Association of pericardial fat and coronary high-risk lesions as determined by cardiac CT

Christopher L. Schlett, Maros Ferencik, Matthias F. Kriegel, Fabian Bamberg, Brian B. Ghoshhajra, Subodh B. Joshi, John T. Nagurney, Caroline S. Fox, Quynh A. Truong, Udo Hoffmann

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Objective: Pericardial adipose tissue (PAT) is a pathogenic fat depot associated with coronary atherosclerosis and cardiovascular events. We hypothesized that higher PAT is associated with coronary high-risk lesions as determined by cardiac CT. Methods: We included 358 patients (38% female; median age 51 years) who were admitted to the ED with acute chest pain and underwent 64-slice CT angiography. The cardiac CT data sets were assessed for presence and morphology of CAD and PAT. Coronary high-risk lesions were defined as >50% luminal narrowing and at least two of the following characteristics: positive remodeling, low-density plaque, and spotty calcification. PAT was defined as any pixel with CT attenuation of -190 to -30. HU within the pericardial sac. Results: Based on cardiac CT, 50% of the patients (n=180) had no CAD, 46% (n=165) had CAD without high-risk lesions, and 13 patients had CAD with high-risk lesions. The median PAT in patients with high-risk lesions was significantly higher compared to patients without high-risk lesions and without any CAD (151.9 [109.0-179.4]cm 3 vs. 110.0 [81.5-137.4]cm 3, vs. 74.8 [58.2-111.7]cm 3, respectively p=0.04 and p<0.0001). These differences remained significant after adjusting for traditional risk factors including BMI (all p<0.05). The area under the ROC curve for the identification of high-risk lesions was 0.756 in a logistic regression model with PAT as a continuous predictor. Conclusion: PAT volume is nearly twice as high in patients with high-risk coronary lesions as compared to those without CAD. PAT volume is significantly associated with high risk coronary lesion morphology independent of clinical characteristics and general obesity.

Original languageEnglish (US)
Pages (from-to)129-134
Number of pages6
Issue number1
StatePublished - May 2012
Externally publishedYes


  • Adipose tissue
  • Cardiac CT angiography
  • Coronary artery disease
  • High-risk lesions
  • Peri-cardial fat
  • Vulnerable plaque

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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