Epicardial adipose tissue on low-dose CT tied to CV mortality risk among lung cancer patients: Study

A new study published in the journal of Radiology showed that in individuals screened for lung cancer, all-cause mortality was linked to increase in the volume and decreases of epicardial adipose tissue (EAT) and an increase in EAT density above normal on follow-up chest CT scans.

Smokers are eligible for non-contrast low-dose CT screening for lung cancer since they have a higher chance of getting the disease. Additionally, smoking causes cardiovascular disease (CVD), and even among heavy smokers, the chance of dying from CVD is larger than that of lung cancer. Despite being mostly used to identify lung cancer, low-dose CT also takes pictures of the complete heart by offering a chance to check cardiovascular health that has not been fully utilized.

The heart and coronary arteries are encircled by EAT, a fat deposit that is situated between the myocardium and the visceral layer of the pericardium. It works as an endocrine organ, generating cytokines and adipokines, and is directly associated to atherogenesis and CVD. Therefore, this study looked into the relationship between mortality and longitudinal changes in EAT in patients receiving low-dose CT lung cancer screening.

A proven automated deep learning technique was used in this secondary study of the National Lung Screening Trial to extract EAT volume and density from serial low-dose CT images. Atypical (increase or decrease beyond typical) and typical (decrease of 7% to increase of 11% and decrease of 3% to increase of 2%, respectively) changes in EAT volume and density over a 2-year period were linked to mortality from lung cancer, cardiovascular disease, and all causes.

Univariate and multivariable Cox proportional hazard regression models were conducted after adjusting for baseline EAT values, sex, age, ethnicity, race, pack-years, smoking, heart disease or myocardial infarction, stroke, diabetes, hypertension, body mass index, education status, and coronary artery calcium.

During a median follow-up of 10.4 years, 3483 of the 20,661 participants passed away. Over the course of 2 years, the mean EAT volume increased (by 2.5 cm3/m2 ± 11.0) and the density decreased (by 0.5 HU ± 3.0). Atypical changes in EAT volume were independent predictors of all-cause mortality, while an atypical decrease in EAT volume was linked to cardiovascular mortality.

Also, an increase in EAT density was linked to lung cancer, cardiovascular, and all-cause mortality. Overall, low-dose CT scans showing epicardial adipose tissue are associated with an increased risk of cardiovascular death in individuals with lung cancer.

Source:

Langenbach, I. L., Hadzic, I., Zeleznik, R., Langenbach, M. C., Maintz, D., Mayrhofer, T., Lu, M. T., Aerts, H. J. W. L., & Foldyna, B. (2025). Association of epicardial adipose tissue changes on serial chest CT scans with mortality: Insights from the national lung screening trial. Radiology, 314(2). https://doi.org/10.1148/radiol.240473