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Sex-Specific Prognostic Value of Automated Epicardial Adipose Tissue Quantification on Serial Lung Cancer Screening Chest CT.

About this Publication
Title
Sex-Specific Prognostic Value of Automated Epicardial Adipose Tissue Quantification on Serial Lung Cancer Screening Chest CT.
Pubmed ID
40879169 (View this publication on the PubMed website)
Digital Object Identifier
Publication
Eur Heart J Cardiovasc Imaging. 2025 Aug 29
Authors
Brendel JM, Mayrhofer T, Hadzic I, Norton E, Langenbach IL, Langenbach MC, Jung M, Raghu VK, Nikolaou K, Douglas PS, Lu MT, Aerts HJWL, Foldyna B
Affiliations
  • Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Center for Preventive Medicine and Digital Health, University of Heidelberg, Mannheim, Germany.
  • Department of Radiology, University of Tuebingen, Tuebingen, Germany.
  • Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
  • Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, The Netherlands.
Abstract

AIMS: Epicardial adipose tissue (EAT) is a metabolically active fat depot associated with coronary atherosclerosis and cardiovascular (CV) risk. While EAT is a known prognostic marker in lung cancer screening, its sex-specific prognostic value remains unclear. This study investigated sex differences in the prognostic utility of serial EAT measurements on low-dose chest CTs.

METHODS AND RESULTS: We analyzed baseline and two-year changes in EAT volume and density using a validated automated deep-learning algorithm in 24,008 heavy-smoking participants from the National Lung Screening Trial (NLST). Sex-stratified multivariable Cox models, adjusted for CV risk factors, BMI, and coronary artery calcium (CAC), assessed associations between EAT and all-cause and CV mortality (median follow-up 12.3 years [IQR: 11.9-12.8], 4,668 [19.4%] all-cause deaths, 1,083 [4.5%] CV deaths).Women (n = 9,841; 41%) were younger, with fewer CV risk factors, lower BMI, fewer pack-years, and lower CAC than men (all P < 0.001). Baseline EAT was associated with similar all-cause and CV mortality risk in both sexes (max. aHR women: 1.70; 95%-CI: 1.13-2.55; men: 1.83; 95%-CI: 1.40-2.40, P-interaction=0.986). However, two-year EAT changes predicted CV death only in women (aHR: 1.82; 95%-CI: 1.37-2.49, P < 0.001), and showed a stronger association with all-cause mortality in women (aHR: 1.52; 95%-CI: 1.31-1.77) than in men (aHR: 1.26; 95%-CI: 1.13-1.40, P-interaction=0.041).

CONCLUSION: In this large lung cancer screening cohort, serial EAT changes independently predicted CV mortality in women and were more strongly associated with all-cause mortality in women than in men. These findings support routine EAT quantification on chest CT for improved, sex-specific cardiovascular risk stratification.

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