Abstract 366: Utilizing epicardial fat thickness as an indicator of cardiac cachexia in resectable pancreatic ductal adenocarcinoma
Authors: Vudatha Vignesh , Freudenberger Devon , Liu Christopher , Trevino Jose 
Published: April 2023

Abstract
Objective: Pancreatic adenocarcinoma (PDAC) is a highly aggressive malignancy with high mortality. A significant component of PDAC is cachexia, or cancer-related muscle wasting. While there are many studies analyzing skeletal muscle cachexia, there is limited data regarding cardiac muscle degradation (cardiac cachexia) in PDAC patients. Prior studies in heart failure patients have utilized epicardial fat thickness (EFT) as a marker for cardiac cachexia. The objective of this study was to determine if there is a relationship between skeletal muscle cachexia and cardiac cachexia in resectable PDAC patients.
Methods: Adult patients with resectable PDAC from 2011-2021 were identified from a single institution. Patients were included in this study if they had available CT Chest and Abdominal scans of adequate quality within one year of their PDAC resection. Scans were acquired from various time points in the pre- and post-operative phases. The patient’s skeletal muscle index (SMI) at the L3 vertebral level was calculated using the software SliceOMatic. Using the SMI and the patient’s BMI, a determination of cachexia was made using criteria established by by Martin et al [2]. EFT was measured on the CT Chest scans by measuring the perpendicular distance of epicardial fat from the base of the right coronary artery the outer border of the epicardium on an axial view. Comparisons were made using t-test or Fisher's exact test with p-value of 0.05 for significance.
Results: Overall, 22 patients met inclusion criteria. EFT was compared to SMI values across all patients and there was no correlation (R2=0.049). There was also no significant difference in EFT between cachectic and non-cachectic patients (2.52 cm vs .2.36 cm, p=0.42). Given the impact of obesity on visceral fat composition, we performed additional analysis after excluding patients with BMI &gt; 25. In this subset, there was a significant difference in EFT between cachectic and non-cachectic patients (2.30 cm vs. 1.90 cm, p=0.03). Race was also a significant factor, with African American patients having lower EFT compared to Caucasians (1.57 cm vs. 2.31 cm, p=0.02).
Conclusion: Although there was no direct correlation between EFT and skeletal muscle cachexia, EFT may be an important predictor of cachexia in PDAC patients with low to normal BMI. Furthermore, the racial difference in EFT demonstrates a possible disparity in cardiac cachexia and function. To establish this parameter as a marker of cachexia, the patient cohort will be expanded to include more time points and those with unresectable/metastatic disease. This will also need to be explored prospectively with functional imaging such as cardiac MRI to determine if there is a relationship between EFT and cardiac function.
Citation Format: Vignesh Vudatha, Devon Freudenberger, Christopher Liu, Jose Trevino. Utilizing epicardial fat thickness as an indicator of cardiac cachexia in resectable pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 366.