Clinical Reference Percentiles for AI-derived Epicardial Adipose Tissue: A Multicenter Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: ABSTRACT Background and Aims Epicardial adipose tissue (EAT) has emerged as an important cardiovascular biomarker that reflects both inflammatory and cardiometabolic risk. EAT volume and density vary significantly across populations, yet there is a lack of multicenter studies investigating the predictive value of population-specific EAT percentiles. Methods In this multicenter study, we retrospectively analyzed low-dose computed tomography correction scans from 42,842 patients undergoing myocardial perfusion imaging. A derivation cohort of 15,082 patients was used to establish sex- and age-specific nomograms for EAT density and EAT volume indexed to body surface area. Percentile-based thresholds were tested for outcome prediction in a validation cohort of 27,760 patients. For clinical implementation, we developed an online EAT percentile calculator. Results Percentile curves demonstrated increased BSA-indexed EAT volume and decreasing EAT density with age. Over a median follow-up of 3.6 years (IQR: 1.83 – 5.14), 4,956 patients experienced a nonfatal myocardial infarction or death. In multivariable Cox models, patients above the 95 th sex- and age-specific percentile had significantly worse outcomes for BSA-indexed EAT volume [adjusted hazard ratio 1.30, 95% CI: 1.14 – 1.49, p < 0.001] and EAT density [adjusted hazard ratio 1.7, 95% CI: 1.51 – 1.92, p<0.001] when compared to patients below the 50 th percentile (p<0.001). Conclusion Age- and sex-specific EAT percentiles provide a clinically interpretable framework for contextualizing automated EAT measurements and identifying patients at increased cardiovascular risk. EAT density was a stronger prognostic marker and identified elevated risk even among patients with normal BMI, supporting its potential to provide information beyond conventional anthropometric assessment. Graphical Abstract
Source: medRxiv
Authors: Assiata Kamagate, Aakash Shanbhag, Mikolaj Buchwald, Robert J.H. Miller, Shaun Khanna, Tara Zuhair Kassem, Jacek Kwieciński, Renee Bullock-Palmer, Wenhao Zhang, Anna M Marcinkiewicz, Jirong Yi, Giselle Ramirez, Mark Lemley, Aditya Killekar, Paul B. Kavanagh, Joanna X. Liang, Leandro Slipczuk, Mark I. Travin, Erick Alexanderson, Isabel Carvajal-Juarez, René R.S. Packard, Mouaz Al-Mallah, Terrence D Ruddy, Robert A deKemp, Ronny R Buechel, Andrew J. Einstein, Wanda Acampa, Stacey Knight, Viet T Le, Steve Mason, Thomas L. Rosamond, Edward J Miller, Panithaya Chareonthaitawee, Daniel S. Berman, Damini Dey, Marcelo F. Di Carli, Piotr J Slomka
Institutions: Cedars-Sinai Medical Center, University of Southern California, University of Calgary, Deborah Heart and Lung Center, Albert Einstein College of Medicine, Montefiore Health System, Montefiore Medical Center, Instituto Nacional de Cardiología, Universidad Nacional Autónoma de México, University of California, Los Angeles, Ronald Reagan UCLA Medical Center, VA West Los Angeles Medical Center, Houston Methodist, Ottawa Heart Institute, University Hospital Zurich, NewYork–Presbyterian Hospital, Columbia University Irving Medical Center, University of Naples Federico II, Intermountain Healthcare, University of Utah, Intermountain Medical Center, University of Kansas Medical Center, Yale University, Mayo Clinic, Brigham and Women's Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204944231