Characterization of epicardial adipose tissue thickness and structure by ultrasound radiomics in acute and chronic coronary patients.

We hypothesize that epicardial adipose tissue (EAT) structure differs between patients with coronary disease and healthy individuals and that EAT may undergo changes during an acute coronary syndrome (ACS). This study aimed to investigate EAT thickness (EATt) and structure using ultrasound radiomics in patients with ACS, patients with chronic coronary syndrome (CCS), and controls and compare the findings between the three groups. This prospective monocentric comparative cohort study included three patient groups: ACS, CCS, and asymptomatic controls. EATt was assessed using transthoracic echocardiography. Geometrical features (as mean gray value and raw integrated density) and texture features (as angular second moment, contrast and correlation) were computed from grayscale Tagged Image File Format biplane images using ImageJ software. EATt did not significantly differ between the ACS group (8.14 ± 3.17 mm) and the control group (6.92 ± 2.50 mm), whereas CCS patients (9.96 ± 3.19 mm) had significantly thicker EAT compared to both the ACS group (p = 0.025) and the control group (p < 0.001). Radiomics analysis revealed differences in geometrical parameters with discriminatory capabilities between both ACS group and controls and CCS group and controls. A multivariate analysis comparing ACS and CCS patients revealed that differences in EAT characteristics were significant only in patients with a body mass index below 26.25 kg/m². In this subgroup, patients older than 68 exhibited a higher modal gray value (p = 0.016), whereas those younger than 68 had a lower minimum gray value (p = 0.05). Radiomic analysis highlights its potential in developing imaging biomarkers for early diagnosis and coronary artery disease progression monitoring.