Associations of Pericardial Fat Area Determined by Routine Chest Computed Tomography With Coronary Risk Factors and Coronary Artery Disease

BACKGROUND: Pericardial fat has been reported to be associated with coronary risk factors and severity of coronary arterial lesions. Previous studies had measured pericardial fat volume (PFV) by using contrast-enhanced cardiac computed tomography (CT) when pericardial fat was quantified. We determined pericardial fat area (PFA) in the cross section with the height of sternal angle by using routine chest CT. METHODS: We picked up 252 patients who underwent chest and abdominal CT, and we selected patients whose coronary arteries were evaluated by coronary angiography or coronary CT. Coronary artery disease (CAD) was defined as more than 75% lumen stenosis. PFA was defined as any pixel with CT attenuation of -150 to -30 Hounsfield Unit (HU) within the pericardial sac at the sternal angle level. RESULTS: Fifty-three patients were eligible. PFA was significantly larger in men than in women. Serum high-density lipoprotein (HDL)-cholesterol level was significantly and negatively correlated with PFA. Hemoglobin A1c and carotid arterial intima-media thickness tended to be positively correlated with PFA. PFA was significantly and nearly 50% larger in patients with CAD than in patients without CAD. The cut-off value of PFA was 10.4 cm(2), and sensitivity and specificity of PFA for CAD were 53.8% and 88.0%, respectively. CONCLUSIONS: Present study is the first to show a significant association of PFA with gender and CAD. PFA can be determined by routine chest CT, and is simpler and more reproducible, and PFA is more available in a greater number of medical institutes as compared with PFV. Present study also showed a discriminatory value of PFA for CAD comparable to PFV.