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

Research output: Contribution to journalArticle

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

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalEuropean Radiology
DOIs
StateAccepted/In press - Jun 14 2018

Fingerprint

Biomarkers
Fats
Myocardial Infarction
Survival
Mortality
Thorax
Calcium

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{53e1d4ee81404dbaa58358db174d7c2e,
title = "Ventricular Myocardial Fat: An Unexpected Biomarker for Long-term Survival?",
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",
author = "Bader, {Anna S.} and Levsky, {Jeffrey M.} and Zalta, {Amin B.} and Anna Shmukler and Arash Gohari and Jain, {Vineet R.} and Victoria Chernyak and Michael Lovihayeem and Bellin, {Eran Y.} and Haramati, {Linda B.}",
year = "2018",
month = "6",
day = "14",
doi = "10.1007/s00330-018-5546-4",
language = "English (US)",
pages = "1--10",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Ventricular Myocardial Fat

T2 - An Unexpected Biomarker for Long-term Survival?

AU - Bader, Anna S.

AU - Levsky, Jeffrey M.

AU - Zalta, Amin B.

AU - Shmukler, Anna

AU - Gohari, Arash

AU - Jain, Vineet R.

AU - Chernyak, Victoria

AU - Lovihayeem, Michael

AU - Bellin, Eran Y.

AU - Haramati, Linda B.

PY - 2018/6/14

Y1 - 2018/6/14

N2 - 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

AB - 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

KW - Biomarkers

KW - Myocardium

KW - Outcomes research

KW - Risk assessment

KW - Tomography, x-ray computed

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U2 - 10.1007/s00330-018-5546-4

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SN - 0938-7994

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