Elevated Pericardial Fat Linked to Severe Coronary Calcium Scores, Suggests Study

While visceral fat is a well-established cardiovascular risk factor, its specific impact on the Indian population remains largely unexplored. To bridge this clinical gap, researchers at AIIMS Rishikesh conducted the first Indian study evaluating the direct association between MDCT-quantified pericardial fat (PF) and the severity of coronary artery disease (CAD).

Therefore, in the 18-month, single-center study, researchers evaluated 80 symptomatic patients undergoing MDCT for suspected CAD. Using semiautomated software, end-systolic pericardial fat (PF) was measured to compare a high-PF group (>100 mL) with a low-PF group (<100 mL). To accurately assess the main endpoints—coronary stenosis severity and calcium burden—the study carefully excluded patients with severe renal dysfunction, contrast allergies, pacing leads, or prior open-heart surgeries.

Key Clinical Findings of the Study Includes:

• Diagnostic Threshold: Researchers found that the median PF volume was approximately 100 mL, and exceeding this specific cutoff demonstrated significant discriminatory power for detecting obstructive coronary artery stenosis.

• Stenosis Severity: Investigators revealed a striking contrast in coronary health, noting that 70.27% of patients in the high-PF group presented with confirmed CAD compared to just 30.23% in the low-PF cohort.

• Calcium Burden: Scientists reported that the high-PF group exhibited a dramatically higher mean coronary calcium score of 128.63 compared to 17.40 in the low-PF group, indicating a substantially greater atherosclerotic burden.

• Multi-Vessel Disease: Authors highlighted that triple-vessel disease was significantly more prevalent among those with elevated PF, affecting 32.43% of the high-PF group versus a mere 2.32% of the low-PF patients.

• Risk Factor Correlation: Clinicians observed robust statistically significant associations between high PF volumes and age, body mass index (BMI), diabetes, and a family history of CAD, though no meaningful links emerged for gender or hypertension.

The results suggest that elevated pericardial fat, specifically volumes surpassing the critical 100 mL threshold, is significantly and directly associated with both severe multi-vessel coronary artery stenosis and exponentially higher coronary calcium scores. This accumulation of localized cardiac adiposity acts as a potent inflammatory mediator, cementing its status as an essential and independent risk predictor in subclinical CAD patients that mirrors the severity of systemic metabolic conditions.

Integrating localized pericardial fat assessment into routine computed tomography coronary angiography workflows offers a highly valuable, noninvasive tool for early cardiovascular risk stratification, thereby empowering healthcare professionals to initiate prompt, targeted preventive lifestyle modifications that can fundamentally mitigate future cardiovascular morbidity.

While these initial findings provide compelling clinical insights, the study's reliance on a relatively small, single-center Indian cohort without direct invasive angiography comparisons highlights a gentle need for broader, multicenter research to establish universal baseline normal pericardial fat values and validate these promising diagnostic thresholds across diverse ethnic populations.

Reference

Kumar S.K.S, Sharma P, Kumar B, Chauhan U. Association of Pericardial Fat with Severity of Coronary Artery Disease. Indian J Radiol Imaging 2026;36:326–333.