762 - Expansion of Intra-Thoracic Adipose Tissue Depots Associate with Prevalence and Burden of Mixed (Vulnerable) Plaques in Coronary Artery Disease-Nave Patients with Rheumatoid Arthritis

Sunday, November 6, 2011: 3:15 PM
W375a (McCormick Place West)
George A. Karpouzas1, Panteja Razaeian2, Jennifer Malpeso2, Dong Li2, Maria V. Peralta2, Silvia Munoz1 and Matthew Budoff2, 1Harbor-UCLA, Torrance, CA, 2Harbor-UCLA Medical Center, Torrance, CA
Presentation Number: 762

Background/Purpose: Expansion of intrathoracic adipose tissue (AT) depots were reported to associate with the risk of myocardial infarction and fatal coronary artery disease (CAD) in the general population. Similarly, such AT increase was correlated with higher prevalence and severity of coronary plaque. Multidetector Computed Tomography Angiography (MDCTA) accurately classifies coronary plaque as non-calcified (NCP), mixed (MP), or fully calcified (CP), and readily recognizes features of plaque vulnerability such as a large lipid core, spotty calcification, and positive remodeling, often expressed in MP. In this report we explored the associations of different coronary plaque types with intrathoracic AT volume status, as well as the ability of such volumes to predict the presence of a specific plaque type in CAD-nave subjects with RA.

Method: One hundred and fifty patients underwent MDCTA for plaque evaluation and assessment of epicardial adipose tissue (EAT) and thoracic adipose tissue (TAT) volumes. The standard 15-segment American Heart Association (AHA) model was used, and plaque burden was reported as total plaque segment score (TPSS) for different plaque types as previously described. Risk regression analysis models adjusted for age, gender, and all cardiac risk factors were constructed to assess the incremental change of EAT or TAT volumes for different plaque types per standard deviation (SD) of such change in subjects without plaque. Subsequent modeling for evaluation of risk for MP prevalence was attempted by quartile of EAT and TAT.

Result: Subjects with any prevalent coronary plaque (TPSS-all>0) displayed higher EAT and TAT volumes compared to those without (TPSS-all=0- table 1). Of the different plaque types, only the presence of MP was associated with significant expansion of EAT and TAT; for each SD of change in subjects without plaque, there was a 2.5-fold and 3.5-fold change in EAT and TAT in patients with prevalent MP (p<0.05 and <0.01 respectively). The highest TAT quartile was significantly associated with MP prevalence; 29% of patients with TAT in the 4th quartile had MP compared to 2.9% in those with TAT in 1st quartile (p=0.012). In an adjusted model, patients on the highest TAT quartile had 13-fold higher risk for MP prevalence compared to those in the lowest quartile.

Conclusion: Coronary plaque presence is associated with a 30% expansion in EAT and 50% expansion in TAT compared to absence of plaque. Of all plaque types, only MP- that commonly harbors vulnerable features- associates with significantly higher EAT and TAT volumes, and highest quartiles of TAT independently predict the presence of MP.

 

Table 1

Plaque (-)

TPSS-all=0

Plaque (+)

TPSS-all>0

TPSS-NCP>0 & TPSS-MP=0 & TPSS-CP=0

TPSS-MP>0 & TPSS-CP=0

TPSS-CP>0 & TPSS-MP=0 & TPSS-NCP=0

EAT (cc)

100.230.2

120.645.3

110.142.73

130.142.1

13547.1

TAT (cc)

153.974.3

193.783.8

171.578.55

224.787.7

21464.3

Risk Regression analysis (n of SD change/ SD change in referent) µ

EAT

1 (ref)

1.3(0.8,1.9)

1.2(0.7,1.9)

2.5(1.0,5.8) *

2.8(0.4,18.7)

TAT

1 (ref)

1.5(1.0,2.4)*

1.4(0.9,2.3)

3.5(1.4,8.8)**

6.4 (0.6,63.1)

µ adjusted for age, gender, all cardiac risk factors, RA duration, presence of TNF-inhibitors

*p<0.05, **p<0.01

MP prevalence by Quartiles of EAT and TAT

 

Quartile 1

N (%)

Quartile 2

N (%)

Quartile 3

N (%)

Quartile 4

N (%)

p-value

EAT

 

 

 

 

 

MP (-)

32(94.1)

28(82.4)

30(85.7)

26(76.5)

0.234

MP (+)

2(5.9)

6(17.6)

5(14.3)

8(23.5)

TAT

 

 

 

 

 

MP (-)

33(97.1)

31(91.2)

28(80.0)

24(70.6)

0.012

MP (+)

1(2.9)

3(8.8)

7(20.0)

10(29.4)

Association between MP burden and quartiles of EAT and TAT

 

Crude

Adjusted µ

 

OR

95% CI

p-value

OR

95% CI

p

EAT-Q1

1.0 (Ref)

 

 

1.0 (Ref)

 

 

EAT-Q2

3.4

0.6,18.4

0.15

3.7

0.6,23.2

0.17

EAT-Q3

2.7

0.5,14.8

0.26

2.2

0.4,14.3

0.39

EAT-Q4

4.9

1.0,25.2

0.06

4.8

0.8,27.7

0.08

TAT-Q1

1.0 (Ref)

 

 

1.0 (Ref)

 

 

TAT-Q2

3.2

0.3,32.4

0.33

3.6

0.3,39.0

0.29

TAT-Q3

8.2

1.0,71.2

0.06

6.5

0.7,61.0

0.10

TAT-Q4

13.7

1.6,114.8

0.02

12.9

1.4,121.1

0.03

µ adjusted for age, gender, all cardiac risk factors, RA duration, presence of TNF-inhibitors

 


Keywords: atherosclerosis and rheumatoid arthritis (RA)

Disclosure: G. A. Karpouzas, None; P. Razaeian, None; J. Malpeso, None; D. Li, None; M. V. Peralta, None; S. Munoz, None; M. Budoff, None.