Scientific Online Resource System

Izvestia Journal of the Union of Scientists - Varna. Medicine and Ecology Series

Correlation between coronary calcium score and epicardial fat in patients with long-term type 1 diabetes and healthy controls – preliminary results

Georgi Valchev, Samar El Shemeri, Daniela Kaloyanova, Tatyana Chalakova, Kaloyan Tsochev, Nataliya Usheva, Yana Bocheva, Mila Boyadzhieva, Yoto Yotov, Violeta Iotova


In recent years еpicardial adipose tissue has been reported to be an independent predictor of coronary risk, along with the already well established coronary calcium score. In our study we look for a corellation between these two markers in patients with long-term diabetes mellitus type 1 and healthy controls. Epicardial fat volume is quantified by semiautomatically and manually segmenting images acquired with computed tomography and magnetic resonance tomography. The two types of images demonstrate excellent correlation between them. A mild to moderate correlation between epicardial fat volume and coronary calcium score is found, regardless of which type of image the fat is calculated from.


epicardial adipose tissue, coronary calcium score, segmentation, type 1 diabetes mellitus, coronary risk

Full Text


American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020 Jan;43(Suppl 1):S14-S31. doi: 10.2337/dc20-S002. PMID: 31862745.

Antonopoulos AS, Antoniades C. The role of epicardial adipose tissue in cardiac biology: classic concepts and emerging roles. J Physiol. 2017 Jun 15;595(12):3907-3917. doi: 10.1113/JP273049. Epub 2017 Mar 13. PMID: 28191635; PMCID: PMC5471417.

Bertaso AG, Bertol D, Duncan BB, Foppa M. Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol. 2013 Jul;101(1):e18-28. doi: 10.5935/abc.20130138. PMID: 23917514; PMCID: PMC3998169.

Budoff M, Backlund JC, Bluemke DA, Polak J, Bebu I, Schade D, et al.; DCCT/EDIC Research Group. The Association of Coronary Artery Calcification With Subsequent Incidence of Cardiovascular Disease in Type 1 Diabetes: The DCCT/EDIC Trials. JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 2):1341-1349. doi: 10.1016/j.jcmg.2019.01.014. Epub 2019 Mar 13. PMID: 30878435; PMCID: PMC6612565.

Douglass E, Greif S, Frishman WH. Epicardial Fat: Pathophysiology and Clinical Significance. Cardiol Rev. 2017 Sep/Oct;25(5):230-235. doi: 10.1097/CRD.0000000000000153. PMID: 28604567.

Goeller M, Achenbach S, Marwan M, Doris MK, Cadet S, et al. Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. J Cardiovasc Comput Tomogr. 2018 Jan-Feb;12(1):67-73. doi: 10.1016/j.jcct.2017.11.007. Epub 2017 Nov 24. PMID: 29233634; PMCID: PMC5776050.

Khurana R, Yadav A, Buxi TBS, Sawhney JPS, Rawat KS, Ghuman SS, Correlation of epicardial fat quantification with severity of coronary artery disease: A study in Indian population, Indian Heart Journal (2018), doi: 10.1016/j.ihj.2018.08.009.

Miao C, Chen S, Ding J, Liu K, Li D, Macedo R, et al. The association of pericardial fat with coronary artery plaque index at MR imaging: The Multi-Ethnic Study of Atherosclerosis (MESA). Radiology. 2011 Oct;261(1):109-15. doi: 10.1148/radiol.11110346. Epub 2011 Aug 16. PMID: 21846753; PMCID: PMC3176423.

Mohammadzadeh M, Mohammadzadeh V, Shakiba M, Motevalli M, Abedini A, Kadivar S, et al. Assessing the Relation of Epicardial Fat Thickness and Volume, Quantified by 256-Slice Computed Tomography Scan, With Coronary Artery Disease and Cardiovascular Risk Factors. Arch Iran Med. 2018 Mar 1;21(3):95-100. PMID: 29688734.

Mohar DS, Salcedo J, Hoang KC, Kumar S, Saremi F, Erande AS, et al. Epicardial adipose tissue volume as a marker of coronary artery disease severity in patients with diabetes independent of coronary artery calcium: findings from the CTRAD study. Diabetes Res Clin Pract. 2014 Nov;106(2):228-35. doi: 10.1016/j.diabres.2014.08.021. Epub 2014 Sep 6. PMID: 25262111; PMCID: PMC4261017.

Sacks HS, Fain JN. Human epicardial adipose tissue: a review. Am Heart J. 2007 Jun;153(6):907-17. doi: 10.1016/j.ahj.2007.03.019. PMID: 17540190.

Saremi F, Mekhail S, Sefidbakht S, Thonar B, Malik S, Sarlaty T. Quantification of epicardial adipose tissue: correlation of surface area and volume measurements. Acad Radiol. 2011 Aug;18(8):977-83. doi: 10.1016/j.acra.2011.03.011. Epub 2011 Jun 11. PMID: 21652235.

Shehata SM, Zaiton FM, AboWarda MH. Role of MDCT in evaluation of epicardial fat volume as an independent risk factor for coronary atherosclerosis. The Egyptian Journal of Radiology and Nuclear Medicine, 2018 June;49(2):329-337. doi: 10.1016/j.ejrnm.2018.01.008

Svanteson M, Holte KB, Haig Y, Kløw NE, Berg TJ. Coronary plaque characteristics and epicardial fat tissue in long term survivors of type 1 diabetes identified by coronary computed tomography angiography. Cardiovasc Diabetol. 2019 May 4;18(1):58. doi: 10.1186/s12933-019-0861-x. PMID: 31054573; PMCID: PMC6500584.

Zhou J, Chen Y, Zhang Y, Wang H, Tan Y, Liu Y, et al. Epicardial Fat Volume Improves the Prediction of Obstructive Coronary Artery Disease Above Traditional Risk Factors and Coronary Calcium Score. Circ Cardiovasc Imaging. 2019 Jan;12(1):e008002. doi: 10.1161/CIRCIMAGING.118.008002. PMID: 30642215.



Font Size