Clinical usefulness of epicardial adipose tissue in patients with high-intermediate pre-test probability for coronary artery disease

Background: Epicardial adipose tissue (EAT) is thought to be associated with the extension and severity of coronary artery disease (CAD), and echocardiographic measurement of EAT thickness is considered to be a possible cardiovascular risk indica­tor. The European Society of Cardiology Task Force recommends further non-invasive testing in patients with an intermediate pre-test probability (PTP) for the diagnosis of CAD. Aim: We sought to evaluate the clinical usefulness of performing EAT measurements in patients with a high-intermediate PTP. Methods: Patients referred to an outpatient clinic with stable chest pain symptoms, with PTP for CAD between 66% and 85%, were included in the study. Echocardiographic measurement of the EAT was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. Single-photon emission computed tomography (SPECT) was performed in all patients. The diagnosis of CAD was based on the presence of reversible perfusion defects on SPECT. Results: A total of 126 patients (76 men, 60.3%) with a mean age of 65.3 ± 9.1 years were recruited. The EAT thickness was 7.3 ± 0.7 mm in patients with positive SPECT and 6.2 ± 0.6 mm in patients with negative SPECT (p < 0.001). Multivariable analysis revealed higher rates of positive SPECT in patients with higher EAT (odds ratio [OR] 9.80; 95% confidence interval [CI] 3.72–25.79; p < 0.001), and receiver operating characteristic curve analysis showed that the greatest specificity was obtained when the cut-off value of EAT thickness was 6.75 mm (sensitivity 76%; specificity 74%). Conclusions: In patients with high-intermediate PTP, EAT is a useful measurement that may assist in risk stratification

Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?

Aortic dissection is a fatal disease that must be considered in the differential diagnosis of chest pain. If the diagnosis cannot be made in early period, mortality is very high. Here, we present a case of aortic dissection, clinically mimicking acute coronary syndrome