Relação entre Gordura Epicárdica e Fibrilação Atrial Não Pode Ser Totalmente Explicada pela Fibrose Atrial Esquerda / The Relationship between Epicardial Fat and Atrial Fibrillation Cannot Be Fully Explained by Left Atrial Fibrosis

Resumo Fundamento O tecido adiposo epicárdico (TAE) tem sido associado à fibrilação atrial (FA), mas seus mecanismos fisiopatológicos permanecem obscuros. Objetivos Medir a correlação entre TAE e fibrose do átrio esquerdo (AE), e avaliar sua capacidade de prever recidiva após o isolamento da veia pulmonar (IVP). Métodos Pacientes com FA inscritos para um primeiro procedimento de IVP foram submetidos à tomografia computadorizada (TC) cardíaca e ressonância magnética cardíaca (RMC) em menos de 48 horas. Quantificou-se o TAECE em imagens de TC realçadas com contraste no nível do tronco da coronária esquerda. Quantificou-se a fibrose do AE em RMC tridimensional com realce tardio isotrópico de 1,5 mm. Após o isolamento da veia pulmonar (IVP), os pacientes foram submetidos a seguimento para checar a recidiva da FA. A significância estatística foi definida com p<0,05. Resultados A maioria dos 68 pacientes (46 homens, idade 61±12 anos) tinha FA paroxística (71%, n=48). Os pacientes apresentavam volume TAECE mediano de 2,4 cm3/m2 (intervalo interquartil [IIQ] 1,6-3,2 cm3/m2) e um volume médio de fibrose do AE de 8,9 g (IIQ 5-15 g). A correlação entre TAECE e fibrose do AE foi estatisticamente significativa, mas fraca (coeficiente de correlação de postos de Spearman = 0,40, p=0,001). Durante um seguimento médio de 22 meses (IIQ 12-31), 31 pacientes (46%) tiveram recidiva da FA. A análise multivariada produziu dois preditores independentes de recidiva da FA: TAECE (FC 2,05, IC de 95% 1,51-2,79, p<0,001) e FA não paroxística (FC 2,36, IC de 95% 1,08-5,16, p=0,031). Conclusão A correlação fraca entre TAE e AE sugere que a fibrose do AE não é o principal mecanismo que liga o TAE e a FA. O TAE mostrou-se mais fortemente associado à recidiva da FA do que à fibrose do AE, corroborando a existência de outros mediadores mais importantes do TAE e da FA.

Abstract Background Epicardial adipose tissue (EAT) has been associated with atrial fibrillation (AF), but its pathophysiological mechanisms remain unclear. Objectives To measure the correlation between EAT and left atrium (LA) fibrosis, and to assess their ability to predict relapse after pulmonary vein isolation (PVI). Methods Patients with AF enrolled for a first PVI procedure underwent both cardiac computerized tomography (CT) and cardiac magnetic resonance (CMR) imaging within less than 48 hours. EATLMwas quantified on contrast-enhanced CT images at the level of the left main. LA fibrosis was quantified on isotropic 1.5 mm 3D delayed enhancement CMR. After pulmonary vein isolation (PVI), patients were followed up for AF relapse. Statistical significance was set at p<0.05. Results Most of the 68 patients (46 men, age 61±12 years) had paroxysmal AF (71%, n=48). Patients had a median EATLMvolume of 2.4 cm3/m2(interquartile range [IQR] 1.6-3.2 cm3/m2), and a median amount of LA fibrosis of 8.9 g (IQR 5-15 g). The correlation between EATLMand LA fibrosis was statistically significant but weak (Spearman's R=0.40, p=0.001). During a median follow-up of 22 months (IQR 12-31), 31 patients (46%) had AF relapse. Multivariate analysis yielded two independent predictors of AF relapse: EATLM(HR 2.05, 95% CI 1.51-2.79, p<0.001), and non-paroxysmal AF (HR 2.36, 95% CI 1.08-5.16, p=0.031). Conclusion The weak correlation between EAT and LA suggests that LA fibrosis is not the main mechanism linking EAT and AF. EAT was more strongly associated with AF relapse than LA fibrosis, supporting the existence of other more important mediators of EAT and AF.

Correlation between Epicardial Fat Thickness and Clinical and Anthropometric Variables in an Elderly Population

Abstract Background Epicardial fat (EF) thickness is a marker of visceral adiposity and consequently considered an important predictive marker of cardiovascular and metabolic risk. Objective To describe echocardiographic features of the heart in an elderly population and to study the correlation between EF thickness and clinical and anthropometric variables. Methods A sample of 34 individuals (25 women) aged between 65 and 92 years, who attended a private institution in the central region of Continental Portugal, was analyzed. A standardized sociodemographic questionnaire was applied, and anthropometric assessment, echocardiography and blood pressure measurement were performed in all subjects. A correlational analysis of EF thickness with anthropometric and clinical parameters was performed. The association between variables was tested by Pearson's correlation and point-biserial correlation. A value of p < 0.05 was defined as statistically significant. Results EF thickness was higher in males (6.0 ± 1.4 mm vs 5.2 ± 0.9 mm in females), and ranged from 4 to 9 mm. There were statistically significant correlations between EF thickness and weight (r = 0.4; p = 0.02), body surface area (r = 0.4; p = 0.02), lean mass (r = 0.4; p = 0.03), calf circumference (r = 0.5; p = 0.01) and left ventricular end-diastolic diameter (r = 0.3; p = 0.04). Conclusion EF thickness was higher in males and was significantly correlated with anthropometric parameters of adiposity and left ventricular end-diastolic diameter. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

The correlation between left atrial fat gray value and the prognosis of patients with atrial fibrillation treated by thoracoscopic radiofrequency ablation / 中国胸心血管外科临床杂志

@#Objective    To analyze the correlation between the gray value of epicardial fat and the prognosis of patients with atrial fibrillation (AF) treated by thoracoscopic radiofrequency ablation. Methods    The clinical data of 97 patients, including 75 males and 22 females with an average age of 57.8±9.4 years, who underwent thoracoscopic radiofrequency ablation in Fuwai Hospital from 2017 to 2018 were analyzed retrospectively. The left atrial fat volume and average gray scale were calculated by left atrial enhanced CT. According to the average gray scale of left atrial fat tissue, the patients were divided into three groups: a high gray scale group, a medium gray scale group and a low gray scale group. The patients were followed up at 3, 6 and 12 months after operation. The end point of follow-up was the recovery rate of sinus rhythm. Survival analysis was used to analyze the correlation between CT features of epicardial fat enhancement and prognosis. Results    After adjustment of body mass index, body surface area, gender and left atrial end diastolic diameter, regression analysis showed that the fat gray of left atrial enhanced CT was correlated with the type of AF (OR=0.30, 95%CI 0.12-0.79, P=0.014). Cox regression analysis showed that the fat gray value of left atrial CT predicted the recurrence of AF after thoracoscopic radiofrequency ablation (OR=0.92, 95%CI 0.85-0.99). The Kaplan-Meier curve showed significant difference in the long-term recurrence rate of AF among the three groups (P=0.011). The lower left atrial fat enhanced CT gray scale was, the higher long-term recurrence rate of AF was. Conclusion    The gray value of left atrial fat enhanced CT can effectively predict the recurrence of AF after radiofrequency ablation in thoracoscopic surgery.

Diferencias en el grosor de la grasa epicárdica en pacientes con diabetes mellitus tipo 2, prediabetes y sujetos no diabéticos / Differences in the epicardial fat thickness in patients with diabetes mellitus 2, prediabetes and nondiabetic subjects

Resumen OBJETIVO Evaluar si hay diferencias en el grosor de la grasa epicárdica en pacientes con diabetes mellitus 2, prediabetes y sujetos no diabéticos. MATERIAL Y MÉTODO Estudio en el que de enero a agosto de 2017 se evaluaron sujetos divididos en tres grupos: sujetos con diabetes mellitus 2, sujetos con prediabetes y sujetos no diabéticos. En todos se midió el grosor de la grasa epicárdica por ecocardiografía, siguiendo la técnica descrita por Iacobelis, con un equipo Aloka alfa 6, usando un transductor de 3.5 MHz, por dos ecocardiografistas que desconocían los datos clínicos de los pacientes. El método estadístico usado fue ANOVA. RESULTADOS Se incluyeron en el estudio 120 pacientes divididos en los tres grupos (40 pacientes cada grupo); se encontró grosor de la grasa epicárdica de 5.63 mm en el grupo de diabetes mellitus, de 4.43 mm en el grupo de prediabetes y de 4.0 mm en el grupo sin diabetes. No hubo diferencia en el grosor de la grasa epicárdica entre los grupos sin diabetes y prediabéticos (p = 0.09). Sin embargo, sí encontramos diferencia significativa entre el grupo de diabetes mellitus y los grupos prediabetes y sin diabetes (p = 0.00017). CONCLUSIÓN Los pacientes diabéticos tipo 2 tienen mayor grosor de la grasa epicárdica que los prediabéticos y los sujetos no diabéticos, lo que apoya la relación entre grasa visceral y diabetes mellitus tipo 2.

Abstract OBJECTIVE To evaluate the differences in epicardial fat thickness in subjects with type-2 diabetes, prediabetes or non-diabetic. MATERIAL AND METHOD A study was done from January to August 2017 evaluating subjects divided into 3 groups: group with type-2 diabetic patients, group with subjects with prediabetes and group with nondiabetic subjects. In all of them the epicardial fat thickness was measured with an Aloka alfa 6 equipment, by 2 cardiologists who were unaware of the clinical data. Statistical analysis was performed with ANOVA. RESULTS There were included 120 patients divided into three groups of 40 patients each. Epicardial fat thickness was of 5.63 mm in diabetes mellitus group, 4.43 mm in prediabetes group and 4 mm in nondiabetic group. We did not find difference in epicardial fat thickness between nondiabetes and prediabetes groups (p = 0.09). However, we found significantly differences in epicardial fat thickness between diabetes group and groups of prediabetes and nondiabetes (p = 0.00017). CONCLUSION Type-2 diabetic patients have greater nondiabetes than prediabetic and nondiabetic subjects; this fact supports the relationship between visceral fat and the risk of type-2 diabetes.

Association of epicardial adipose tissue with incidence, severity and recurrences of atrial fibrillation: results of a systematic review / Asociación del tejido adiposo epicárdico con la incidencia, la gravedad y las recurrencias de la fibrilación auricular: resultados de una revisión sistemática

Abstract: Introduction: Atrial fibrillation is the most prevalent arrhythmia in clinical practice. Evidence has recently shown a relationship between epicardial adipose tissue and atrial fibrillation, which may be stronger than that for traditional obesity markers. Objective: To analyse the available evidence associating adipose epicardial tissue with incidence, severity and recurrences of atrial fibrillation. Methods: A systematic search in PubMed, EBSCO, Cochrane, SciELO and LILACS databases for observational studies published in the last 10 years, evaluating the association between atrial fibrillation and epicardial adipose tissue was undertaken. All articles were evaluated by two authors and differences were solved by consensus. Results: After having screened and evaluated articles for quality, 15 were selected for the qualitative synthesis. All studies reported a statistically significant association between total fat and periatrial epicardial adipose tissue and the presence of atrial fibrillation, which persisted after adjustment of covariates. The evidence was not uniform regarding arrhythmia severity. Periatrial epicardial fat was significantly higher in patients who had a recurrent disease. Conclusion: the presence of epicardial adipose tissue (total and periatrial) is significantly associated with atrial fibrillation and arrhythmia recurrence.(AU)

Resumen: Introducción: La fibrilación auricular es la arritmia más prevalente en la práctica clínica. Recientemente se ha demostrado una relación entre el tejido adiposo epicárdico y la fibrilación auricular, que puede ser más fuerte que la de los marcadores de obesidad tradicionales. Objetivo: Analizar las pruebas disponibles que asocian el tejido epicárdico adiposo con la incidencia, gravedad y recurrencia de la fibrilación auricular. Métodos: Se realizó una búsqueda sistemática en las bases de datos PubMed, EBSCO, Cochrane, SciELO y LILACS de estudios observacionales publicados en los últimos 10 años, evaluando la asociación entre la fibrilación auricular y el tejido adiposo epicárdico. Dos autores evaluaron todos los artículos y las diferencias se resolvieron por consenso. Resultados: Después de haber examinado y evaluado la calidad de los artículos, se seleccionaron 15 para la síntesis cualitativa. Todos los estudios informaron una asociación estadísticamente significativa entre la grasa total y el tejido adiposo epicárdico periatrial y la presencia de fibrilación auricular, que persistió después del ajuste de las covariables. Las evidencias no fueron uniformes con respecto a la gravedad de la arritmia. La grasa epicárdica periatrial fue significativamente mayor en los pacientes que tuvieron una enfermedad recurrente. Conclusión: La presencia de tejido adiposo epicárdico (total y periatrial) se asocia significativamente con fibrilación auricular y recurrencia de arritmia.(AU)

Reaearch of the association of epicardial fat volume indexed to body surface area with the risk of coronary heart disease and vascular remodeling / 医学研究生学报

Objective Epicardial fat volume(EFV)is the risk factor of coronary heart disease(CHD)and positive remod-el of coronary artery.This study aimed to investigate the association of the unit surface area Epicardial fat volume(Epicardial fat volume indexed to the body surface area,EFVi)with the risk of coronary heart disease(CHD)and vascular remodeling. Methods A total of 208 consecutive patients with suspected CHD underwent coronary computed tomography angiography(CTA)were selected between December 2016 and December 2017 in cardiology department, Nanjing General Hospital of Nanjing Military Area Command. They were divided into CHD group(n=135)and non-CHD group(n=73). 135 CHD group patients were divided into 2 subgroups according to the type of vascular Remodeling-positive remodeling group[vascu-lar remodeling index(RI)>1.05,n=56]and non-positive remode-ling group[vascular remodeling index(RI)<1.05,n=79]. Clinical data was collected and peripheral blood lipid was detected in the same period;EFV and RI were determined by coronary CTA and software on a workstation[Syngo MMWP(VE32B)];.EFVi was calculated and the association with plate property and vascular remodelingwas explored;To investigate the risk factor of vascular remodeling Results The EFVi and EFV[(128.91±52.22)cm3,(74.12±28.77) cm3/m3]of CHD group were obviously higher than that of non-CHD group[(76.14±30.40)cm3,(45.41±16.97)cm3/m3](P<0.01). Logistic regression analysis showed that EFVi(OR=1.06,95% CI:1.02-1.10),LDL-C(OR=2.56,95% CI:1.06-6.12),EFV (OR=1.05,95% CI:1.02-1.07)were the risk factors of CHD.Compared with the positive remodeling group[(128.91±52.22)cm3, (74.12±28.77)cm3/m3]of CHD group were obviously higher than that of non-CHD group[(17.25±6.43),(38.15±10.56)μm3], the fiber volume[(23.66±9.05)μm3]and calcification volume[(182.75±46.51)μm3]were significantly higher in non-positive re-modeling group. While EFVi[(68.31±25.16)cm3/m3]was significantly lower than the positive remodeling group[(92.15±31.04) cm3/m3](P<0.05). Hypertension(OR=2.78,95% CI:1.12-6.88),TG(OR=1.96,95% CI:1.04-3.70),LDL-C(OR=3.91, 95% CI:2.58-7.51)and EFVi(OR=1.02,95% CI:1.01-1.31)were high risk factors of vascular remodeling(P<0.05). Conclusion EFVi can be used as an important predictor of coronary heart disease risk and coronary vascular positive remodeling.

Association between epicardial fat volume and coronary artery calcification in patients with chronic kidney disease / 中华心血管病杂志

Objective@#To evaluate whether epicardial fat volume (EFV) is related to coronary artery calcification in patients with chronic kidney disease(CKD).@*Method@#Multi-slice computed tomography was performed in 30 healthy subjects and 120 patients with CKD. Cross-sectional tomographic cardiac slices from base to apex were traced semi-automatically using a Volume Viewer of AW4.3 off-line workstation, and EFV was measured by assigning Hounsfield units ranging from -250 to -30 HU to fat.The coronary artery calcification score was assessed by CaScoring software. High density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C) and collecting the body mass index (BMI), dialysis route, history of diabetes and coronary artery disease were used to analyze the relationship between EFV and other risk factors in patients with CKD.@*Results@#There were 60.8%(73/120) male (mean age 62.8 years) and 39.2%(47/120) female (mean age 66.6 years) in the patients cohort, 73.3%(88/120) patients had coronary artery disease, 55.8%(67/120) had diabetes, 21 patients were on peritoneal dialysis and 9 on hemodialysis. EFV was apparently higher in stage 4-5 D CKD group compared with the control group((140.03±54.71), (145.01±64.56)and (141.45±62.04) cm3 vs.(92.42±39.56)cm3, P=0.007, 0.015 and 0.001), was similar between CKD3 and control group, and EFV was significantly higher in peritoneal dialysis group than in hemodialysis group and in coronary artery disease group compared with no coronary artery disease group((140.67±70.31) cm3 vs.(105.22±61.49) cm3, P=0.002). EFV was obviously higher in diabetes group than no diabetes group((148.41±65.78) cm3 vs.(110.53±62.37) cm3, P=0.007). CACS was apparently increased in stage 3-5 CKD group compared with the control group(140.0 vs.4.3, P<0.001). (3)When the patients were divided into four groups according to the eGFR, EFV was positively associated with CACS(rs=0.539, P=0.004) in control group, and the association become more robust in patients with CKD5(rs=0.841, P<0.000 1). EFV was related to age(r=0.662, P=0.005), BMI(r=0.648, P=0.009)and HDL-C(r=-0.433, P=0.024), but not related to eGFR and LDL-C. EFV was related to CACS(r=0.427, R2=0.182 3, P<0.001). CACS was positively correlated to age and BMI (all P<0.05)and negatively correlated with eGFR(P<0.05).@*Conclusions@#Measurement of EFV may provide another useful noninvasive indicator of coronary artery calcification in CKD patients.

Epicardial Fat Thickness is Correlated with Vagal Hyperactivity in Patients with Neurally-Mediated Syncope

BACKGROUND: Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. The head-up tilt test (HUTT) is a simple non-invasive measurement that assesses autonomic nervous system dysfunction. We investigated the association between epicardial fat thickness (EFT) and autonomic neural tone, such as vagal tone. METHODS: A total of 797 consecutive patients (mean age 46.5 years, male: 45.7%) who underwent HUTT and echocardiography between March 2006 and June 2015 were enrolled. EFT was measured during the diastolic phase of the parasternal long axis view. We excluded patients with prior percutaneous coronary intervention, old age (* 70 years old), valvular heart disease, symptomatic arrhythmias and diabetes. We divided patients into two groups based on the HUTT (positive vs. negative). RESULTS: There were 329 patients (41.3%) with a negative HUTT result and 468 patients (58.7%) with a positive result. The HUTT-positive patients showed a significantly lower waist circumference, body mass index and systolic and diastolic blood pressure, although a significantly higher EFT as compared to the HUTT-negative patients (HUTT-positive, 5.69 ± 1.76 mm vs. HUTT-negative, 5.24 ± 1.60 mm; p 5.4 mm was associated with a positive HUTT result with 51.7% sensitivity and 63.8% specificity (p < 0.001) on receiving operator characteristic analysis. Multivariate Cox regression analysis revealed that EFT (hazard ratio: 1.02, 95% confidence interval: 1.01–1.30, p = 0.004) was an independent predictor of HUTT-positivity. CONCLSION: EFT was significantly correlated with positive HUTT, which suggests an association between EFT and autonomic dysregulation.

The Relation of Androgenetic Alopecia Severity with Epicardial Fat Thickness

BACKGROUND: Androgenetic alopecia (AGA) is the most commonly encountered baldness pattern in men. Epicardial fat tissue is found on the cardiac surface between the myocardium and visceral pericardium. Both AGA and epicardial fat thickness (EFT) are related to coronary artery disease, which is also reflected by an increase in carotid intima media thickness (CIMT). OBJECTIVE: The purpose of this study was to investigate the relation of AGA severity with EFT. METHODS: One hundred twenty-six male patients with AGA aged 18 to 55 years without histories of chronic disease were enrolled. Subjects were divided into three groups (mild, moderate, and severe) on the basis of the Hamilton baldness scale as modified by Norwood. Maximum EFT was measured at end-systole on the midventricular free wall of the right ventricle. CIMT was also recorded for all patients. RESULTS: The groups did not have statistically significant differences with respect to age, height, weight, body mass index, left ventricular ejection fraction, or left atrial diameter (p>0.05 for all comparisons), but the severe group had a higher EFT compared with the moderate (p<0.001; z score, -7.040) and mild groups (p<0.001; z score, -6.667). The moderate group also had higher EFT than the mild group (p<0.001; z score, -5.931). Mean CIMT value in the severe group was significantly higher compared with the value in the other groups. CONCLUSION: The study showed that subjects in advanced stages of AGA had increased EFT, which was measured via echocardiography.

The Relation of Androgenetic Alopecia Severity with Epicardial Fat Thickness

BACKGROUND: Androgenetic alopecia (AGA) is the most commonly encountered baldness pattern in men. Epicardial fat tissue is found on the cardiac surface between the myocardium and visceral pericardium. Both AGA and epicardial fat thickness (EFT) are related to coronary artery disease, which is also reflected by an increase in carotid intima media thickness (CIMT). OBJECTIVE: The purpose of this study was to investigate the relation of AGA severity with EFT. METHODS: One hundred twenty-six male patients with AGA aged 18 to 55 years without histories of chronic disease were enrolled. Subjects were divided into three groups (mild, moderate, and severe) on the basis of the Hamilton baldness scale as modified by Norwood. Maximum EFT was measured at end-systole on the midventricular free wall of the right ventricle. CIMT was also recorded for all patients. RESULTS: The groups did not have statistically significant differences with respect to age, height, weight, body mass index, left ventricular ejection fraction, or left atrial diameter (p>0.05 for all comparisons), but the severe group had a higher EFT compared with the moderate (p<0.001; z score, -7.040) and mild groups (p<0.001; z score, -6.667). The moderate group also had higher EFT than the mild group (p<0.001; z score, -5.931). Mean CIMT value in the severe group was significantly higher compared with the value in the other groups. CONCLUSION: The study showed that subjects in advanced stages of AGA had increased EFT, which was measured via echocardiography.

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

BACKGROUND: In this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. METHODS: A total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group. RESULTS: The mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors. CONCLUSION: EFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

Epicardial adipose tissue thickness and its association with adiponectin in metabolic syndrome patients from Mérida, Venezuela / Associação entre a espessura do tecido adiposo epicárdico e a adiponectina em pacientes com síndrome metabólica em Mérida, Venezuela

Objective: To study the relationship between epicardial adipose tissue (EAT) thickness and plasma levels of adiponectin in Venezuelan patients. Subjects and methods: Thirty-one patients diagnosed with metabolic syndrome (study group) and 27 controls were selected and tested for glycemia, lipids, and adiponectin. EAT thickness, ejection fraction, diastolic function, left ventricular mass (LVM), and left atrial volume (LAV) were determined by transthoracic echocardiography. Results: EAT thickness was greater in metabolic syndrome patients (5.69 ± 1.12 vs. 3.52 ± 0.80 mm; p = 0.0001), correlating positively with body mass index (BMI) (r = 0.661; p = 0.0001); waist circumference (WC) (r = 0.664; p = 0.0001); systolic (SBP) (r = 0.607; p = 0.0001), and diastolic blood pressure (DBP) (r = 0.447; p = 0.0001); insulin (r = 0.505; p = 0.0001); Tg/HDL-C ratio (r = 0.447; p = 0.0001), non-HDL-C (r = 0.353; p = 0.007); LAV (r = 0.432; p = 0.001), and LVM (r = 0.469; p = 0.0001). EAT thickness correlated negatively with adiponectin (r = -0.499; p = 0.0001). Conclusion: A significant association exists between EAT thickness and both metabolic syndrome components and adiponectin concentration, a link that might be used as a biomarker for this disease. .

Objetivo: Estudar a relação entre a espessura do tecido adiposo epicárdico (TAE) e os níveis plasmáticos de adiponectina em pacientes venezuelanos. Sujeitos e métodos: Foram selecionados 31 pacientes com diagnóstico de síndrome metabólica (SM) (grupo de estudo) e 27 controles. Foram medidos a glicose, os lipídios e a adiponectina. Foram determinados a espessura do TAE, a fração de ejeção, a função diastólica, a massa ventricular esquerda (MVE) e o volume atrial esquerdo (VAI) pela ecocardiografia transtorácica. Resultados: A espessura do TAE foi maior em pacientes com SM (5,69 ± 1,12 contra 3,52 ± 0,80 mm; p = 0,0001) com uma correlação positiva com o índice de massa corporal (IMC) (r = 0,661; p = 0,0001), circunferência da cintura (CC) (r = 0,664; p = 0,0001), pressão arterial sistólica (PAS) (r = 0,607; p = 0,0001), diastólica (PAD) (r = 0,447; p = 0,0001), insulina (r = 0,505; p = 0,0001), com a relação TG/HDL-C (r = 0,447; p = 0,0001), com o colesterol HDL (r = 0,353; p = 0,007), VAI (r = 0,432; p = 0,001) e MVI (r = 0,469; p = 0,0001). A espessura do TAE se correlacionou negativamente com a adiponectina (r = -0,499; p = 0,0001). Conclusão: Existe uma relação significativa entre a espessura do TAE, os componentes do SM e a concentração plasmática de adiponectina, o que poderia ser utilizado como um biomarcador para essa doença. .

The effect of epicardial fat volume in patients with metabolic syndrome on insulin resistance and coronary heart disease / 医学研究生学报

Objective Epicardial fat volume ( EFV) was a risk factor for coronary heart disease ( CHD) , but there is little research regarding the relationship of EFV with insulin resistance ( IR) and CHD in patients with metabolic syndrome ( MS) .The aim of the article was to explore the effect of EFV in patients with MS on CHD and IR . Methods Patients with MS treated by percutane-ous coronary angiography ( CAG) in our hospital from February 2013 to August 2013 were recruited in this study .The data of height , weight, waist circumference(WC) and hip circumference(HP) were recorded.EFV were measured by MSCT.Fasting blood samples were collected for blood biochemical test . Results EFV in patients with MS was in positive relation with IR index (IRI)(r=0.335, P<0.001) and CHD (r=0.321, P<0.05), and the correlation still remained when the influences of WC and body mass index (BMI) were excluded.Logistic regression analysis showed that EFV was an independent risk factor for CHD (P<0.05), while linear regression analysis indicated EFV , BMI and LDL-C were the risk factors for IRI .ROC curves analysis proved EFV and BMI had diag-nosis value for IRI, and the areas under curve of EFV were 0.755 and 0.679 (P<0.05) respectively. Conclusion EFV is an in-dependent risk factor for CHD and IRI in patients with MS , and EFV has an advantage over BMI in the diagnosis value of IRI .

The correlations of coronary artery disease with epicardial adipose tissue, insulin resistance and C-reactive protein in different body mass index patients / 中国综合临床

Objective To evaluate the influence of C-reactive protein (CRP),insulin resistance (IR) and epicardial fat volume (EFV) on the extent of coronary atherosclerosis in patients with different body mass index(BMl).Methods One hundred and three patients with coronary artery disease were involved in current study who underwent 64-slice dual source CT and percutaneous coronary angiography.Measurements of height,weight,waist circumference (WC) were recorded,and BMI was calculated.All patients were divided into obesity group (n =45) and non-obesity group (n =58) based on BMI.EFV were calculated through 64-slice dual source CT.Blood samples were collected for biochemical examination.Gensini score were adopted to quantify the severity of coronary artery stenosis.The relationship between Gensini score and EFV,CRP and homeostasis model assessment-insulin resistance(HOMA-IR) index were statistical analyzed by SPSS16.0 software.Results The level of CRP,WC,EFV and BMI in obesity group were (11.0 ± 5.8) mg/L,(96.1 ± 7.0) cm,(122.7 ± 43.3) cm3,(27.9 ± 2.9) kg/m2 respectively,significantly higher than those in non-obesity group ((6.5 ± 3.4) mg/L,(86.4 ± 7.6) cm,(92.9 ± 39.5) cm3,(22.4 ± 1.9) kg/m2) and the differences were significant (t =2.24,6.74,3.64,11.74,and P ＜ 0.05).CRP were positively correlated with EFV (r =0.404,0.364,P ＜0.05) in both obesity and non-obesity group,While HOMA-IR were only associated with BMI in obese group(r =0.322,P ＜0.05).Gensini score in non-obesity groups were positively related with EFV and CRP (r =0.358,0.315,P ＜ 0.05),while in obesity groups were positively related with EFV,CRP and HOMA-IR(r =0.348,0.297,0.384; P ＜ 0.05).The associations between Gensini score and CRP were not significant in obesity group after adjusting BMI and WC.Multiple linear regression analysis showed that EFV and diabetes mellitus were independent risk factors of patient Gensini score.Conclusion Coronary atherosclerosis is positively related with EFV and CRP in all patients.While,coronary atherosclerosis is influenced by BMI,WC and HOMA-IR in obese group.EFV is an independent risk factor of coronary atherosclerosis.

Grasa epicárdica y su asociación con el HOMA-IR y el grosor íntima-media carotídeo / Association Between Epicardial Fat, HOMA-IR and Carotid Intima-media Thickness / Association Between Epicardial Fat, HOMA-IR and Carotid Intima-media Thickness

Introducción La grasa epicárdica se considera actualmente como un verdadero órgano endocrino y su determinación ecocardiográfica ha surgido como un nuevo parámetro de fácil adquisición en la evaluación del riesgo cardiometabólico. Objetivo Determinar la asociación entre la grasa epicárdica, la presencia de insulinorresistencia y el grosor íntima-media carotídeo. Material y métodos Se realizó un estudio transversal en 239 pacientes con sospecha de trastornos en el metabolismo de los carbohidratos en colaboración entre el Instituto Nacional de Endocrinología y el Instituto Nacional de Cardiología y Cirugía Cardiovascular. Se incluyeron variables clínicas (edad, sexo, antecedentes de tabaquismo, presión arterial sistólica y diastólica), antropométricas (circunferencia de la cintura e índice de masa corporal), bioquímicas (glucemia, colesterol total, C-HDL, C-LDL, triglicéridos, insulina en ayunas y HOMA-IR) y ultrasonográficas (grosor íntima-media carotídeo). Resultados La glucemia, la grasa epicárdica y la circunferencia de la cintura fueron las variables que mostraron, en ese orden, una asociación significativa e independiente con la presencia de un HOMA-IR > 2,6. La grasa epicárdica mostró también una correlación positiva y significativa con los niveles de insulinemia en ayunas (r = 0,536; p = 0,0001) y con el HOMA-IR (r = 0,512; p = 0,001). La correlación entre la grasa epicárdica y el grosor íntima-media carotídeo fue superior en los pacientes insulinorresistentes (r = 0,523; p = 0,0001), en comparación con los pacientes con valores de HOMA-IR < 2,6 (r = 0,173; p = 0,029). La grasa epicárdica = 4,9 mm tuvo una sensibilidad del 85% y una especificidad del 75% en la predicción de insulinorresistencia, con un área bajo la curva ROC de 0,815 IC 95% (0,759-0,871). Conclusiones La grasa epicárdica mostró una asociación significativa e independiente con la presencia de insulinorresistencia y una correlación significativa con el grosor íntima-media carotídeo en el grupo de pacientes con HOMA-IR > 2,6.

Background Epicardial fat is currently considered a real endocrine organ that can be easily determined by echocardiography, emerging as a novel parameter for the estimation of cardiometabolic risk. Objective To determine the association between epicardial fat, insulin resistance and carotid intima-media thickness. Methods The Instituto Nacional de Endocrinología and the Instituto Nacional de Cardiología y Cirugía Cardiovascular conducted a cross-sectional study on 239 patients with suspected disorders of carbohydrate metabolism. Clinical variables (age, gender, smoking habits, systolic and diastolic blood pressure), anthropometric measurements (waist circumference and body mass index), biochemical determinations (blood glucose, total cholesterol, HDL-C, LDL-C, triglycerides, fasting insulin levels and HOMA-IR) and echocardiographic variables (carotid intima-media thickness) were included. Results A significant and independent association was found between blood glucose, epicardial fat and waist circumference, in that order, and HOMA-IR >2.6. Epicardial fat also showed a positive and significant correlation with fasting insulin levels (r=0.536; p=0.0001) and HOMA-IR (r=0.512; p=0.001). The correlation between epicardial fat and carotid intimamedia thickness was greater in insulin resistant patients (r=0,523; p=0.0001), compared to patients with HOMA-IR <2.6 (r=0.173; p=0.029). Epicardial fat thickness =4.9 mm had a sensitivity of 85% and a specificity of 75% to predict insulin resistance, with an area under the ROC curve of 0.815 (95% CI 0.759-0.871). Conclusions Epicardial fat had a significant an independent association with insulin resistance and a significant correlation with carotid intima-media thickness in the group of patients with HOMA-IR >2.6.

Correlation Between Epicardial Fat Thickness by Echocardiography and Other Parameters in Obese Adolescents

BACKGROUND AND OBJECTIVES: Obesity has reached epidemic proportions globally and affects people of all ages. Recent studies have shown that visceral adipose tissue measured by magnetic resonance imaging and/or computed tomography correlates positively with epicardial adipose tissue. Epicardial fat, which is correlated to several metabolic parameters, can be assessed by echocardiography. The aim of this study was to evaluate epicardial fat thickness and other metabolic parameters in obese adolescents and investigate the correlation between epicardial fat thickness and other metabolic parameters in obese adolescents. SUBJECTS AND METHODS: We selected 99 subjects, between ages 15-17 years of age, to be enrolled in this study. Sixty five obese adolescents with a body mass index (BMI) >95 percentile and 34 control subjects were included in this study. Echocardiographic measurements including epicardial fat thickness as well as anthropometric and blood pressure (BP) measurements were performed. The following parameters were estimated: blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, free fatty acid, interleukin-6, tumor necrosis factor-alpha, leptin, adiponectin and high sensitive C reactive protein. RESULTS: The obese group showed a statistically significant correlation with echocardiographic epicardial fat thickness and, BMI, waist circumference, obesity index, fat percentage, systolic BP, insulin level, leptin and adiponectin. Multivariate linear regression analysis showed epicardial fat thickness as the most significant independent parameter to correlate with obese adolescents. CONCLUSION: These data suggest that epicardial fat thickness measured by echocardiography is a practical and accurate parameter for predicting visceral obesity.

Grasa epicárdica: un nuevo indicador de riesgo cardiometabólico / Epicardia fat: new cardiometabolic risk marker

La grasa epicárdica es el verdadero depósito de grasa del corazón y puede ser observada y medida utilizando ecocardiografía estandar en dos dimensiones. La vista en eje paraesternal largo y paraesternal corto permite medir con mayor precisión el espesor de la grasa epicárdica sobre el ventriculo derecho. La medición ecocardiográfica de la grasa epicárdica tiene varias ventajas incluyendo bajo costo, fácil accesibilidad y buena reproducibilidad, y además se correlaciona positivamente con el síndrome metabólico, resistencia insulínica, enfermedad arterial coronaria y aterosclerosis subclínica, y por tanto puede servir como una herramienta sencilla para la predicción del riesgo cardiometabólico.

Epicardial fat is the true visceral fat depot of the heart and it can be visulized and measured using standard two-dimensional echocardiography. Standar parasternal long-axis and short-axis views permit the most accurate measurement of epicardial fat thickness overlying the right ventricle. Echocardiographic epicardial fat measurement has several advantages, including low cost, easy accessibility and good reproducibility, and also it correlates with metabolic syndrome, insulin resistance, coronary artery disease, and subclinical atherosclerosis, and therefore it might serve as a simple tool for cardiometabolic risk prediction.

Grasa epicárdica e insulinorresistencia. Nuestros primeros resultados / Epicardium fat and insulin-resistance: Our first results

La grasa epicárdica evaluada mediante ecocardiografía refleja claramente el grado de adiposidad visceral más que el de obesidad general y ha sido recientemente reconocida como una fuente de moléculas bioactivas, ácidos grasos libres, adiponectina y citocinas inflamatorias, por lo que desempeña un papel fundamental en las enfermedades cardiovasculares, con una relación directa con el grado de insulinorresistencia en la población general. El objetivo de este estudio fue determinar la utilidad de la evaluación ecocardiográfica de la grasa epicárdica como predictor de riesgo de insulinorresistencia. Otras variables estudiadas fueron: edad, sexo, antecedentes patológicos personales de tabaquismo, dislipidemia e hipertensión arterial y familiares con diabetes mellitus; antropométricas (circunferencia de la cintura, cociente cintura/cadera, índice de masa corporal), y hemoquímicas (glucosa e insulina en ayunas, colesterol total, triglicéridos, HDL-c). La media de grasa epicárdica fue significativamente mayor en los pacientes con HOMA-IR>2,6 (p=0,001), con sensibilidad y especificidad aceptables en su asociación a insulinorresistencia para valores de corte de grasa epicárdica ³ 3,5 mm

The epicardial fat evaluated by echocardiography clearly reflects the grade of visceral adiposity more than general obesity, and it has been recently recognizedas a source of bioactive molecules as well as free fatty acids,adiponectin, and inflammatory cytokines. Therefore, it plays a fundamental role in the cardiovascular diseases, with a direct relationship with insulin resistance in the general population. The objective of this study was to determine the utility of the echocardiography evaluation of the epicardial fat as a risk predictor of insulin resistance. Fifty patients were divided in two groups according to the diagnosis of insulin resistance (n=25 respectively). Each subject underwent a transthoracicechocardiogram to evaluate epicardial adipose tissue thickness, as well as both fasting glucose and insulin to determine the HOMA-IR (gold standard for the diagnosis of insulin resistance). Other studied variables were: age, sex, personal history of smoke, dislipidemie and hypertension and family history of diabetes mellitus, anthropometric measurements as waist and hip circumferences, waist /hip ratio and body mass index , by other hand were also measured the fasting glucose and insulin and serum lipids levels as total cholesterol, triglycerides and HDL-c. The epicardial fat media thickness was significantly higher in patients with HOMA-IR>2.6 (p=0.001), with acceptable sensibility and specificity in the association to insulin resistance for cut off values of epicardial fat ³ 3.5 mm

Effects of Statins on the Epicardial Fat Thickness in Patients with Coronary Artery Stenosis Underwent Percutaneous Coronary Intervention: Comparison of Atorvastatin with Simvastatin/Ezetimibe

BACKGROUND: Epicardial fat is a visceral thoracic fat and known to be related with presence of dyslipidemia and coronary arterial stenosis. We evaluated the effects and differences of statins on epicardial fat thickness (EFT) in patients underwent successful percutaneous coronary intervention (PCI). METHODS: In this retrospective cohort study, we enrolled consecutive patients underwent successful PCI and scheduled six to eight-months follow-up coronary angiography from March 2007 to June 2009. EFT was measured by echocardiography twice at the time of PCI and the follow-up coronary angiography. We included 145 patients (58 females; mean, 63.5 +/- 9.5 years). RESULTS: Of the 145 patients, 82 received 20 mg of atorvastatin (atorvastatin group) and 63 medicated with 10 mg of simvastatin with 10 mg of ezetimibe (simvastatin/ezetimibe group). With statin treatments, total cholesterol concentration (189.1 +/- 36.1 to 143.3 +/- 36.5 mg/dL, p < 0.001), triglycerides (143.5 +/- 65.5 to 124.9 +/- 63.1 mg/dL, p = 0.005), low density lipoprotein-cholesterol (117.4 +/- 32.5 to 76.8 +/- 30.9 mg/dL, p < 0.001) and EFT (4.08 +/- 1.37 to 3.76 +/- 1.29 mm, p < 0.001) were significantly decreased. Atorvastatin and simvastatin/ezetimibe showed similar improvements in the cholesterol profiles. However, atorvastatin decreased EFT more significantly than simvastatin/ezetimibe (EFT change 0.47 +/- 0.65 in the atorvastatin vs. 0.12 +/- 0.52 mm in the simvastatin/ezetimibe group; p = 0.001). CONCLUSION: In this study, the atorvastatin group showed significant reduction in EFT than in the simvastatin/ezetimibe group. This might be originated from the statin difference. More large, randomized study will be needed to evaluate this statin difference.