Is elevated calcium score alone or with the additional contribution of excess epicardial fat the trigger causing early inflammation leading to ECG abnormalities?

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Elevated EFV has been recently reported to be prevalent and a possible contributor to higher cardiovascular morbidity and mortality, particularly in the presence of elevated CACS. PURPOSE: To assess whether elevated EFV in the presence of CACS has significant effects on the cardiac electrical activity as evidenced by 12-lead ECG abnormalities, in addition to triggering inflammation in the microvasculature (C2), altering the lipid profile and altering BP rise PME, in comparison to population without elevated EFV and the same demographic. METHODS: 2932 asymptomatic subjects, 50 years +, underwent cardiovascular disease (CVD) risk assessment using the Early Cardiovascular Disease Risk Scoring System (ECVDRS), known as Rasmuessen Risk Score (RRS), which has been previously reported. The ECVDRS includes 10 cardiovascular tests, 7 of these tests are vascular and 3 are cardiac. 334 subjects underwent a cardiac CT for EFV and CACS determination. Out of these, 55 participants (43M + 12F) with significantly elevated CACS and elevated or normal EFV were further assessed regarding their exercise level, structural/functional abnormalities, presence of significant OCAD or INOCAD as assessed by cardiac catheterization, exercise stress test, and nuclear stress test. RESULTS: As shown in Table: CONCLUSION: Increased CACS in the presence of normal EFV is not associated with significant inflammatory factors, obstructive CAD, and functional abnormalities. We postulate that increased CACS in the presence of normal EFV may be associated with perivascular rather than intravascular calcium deposition. Subjects with normal EFV have less structural and functional abnormalities even in the presence of elevated CACS in comparison to subjects with elevated EFV. Subjects with elevated EFV are associated with significant prevalence of ECG abnormalities. Based on our data, we recommend lifestyle modification with an emphasis on high levels of exercise along with novel treatment reported recently to decrease EFV aiming to reduce the risk of arrhythmia. [Figure: see text]