A modifiable imaging biomarker: epicardial adipose tissue density in ischemia with non-obstructive coronary arteries.

The impact of epicardial adipose tissue (EAT) on the risk of non-obstructive coronary artery disease (CAD) remains unclear. This study aims to investigate the association between EAT and ischemia with non-obstructive coronary arteries (INOCA). This study enrolled 281 patients with angina or other symptoms suggestive of myocardial ischemia who underwent single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). All patients had confirmed non-obstructive coronary artery disease (stenosis <50%) by either coronary angiography (CAG) or coronary CT angiography (CCTA) within 3 months before or after MPI. Based on MPI results, patients were categorized into ischemic and non-ischemic groups. Epicardial adipose tissue (EAT) density and volume were measured, and relevant clinical parameters were collected for analysis. The results revealed that 37.72% of the patients had INOCA, and these patients exhibited significantly higher body mass index (BMI) and EAT density. No statistically significant difference in EAT volume was observed between groups. Both EAT density (OR = -1.846, 95% CI: 1.353-2.559, p < 0.05) and volume (OR = -1.703, 95% CI: 1.151-2.551, p < 0.05) were identified as independent risk factors for INOCA. Furthermore, EAT density demonstrated a linear relationship with disease risk. In statin users, the positive association between EAT density and INOCA was attenuated. (β = -0.039, p = 0.046). EAT density is an independent risk factor for INOCA, with its increase showing a linear association with INOCA risk. Further, statin use was associated with a reduction in this EAT density-related INOCA risk.