated pulmonary arterial hypertension (PAH) groups. Significant difference of EFV across the groups. EFV is the largest in the SSc-associated PAH group than in the SSc alone and control groups.

TABLE 3

(a) Logistic Regression Analysis for Systemic Sclerosis Versus Control and (b) Logistic Regression Analysis for Systemic Sclerosis Versus Systemic Sclerosis-Associated Pulmonary Arterial Hypertension

(a) Systemic Sclerosis Versus Controls OR (95% CI)P Value EFV Unadjusted 1.058 (1.042–1.075) <0.0001 Adjusted \* 1.065 (1.046–1.084) <0.0001 EPFV \* Unadjusted 1.014 (1.007–1.021) 0.0001 Adjusted \* 1.028 (1.017–1.038) <0.0001 ITFV \* Unadjusted 1.022 (1.016–1.028) <0.0001 Adjusted \* 1.033 (1.023–1.043) <0.0001

(b) SSc without PAH Versus SSc with PAH OR (95% CI)P Value EFV Unadjusted 1.010 (1.004–1.015) 0.0002 Model 1 1.008 (1.001–1.015) 0.025 Model 2 1.008 (1.000–1.015) 0.044 EPFV Unadjusted 1.006 (1.002–1.011) 0.009 Model 1 1.002 (0.995–1.009) 0.52 Model 2 0.998 (0.991–1.006) 0.70 ITFV Unadjusted 1.005 (1.002–1.008) 0.0004 Model 1 1.004 (1.000–1.008) 0.083 Model 2 1.002 (0.998–1.007) 0.304 CAC Unadjusted 4.529 (2.228–9.208) < 0.0001 Model 1 1.826 (0.782–4.267) 0.1642 Model 2 2.184 (0.878–5.432) 0.09

CAC, coronary artery calcium; CI, confidence interval; EFV, epicardial fat volume; EPFV, extrapericardial fat volume; ITFV, intrathoracic fat volume; OR, odds ratio; PAH, pulmonary arterial hypertension; SSc, systemic sclerosis.

Models 1: adjusted for age, gender, body mass index, hyperlipidemia, smoking, CAC, and diabetes. Model 2: adjusted for age, gender, body mass index, hyperlipidemia, smoking, diabetes, CAC, and interstitial lung disease.

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Figure 5, ( a ) A 24-year-old woman with systemic sclerosis and upper limit of weight with body mass index of 25 kg/m 2 . Epicardial fat volume (arrow) quantified from this axial high-resolution computed tomography (CT) was 56 cc. The arrowhead delineates the pericardium. ( b ) A 69-year-old overweight woman with systemic sclerosis-associated pulmonary arterial hypertension and body mass index of 29 kg/m 2 . The epicardial fat volume (arrow) quantified from this axial high-resolution CT was 246 cc. The extrapericardial fat is also shown (arrow). ( c ) As a comparison, quantified epicardial fat volume (arrow) from an axial CT image of a 34-year-old overweight healthy man with no history of systemic sclerosis, pulmonary arterial hypertension, or cardiovascular disease, and body mass index of 28 kg/m 2 was 25 cc. The arrowhead depicts the pericardium.

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ITFV and Severity of SSc (PAH Versus No PAH)

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Discussion

Main Results

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ITFV and Presence of SSc

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ITFV and Severity of SSc (SSc-PAH)

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Prior Studies

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Limitations

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Conclusion

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Acknowledgements

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Academic Radiology, Volume 24, Issue 12
Journals General Radiology
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