Pericardial fat volume is related to atherosclerotic plaque burden rather than to lesion severity

Aims: We sought to explore the relationship between pericardial fat volume (PFV) and both coronary atherosclerosis (CA) extent and severity using coronary artery calcium score (CAC), computed tomography coronary angiography (CTCA), and invasive coronary angiography in patients at high to intermediate likelihood of coronary artery disease (CAD). Methods and results: Patients clinically referred to invasive angiography who underwent CTCA and CAC within 1 month before the procedure comprised the study population. PFV, CAC, atherosclerotic burden indexes [segment involvement score (SIS); segment stenosis score; three-vessel plaque; and any left main plaque], and the invasive angiography-derived CAD index were evaluated independently. A total of 75 patients were included in the study. PFV did not differ between patients with or without obstructive (stenosis .70%) CAD defined by invasive angiography (86.4±31.7 vs. 77.1±42.8 cm3, P = 0.34), although patients with obstructive CAD had significantly higher CAC scores [636.0 (IQR 229.5-1101.0) vs. 206.0 (IQR 0.0-675), P<0.0001] than patients without obstructive CAD. Patients with extensive CA (SIS . 5) had significantly larger PFV (89.9±33.9 vs. 58.7±33.2 cm3, P = 0.003) than patients with non-extensive CA. Significant correlations were found between PFV and CAC (r = 0.49, P<0.0001), and SIS (r = 0.46, P