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Eur Radiol. 2019 Jan;29(1):241-250. doi: 10.1007/s00330-018-5546-4. Epub 2018 Jun 14.

Ventricular Myocardial Fat: An Unexpected Biomarker for Long-term Survival?

Author information

1
Department of Radiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA. ashlionsky@gmail.com.
2
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St., PO Box 208042, New Haven, CT, 06520, USA. ashlionsky@gmail.com.
3
Department of Radiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA.
4
Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
5
Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY, USA.

Abstract

PURPOSE:

To examine the association between myocardial fat, a poorly understood finding frequently observed on non-contrast CT, and all-cause mortality in patients with and without a history of prior MI.

MATERIALS AND METHODS:

A retrospective cohort from a diverse urban academic center was derived from chronic myocardial infarction (MI) patients (n = 265) and three age-matched patients without MI (n = 690) who underwent non-contrast chest CT between 1 January 2005-31 December 2008. CT images were reviewed for left and right ventricular fat. Electronic records identified clinical variables. Kaplan-Meier and Cox proportional hazard analyses assessed the association between myocardial fat and all-cause mortality. The net reclassification improvement assessed the utility of adding myocardial fat to traditional risk prediction models.

RESULTS:

Mortality was 40.1% for the no MI and 71.7% for the MI groups (median follow-up, 6.8 years; mean age, 73.7 ± 10.6 years). In the no MI group, 25.7% had LV and 49.9% RV fat. In the MI group, 32.8% had LV and 42.3% RV fat. LV and RV fat was highly associated (OR 5.3, p < 0.001). Ventricular fat was not associated with cardiovascular risk factors. Myocardial fat was associated with a reduction in the adjusted hazard of death for both the no MI (25%, p = 0.04) and the MI group (31%, p = 0.018). Myocardial fat resulted in the correct reclassification of 22% for the no MI group versus the Charlson score or calcium score (p = 0.004) and 47% for the MI group versus the Charlson score (p = 0.0006).

CONCLUSIONS:

Patients with myocardial fat have better survival, regardless of MI status, suggesting that myocardial fat is a beneficial biomarker and may improve risk stratification.

KEY POINTS:

• Myocardial fat is commonly found on chest CT, yet is poorly understood • Myocardial fat is associated with better survival in patients with and without prior MI and is not associated with traditional cardiovascular risk factors • This finding may provide clinically meaningful prognostic value in the risk stratification of patients.

KEYWORDS:

Biomarkers; Myocardium; Outcomes research; Risk assessment; Tomography, x-ray computed

PMID:
29948081
DOI:
10.1007/s00330-018-5546-4
[Indexed for MEDLINE]

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