Relationship between epicardial adipose tissue volume and coronary artery spasm

https://doi.org/10.1016/j.ijcard.2020.09.074Get rights and content

Highlights

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    We assessed the relationship between coronary artery spasm and adipose tissues.

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    Epicardial adipose tissue volume was higher in patients with coronary artery spasm.

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    No relationship was observed between abdominal adipose tissues and coronary spasm.

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    Increased epicardial adipose tissue volume was a predictor of coronary artery spasm.

Abstract

Background

Epicardial adipose tissue (EAT) is considered to play a critical role in vascular endothelial function. Coronary artery spasm has been postulated to be a causal factor in vascular endothelial abnormalities and atherosclerosis. This study aimed to investigate the relationship between coronary artery spasm and EAT volume, total abdominal adipose tissue (AAT) area, and abdominal visceral adipose tissue (AVAT) area.

Method

Among patients undergoing coronary computed tomography (CT) to evaluate coronary artery disease, we identified 110 patients who did not have significant coronary artery stenosis and underwent a coronary spasm provocation test with cardiac catheterization. They were divided into two groups according to the results of the spasm provocation test: spasm-positive and spasm-negative. EAT volume, total AAT area, and AVAT area were evaluated using CT images.

Results

Seventy-seven patients were included in the spasm-positive group and 33 patients in the spasm-negative group. There were no significant differences in baseline clinical characteristics between the two groups, except for the prevalence of current smoking (48% vs. 27%, p = 0.04). EAT volume was significantly higher in the spasm-positive group (108 ± 38 mL vs. 87 ± 34 mL, p = 0.007), while no significant difference was seen in total AAT area (280 ± 113 cm2 vs. 254 ± 128 cm2, p = 0.32) or AVAT area (112 ± 54 cm2 vs. 98 ± 55 cm2, p = 0.27). Multivariate logistic analysis indicated that EAT volume (per 10 cm3) (odds ratio, 1.198; 95% confidence interval, 1.035–1.388; p = 0.016) was a significant predictor of coronary artery spasm.

Conclusion

Our results suggest that EAT has a strong association with coronary artery spasm, while AAT may not.

Introduction

Previous studies have shown that increased epicardial adipose tissue (EAT) and abdominal adipose tissue (AAT) are risk factors for cardiovascular disease [[1], [2], [3], [4], [5], [6]]. Adipose tissues produce adipokines, including cytokines and chemokines, which can have systemic effects and cause vascular endothelial function disorders [7].

Coronary spasm has shown to be caused by vascular endothelial abnormality and arteriosclerosis [8]. Acetylcholine (Ach), serotonin, ergonovine, and histamine induce vasodilation by causing the release of nitric oxide from the healthy endothelium [9], whereas such substances can cause vasoconstriction in the coronary artery when endothelial dysfunction exists [10]. Thus, there is a hypothesis that various adipose tissues contribute to coronary artery spasm; however, the difference between EAT and other adipose tissue regarding their effect on the occurrence of coronary artery spasm has not been elucidated. This study aimed to investigate the relationship between coronary artery spasm and various adipose tissues by analyzing the EAT volume, total AAT area, and abdominal visceral adipose tissue (AVAT) area.

Section snippets

Subjects

We examined patients with chest discomfort who underwent cardiac computed tomography (CT) owing to suspicion of coronary artery disease from January 2008 to July 2015 at Chubu Rosai Hospital. After excluding patients with coronary artery stenoses (≥50% narrowing of at least one major epicardial coronary artery), we finally identified 110 patients who were suspected of coronary artery spastic angina and underwent coronary angiography with a spasm provocation test using intra-coronary Ach. These

Results

Among all enrolled patients, 77 were included in the spasm-positive group and 33 in the spasm-negative group.

The baseline characteristics are presented in Table 1. The prevalence of current smoking was significantly higher in the spasm-positive group (48.1% vs 27.1%, p = 0.04). There were no significant differences between the two groups in terms of other comorbidities or laboratory data.

The intra- and inter-observer variabilities of EAT volume in CT images were well correlated (intra-: r

Discussion

The main findings of this study are as follows:

1) EAT volume was significantly higher in patients with coronary artery spasm than in those without, whereas there were no significant differences in total AAT area or AVAT area.

2) Increased EAT volume was a significant predictor of coronary artery spasm.

Adipose tissue has various functions not merely as a lipid store, but as an endocrine and paracrine organ [16]. Adipose tissue produces anti-inflammatory and metabotropic adipokines (e.g.,

Declaration of Competing Interest

H·I received lecture fees from Astellas Pharma Inc., Astrazeneca Inc., Daiichi-Sankyo Pharma Inc., and MSD K. K. T.A. received lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi Sankyo, and Bristol-Myers Squibb. T.M received lecture fees from Bayel Pharmaceutical Co., Ltd., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Pfizer Japan Inc.,

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    This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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