Abstract
Background: Epicardial adipose tissue (EAT) is increasingly recognized as a risk factor for coronary atherosclerosis. This study evaluates the association between EAT thickness, measured by 2D transthoracic echocardiography, and coronary plaque morphology in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI).
Methods: A cross-sectional study was conducted on 42 CCS patients at Institute of Cardiology, Bach Mai Hospital, Hanoi, Vietnam, from July 2024 to August 2025. EAT thickness was measured at end-diastole in two echocardiographic views (parasternal long-axis, short-axis) using 2D transthoracic echocardiography (Philip Epic 7G). Coronary plaque morphology was assessed by intravascular ultrasound (IVUS) in target vessels with ≥50% stenosis.
Results: Median EAT thickness was 4.73 mm. Patients with thick EAT (≥4.73 mm, n=21) had higher BMI (24.19 ± 2.28 vs. 22.39 ± 2.71 kg/m², p<0.030) and a greater prevalence of soft plaques (57.1% vs. 14.3%, p=0.010) and eccentric plaques (61.9% vs. 23.8%, p=0.029) compared to those with thin EAT (<4.73 mm, n=21). EAT thickness correlated strongly with plaque burden (r=0.84, 95% CI: 0.71–0.90, p<0.001) and thickness (r=0.79, 95% CI: 0.67–0.89, p<0.001).
Conclusion: EAT thickness measured by transthoracic echocardiography is associated with vulnerable plaque morphology in CCS patients, suggesting its potential as a non-invasive marker for risk stratification before PCI. Larger prospective studies are needed to validate these findings and assess clinical outcomes.