Epicardial Adipose Tissue Thickness and Coronary Artery Disease: Role of Cardiac Magnetic Resonance Imaging

Objective: To determine mean epicardial adipose tissue (EAT) thickness using cardiac MRI in individuals with coronary artery disease (CAD) compared to controls. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, Pakistan; from July to September 2025. Methodology: Eighty-four adults were recruited through consecutive sampling and allocated equally to CAD-Group (n = 42) and non-CAD-Group (n = 42). Greater than 50% luminal stenosis was used to identify CAD on CT coronary angiography (CTCA). Inclusion criteria included adults aged 25–55 years with either CTCA-confirmed CAD or normal coronary anatomy. Exclusion criteria comprised MRI contraindications (such as pacemakers, cochlear implants, or severe claustrophobia), nondiagnostic CMR images, prior PCI or CABG, previous valve surgery, known cardiomyopathies, eGFR <30 mL/min/1.73m², and active malignancy or recent chemotherapy or radiotherapy. All participants underwent non-contrast 3.0T cardiac MRI, and EAT thickness was measured at the left atrioventricular groove during end-diastole. Results: Mean EAT thickness was significantly higher in CAD participants (13.24±3.32 mm) than in controls (11.49±2.15 mm) (p-value=0.005). Logistic regression demonstrated that each 1 mm increase in EAT thickness was independently associated with CAD (adjusted OR 1.256; 95% CI 1.061–1.487; p-value = 0.008). Conclusion: EAT thickness assessed on non-contrast CMR was significantly elevated in CAD patients and independently associated with disease presence, supporting its potential as a noninvasive imaging biomarker for CAD risk assessment.