Epicardial Fat Volume Tracks Coronary Plaque Burden on Non-Contrast CT, but Adds Little Beyond Calcium Score

In 221 patients undergoing cardiac CT/CTA, epicardial adipose tissue volume (EAV) independently associated with CAD after adjusting for traditional risk factors and calcium score; extensive plaque burden rose from 15.6% to 46.7% across EAV quartiles. EAV did not predict high-ris…

• Retrospective single-center study (n=221); EAV semi-automatically measured on non-contrast CT (attenuation −200 to −30 HU); CAD-RADS 2.0 P-score used to classify plaque burden — design limits generalizability.
• EAV improved prediction of extensive plaque burden beyond traditional cardiovascular risk factors alone, but its incremental predictive value beyond coronary artery calcium (CAC) score was limited — suggesting EAV is complementary, not superior, to CAC.
• EAV was not consistently associated with plaque phenotype or high-risk plaque features (positive remodeling, low-attenuation plaque, napkin-ring sign, spotty calcium), tempering enthusiasm for its role in plaque characterization; reproducibility was excellent (ICC 0.969–0.998).

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