Correlation and prognostic value of epicardial adipose tissue density in acute myocardial infarction

Background Epicardial adipose tissue (EAT) is a specialized adipose tissue located between the myocardium and visceral pericardium, with unique anatomical and physiological characteristics. EAT shares the coronary microcirculation with the myocardium without fascial separation and regulates myocardial and coronary function by secreting bioactive substances. Previous studies have shown that excessive EAT promotes myocardial fat infiltration and fibrosis, and impairs myocardial function through pathophysiological processes such as inflammation and oxidative stress. Its volume or thickness plays an important role in the occurrence and development of cardiovascular diseases related to coronary artery disease (CAD), such as myocardial injury and myocardial infarction. EAT volume can independently predict the risk of CAD. However, few studies have explored the relationship between EAT density and acute myocardial infarction (AMI). Purpose This study aimed to explore the correlation between EAT density and AMI, and further evaluate its value in predicting the prognosis of patients with AMI. Methods A total of 39 patients with ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI) at Yili Kazakh Autonomous Prefecture Friendship Hospital from March 2024 to June 2025 were prospectively enrolled. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) were performed one week after STEMI. Additionally, 12 patients with old myocardial infarction (OMI) and 17 control subjects with non-obstructive coronary artery disease who underwent CCTA during the same period were included. Clinical data including demographic, anthropometric, and laboratory indicators were collected. CCTA was performed using a dual-source CT scanner, and CMR was conducted with a 3.0T scanner. EAT volume and density were measured using post-processing software, with patients divided into high and low EAT density groups based on the median EAT density. CMR late gadolinium enhancement (LGE) was used to assess left ventricular infarct volume. Statistical analysis was performed using SPSS 26.0. Results There were no significant differences in EAT volume and density between the control group and the OMI group ( p  > 0.05). EAT density in the AMI group was significantly higher than that in the OMI group ( p  < 0.05), while no significant difference in EAT volume was observed between the two groups ( p  > 0.05). Paired comparison showed that EAT density at baseline (AMI) was significantly higher than that at follow-up (OMI) ( p  < 0.05). The high EAT density group (≥ -56.6 HU) had a significantly larger CMR-LGE volume than the low EAT density group (< -56.6 HU) (p < 0.05). No significant differences in clinical or laboratory indicators were found between the two EAT density groups ( p  > 0.05). Conclusions EAT density can serve as a sensitive indicator for assessing the severity and pathophysiological state of AMI patients, providing important references for clinical prognosis evaluation and individualized treatment. With further research, EAT density is expected to become an effective imaging evaluation indicator in the comprehensive management of AMI patients, promoting the development of precision medicine for CAD.