The accumulation of epicardial adipose tissue is associated with cardiovascular death after open surgical repair for abdominal aortic aneurysms

Abstract

Background

The accumulation of adipose tissue, such as increased epicardial adipose tissue volume (EATV) and visceral fat area (VFA), is associated with the development of cardiovascular (CV) disease. However, little information is available regarding the relationship between EATV and CV death in patients who undergo open surgical repair (OSR) for abdominal aortic aneurysms (AAAs). The aim of this study was to evaluate the association between adipose tissue and CV death and to identify factors related to CV death after AAA repair.

Methods

Between June 2005 and December 2019, a total of 739 patients underwent OSR for AAA with or without iliac artery aneurysm and isolated iliac artery aneurysm at our institution. AAA with a diameter of 50 mm or more and iliac artery aneurysm with 35 mm or greater were considered to be a surgical indication. Patients with ruptured AAAs and infected AAAs were excluded. Four hundred ninety-two patients with preoperative optimal computed tomography (CT) scans were included in this study. The EATV, VFA, and subcutaneous fat area (SFA) were retrospectively quantified from preoperative noncontrast CT images. The EATV index was defined as the EATV divided by the body surface area, and the VFA index and SFA index were defined as each number divided by height squared. The correlations among the EATV, VFA, and SFA indices were analyzed, and the cut-off values of the parameters for predicting CV death after OSR for AAA patients were determined via receiver operating characteristic curves. Regression analysis was used to assess predictors of CV death during the follow-up period. Cox hazard regression analysis was performed.

Results

The median age was 71 years, and 12% of the patients were female. The median body mass index was 23.1 kg/m². The prevalence of comorbidities was 31% for coronary artery disease, 9% for stroke, 15% for diabetes, and 41% for chronic kidney disease. The median follow-up period for overall patients was 62.5 months (interquartile range: 33.7–99.6). The EATV index was positively correlated with the VFA (R = 0.615, p < .001) and SFA (R = 0.421, p < .001) indices. The cut-off value of the EATV index was 73.8 cm³/m² (area under the curve (AUC); 0.566). Multivariate analysis revealed that age ≥75 years and an EATV index ≥73.8 cm³/m² were significantly associated with CV death after AAA repair.

Conclusions

This study demonstrated that the EATV index was associated with CV death in patients who underwent OSR for AAA, suggesting its potential utility as a novel risk stratification tool for personalized postoperative management.