The relationship between coronary artery calcium score measured by coronary CT angiography and epicardial fatty tissue and pericoronary fatty tissue thickness

Objective: The primary aim of this study is to evaluate the relationship between coronary artery calcium score (CACS), a widely used predictor of coronary artery disease (CAD), and the thickness of epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT), which play significant roles in local atherosclerosis progression and plaque stability, and to emphasize the prognostic value of these parameters. Materials and Methods: Retrospective analysis was performed on coronary CT angiography images of 1032 individuals. The thicknesses of PCAT and EAT were measured, and their relationships with CACS were assessed using correlation and multivariate regression analyses. The effects of age and gender were also analyzed. Results: Significant positive correlations were found between both PCAT and EAT thicknesses and CACS (PCAT: r=0.461; EAT: r=0.375; p<0.001). In multivariate regression analysis, PCAT emerged as a strong and independent predictor of CACS, regardless of age and gender (p<0.001), whereas EAT was not found to be an independent predictor. Calcium score and calcification prevalence were significantly higher in males compared to females (p<0.001). Each 1 mm increase in PCAT thickness raised the risk of calcification by approximately 44%. Conclusion: PCAT thickness shows a significant and independent association with CACS and can be used as a non-invasive and reliable biomarker for subclinical atherosclerosis. Although EAT thickness was positively correlated, it is not as strong an independent predictor as PCAT. These adipose tissue parameters measured by non-invasive cardiac CT imaging can provide important contributions to CAD risk assessment.