SRS275 - The association between epicardial adipose tissue measurement and the severity of coronary artery disease: a systematic review and network meta-analysis across severity strata

Abstract The role of epicardial adipose tissue (EAT) as a metabolically active fat store has attracted increasing interest. However, how EAT volume relates to the severity of coronary artery disease (CAD) remains unclear. We conducted a systematic review and meta-analysis to compare EAT volumes in patients with and without CAD and assess if higher EAT volume correlates with more severe CAD. This study was registered in PROSPERO (CRD42023466043). We searched PubMed, Embase, and Scopus for studies reporting EAT volume in CAD patients versus non-CAD or based on severity up to 11 February 2025. Covidence was used for study selection, data extraction, and quality assessment. Meta-analyses were conducted in R using random effects models. By analysing 47 studies involving a total of 15976 participants, we found that, in pairwise analysis, patients with CAD had significantly higher EAT volumes than those without CAD (mean difference: 26.2 cm³, 95% c.i.: 21.5–31.0, P < 0.001; I² = 94.7%). In the network meta-analysis, severe CAD caused the largest increase in EAT volume compared to mild CAD (mean difference = 30.88 mL, 95% c.i.: 20.21–41.55), whilst non-CAD was associated with a significantly lower volume (mean difference = −13.53 mL, 95% c.i.: −22.67 to −4.40). Meta-regression demonstrated a significant linear relationship between EAT volume and CAD severity (estimate per severity level: 10.17 cm³, 95% c.i.: 1.36–18.98, P = 0.0236). Conclusions: The current findings suggest that EAT could serve as a non-invasive imaging biomarker to assess the severity of coronary artery disease.