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Epicardial adipose tissue volume normalized to heart volume associated with obstructive coronary artery diseaseHeart fat levels may link to coronary artery disease

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Key Takeaway
Note the association between high epicardial adipose tissue volume and increased risk of obstructive coronary artery disease.

This cohort study analyzed 27,500 CT scans, comprising 25,155 individuals from the general population and 2,482 individuals from a clinical cohort with suspected coronary artery disease (CAD). The researchers investigated the optimal normalization procedure for epicardial adipose tissue volume (EATV) and its relationship to cardiac risk and obstructive CAD.

Results indicated that normalizing EATV to total heart volume (EATVh) was superior across all metrics and neutralized the effects of sex. In the population cohort, higher SCORE2 cardiac risk and higher prevalence of obstructive CAD increased across quartiles of EATVh. A positive association was observed between significantly higher EATVh and obstructive CAD in both the general and clinical cohorts.

A cut-off of 0.1 for EATVh demonstrated a negative predictive value (NPV) of 97.1% in the general population and 88.9% in the clinical cohort for obstructive CAD. No adverse events or safety data were reported.

While EATVh may serve as a useful marker for obstructive CAD in both symptomatic and asymptomatic patients, these findings are observational. The study reports associations between EATVh and CAD/SCORE2 risk rather than causal relationships.

Researchers studied a large group of people, including over 25,000 individuals from the general population and nearly 2,500 patients with suspected heart disease. The study looked at the volume of epicardial adipose tissue (EATV), which is the fat surrounding the heart, and how it relates to heart health.

The findings showed that as the volume of this heart fat increases, so does the risk of heart disease and overall cardiac risk. Specifically, higher levels of this fat were associated with a higher prevalence of obstructive coronary artery disease in both the general and clinical groups.

This type of study shows a link between fat levels and disease, but it does not prove that the fat causes the disease. However, the researchers found that measuring this fat relative to the total heart volume is a useful way to help identify potential risks.

While these results are promising for identifying markers of heart health, they are part of an observational study. Patients should discuss their specific cardiac risk factors and imaging results with their doctors.

What this means for you:
Higher levels of fat around the heart are linked to an increased risk of coronary artery disease.

Study Details

Study typeCohort
Sample sizen = 25,155
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Background: Increased epicardial adipose tissue volume (EATV) is a potentially important risk marker for coronary artery disease (CAD) available from cardiac computed tomography (CT) images. Sex-differences and effects of age and body size on EATV have been insufficiently explored, and no reliable reference values exist. Consequently, EATV has yet to find its deserved use in clinical practice. Objectives: To define normal values by sex and age, the best normalization procedure for EATV to neutralize effects of body-size, explore the relationship between normalized EATV and cardiac risk, and propose a clinically meaningful cut-off. Methods: AI-based automated EATV data from the general population (n=25,155) and a clinical cohort (n=2,482) with suspected CAD was normalized to height, BSA and heart volumes. Correlation between EATV and EAT attenuation was tested with Spearman?s rank correlation and linear regression to find the optimal normalization. Normalized EATV was compared to high-risk by SCORE2 and obstructive CAD in the population cohort. A cut-off including 95% of cases with obstructive CAD was defined in the general population and tested in the clinical cohort. Results: EATV varied with sex and age across cohorts. Normalization of EATV to total heart volume (EATVh) was superior by all metrics and neutralized the effects of sex. High-risk by SCORE2 and the prevalence of obstructive CAD increased over quartiles of EATVh in the population cohort, and significantly higher EATVh was seen with obstructive CAD in both cohorts. A cut-off of 0.1 in EATVh had a negative predictive value for obstructive CAD of 97.1% in the general population and 88.9% in the clinical cohort. Conclusions: EATV varies considerably with sex, age and body size. Normalization to heart volume outperformed other procedures, and EATVh is a useful marker of obstructive CAD in both the general population and symptomatic patients.
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