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Background Pericardial adipose tissue(PAT) is a metabolically active fat depot implicated in coronary atherosclerosis.Emerging evidence from clinical studies suggest that PAT is a potent risk factor for heart disease via inflammation,atherosclerosis and myocardial fibrosis.PAT’s relationship with myocardial blood flow in patients with chronic kidney disease(CKD) has not been evaluated with cardiovascular magnetic resonance(CMR) quantitative perfusion(QP) previously.Objectives To evaluate the correlation between PAT and CMR QP in patients with advanced CKD and to assess the association of PAT with demographic and clinical risk factors.Methods We recruited patients with CKD stages 3B,4, and 5 to undergo CMR including HASTE sequence to calculate PAT area(cm 2) and rest/stress QP to calculate resting myocardial blood flow (rMBF),stress myocardial blood flow(sMBF) and myocardial perfusion reserve(MPR).Pearson’s rank,independent t-test and multiple linear regression analysis were used to analyse the results.Results We recruited 110 patients(19 CKD 3,54 CKD 4,37 CKD 5),out of which 81(73%) were male. Demographics and CMR results are given in table 1.Mean PAT was significantly higher in DM patients(19.4 vs 12.8 cm2, p<0.001), in men(16.1 vs 10.08 cm2,p<0.001) and in patients with incidental CAD on CMR(coronary artery distribution ischaemia or infarct )(18.8 vs 13.9cm2,p=0.038). No significant difference was observed in mean PAT in those with smoking history,dyslipidaemia or by CKD stage.PAT showed a moderate positive correlation with age(r=0.40,p< 0.001) and BMI (r=0.47,p< 0.001). sMBF was significantly lower in diabetic patients(1.74 v 2.13ml/g/min,p 0.012).PAT demonstrated a statistically significant but weak negative correlation with sMBF(r −0.26,p 0.009).In both diabetic and non-diabetic patients,there was no significant correlation between PAT and rMBF(r -0.11,p 0.203) or MPR(r -0.09,p 0.372). On multivariate regression analysis including age,gender,PAT,BMI and DM,PAT was no longer a significant determinant of sMBF(p=0.731),whereas age(p=0.026) and gender(p =0.031) remained significant determinants.Conclusion In this cohort with advanced CKD,we have found PAT area is significantly greater in diabetic patients,with a negative correlation between PAT area and sMBF.PAT was also significantly greater in those found to have previously undiagnosed coronary artery disease.Future longitudinal studies are needed to clarify whether PAT area assessed by CMR contributes to cardiovascular risk and whether it has prognostic value in advanced CKD patients.Abstract 102 Figure 1Abstract 102 Table 1 Diabetic(n=29)Non-diabetic(n=81)p-valueAge(years)65±1158±16 0.049 HTN(n)21(72%)61(75%)0.759 Dyslipidaemia(n)15(52%)36(44%)0.501 Smoker(n)15(52%)33(40%)0.308 PAT(cm2)19.37±8.54 12.79±7.09 <0.001 Rest MBF(ml/g/min)0.77±0.20 0.84±0.21 0.183 Stress MBF(ml/g/min)1.74±0.64 2.13±0.62 0.012 MPR(ml/g/min)2.38±0.99 2.66±0.91 0.235 CAD(n)7(24%)5(6%)0.008 PAT=pericardial adipose tissue, MPR=myocardial perfusion reserve, MBF=myocardial blood flow,HTN= hypertension,CAD= coronary artery disease