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Abstract Background: Inflammation, which is associated with an unhealthy lifestyle, plays a critical role in the development of both cardiometabolic diseases (CMD) and cancer. Carcinoembryonic antigen (CEA) is a tumor marker which also has proinflammatory properties. Recent studies have reported CEA to be associated with atherosclerosis, metabolic syndrome, and visceral adiposity. Epicardial adipose tissue (EAT) can exhibit highly inflammatory and pathogenic properties, and is a known risk factor for CMD. However, its relationship with CEA is still unknown. Objectives: This study aimed to investigate the possible association of CEA with EAT. Methods: A total of 134 Caucasian (males = 56, females = 78) individuals, aged (22-83 years), who were admitted for routine health control, were enrolled in this cross-sectional study. CEA was measured with chemiluminescent microparticle immunoassay (CMIA). EAT was measured by transthoracic echocardiography, and the visceral fat rating (VFR) was assessed by a body composition analyzing machine. The p-value <0.05 was considered statistically significant. Results: CEA levels were categorized as tertiles: T1, 0.5-1.04; T2, 1.06-1.69; and T3, ≥1.7 ng/ml. The mean age, weight, VFR, EAT, and fasting glucose, as well as the median of systolic blood pressure (SBP), creatinine, and AST increased with the increasing CEA tertiles. CEA was significantly associated with EAT (r = 0.55, P<0.001) and VFR (r = 0.36, P<0.001). Multivariate linear regression analysis confirmed that gender, age, and EAT were the significant independent variables associated with CEA. Conclusion: Individuals with increased EAT have higher levels of CEA, suggesting that this biomarker is most likely produced by EAT; however, additional investigations are required to improve the present work.
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ABSTRACT Objective: To evaluate the expression of UCP1, UCP2, and UCP3 mRNA and encoded proteins in epicardial and mediastinal adipose tissues in patients with coronary artery disease (CAD). Subjects and methods: We studied 60 patients with CAD and 106 patients undergoing valve replacement surgery (controls). Expression levels of UCP1, UCP2, and UCP3 mRNA and encoded proteins were measured by quantitative real-time PCR and Western blot analysis, respectively. Results: We found increased UCP1, UCP2, and UCP3 mRNA levels in the epicardial adipose tissue in the CAD versus the control group, and higher UCP1 and UCP3 mRNA expression in the epicardial compared with the mediastinal tissue in the CAD group. There was also increased expression of UCP1 protein in the epicardial tissue and UCP2 protein in the mediastinum tissue in patients with CAD. Finally, UCP1 expression was associated with levels of fasting plasma glucose, and UCP3 expression was associated with levels of high-density lipoprotein cholesterol and low-density cholesterol in the epicardial tissue. Conclusions: Our study supports the hypothesis that higher mRNA expression by UCP genes in the epicardial adipose tissue could be a protective mechanism against the production of reactive oxygen species and may guard the myocardium against damage. Thus, UCP levels are essential to maintain the adaptive phase of cardiac injury in the presence of metabolic disorders.
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RESUMEN La asociación entre el tejido adiposo visceral y la enfermedad cardiovascular ha sido claramente establecida. Asimismo, se ha determinado que la adiposidad ectópica se asocia con un mayor riesgo cardiovascular en comparación a la adiposidad subcutánea. En este contexto, múltiples investigaciones han evaluado el rol del tejido adiposo epicárdico (TAE) en la enfermedad cardiovascular. El TAE se localiza entre la superficie miocárdica y la hoja visceral del pericardio, y puede cuantificarse mediante técnicas no invasivas como ser el ecocardiograma, la tomografía computada o la resonancia nuclear magnética. El TAE no es simplemente un órgano de depósito. Actualmente, se considera que es un tejido metabólicamente activo capaz de secretar múltiples adipoquinas que actúan mediante diferentes vías de señalización parácrina, endócrina, vasócrina y/o autócrina. La evidencia actual sugiere que el TAE puede ser un factor contribuyente en la patogénesis de la enfermedad coronaria, asociándose además con su gravedad y progresión. En ese sentido, algunos autores han postulado al TAE como un nuevo factor de riesgo cardiovascular y como un potencial blanco terapéutico. El objetivo de esta revisión es analizar la relación del TAE con la enfermedad cardiovascular, principalmente con la enfermedad coronaria.
ABSTRACT The association between visceral adipose tissue and cardiovascular disease has been clearly established. Likewise, it has been determined that ectopic adiposity is associated with a higher cardiovascular risk compared to subcutaneous adiposity. In this context, multiple investigations have evaluated the role of epicardial adipose tissue (EAT) in cardiovascular disease. EAT is located between the myocardial surface and the visceral layer of the pericardium, and can be quantified by noninvasive techniques such as echocardiography, computed tomography, or magnetic resonance imaging. The EAT is not simply a storage organ. Currently, it is considered to be a metabolically active tissue capable of secreting multiple adipokines that act through different paracrine, endocrine, vasocrine and/or autocrine signaling pathways. Current evidence suggests that EAT may be a contributing factor in the pathogenesis of coronary heart disease, as well as being associated with its severity and progression. In this sense, some authors have postulated EAT as a new cardiovascular risk factor and as a potential therapeutic target. The aim of this review is to analyze the association between EAT and cardiovascular disease, mainly coronary artery disease.
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Background: Epicardial Adipose Tissue (EAT) is recognized to be a cardiovascular risk factor. In addition to providing fuel to heart, it plays a pivotal role in the pathogenesis of atherosclerosis though the secretion of adipokines. This study aims to find the correlation of EAT with Left Ventricular Mass (LVM) and Left Ventricular Mass Index (LVMI) in patients with essential hypertension. Increasing LVM and LVMI are predictors of poor cardiovascular outcome. So, if we find a positive correlation, we can say that measurement of epicardial fat in essential hypertension may help us identify high risk hypertensive patients.Methods: This study was carried out in SMS Hospital, Jaipur, after approval from the Ethics Committee. 100 consecutive eligible patients were included in the study after application of inclusion and exclusion criteria and taking proper informed consent. After history, examination and routine laboratory investigations, all patients underwent transthoracic 2D and Doppler echocardiography. EAT thickness, LVM and LVMI were measured and correlated using Spearman correlation coefficient.Results: The mean LVM was 139±42.12 g and mean LVMI was 35.76±11.28 g/m2.7. The spearman correlation coefficient (r) was calculated to be 0.691 between EAT and LVM and 0.677 between EAT and LVMI, indicating strong positive correlation between EAT and both LVM and LVMI. This implies that as; EAT increases, LVM and LVMI increases significantly.Conclusions: Thus, authors have found that EAT is positively correlated with LVM and LVMI. So, we can say that increase in EAT may lead to adverse cardiovascular outcome in patients with essential hypertension.
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ObjectiveEpicardial adipose tissue directly affects coronary arteries and myocardium due to its special anatomical position and physiological function, but its exact effects in patients with type 2 diabetes mellitus (T2DM) have yet to be confirmed. In this paper, the epicardial adipose tissue volume (EATV) was quantitatively measured by Multi-slice spiral computed tomography (MSCT) to evaluate the correlation between EATV and coronary atherosclerosis in patients with T2DM.MethodsThe clinical data of 172 patients with coronary heart disease and coronary artery computed tomographic angiography (CCTA) were retrospectively analyzed in the first affiliated hospital of Anhui medical university from December 2015 to March 2018. According to the diagnostic criteria for CHD and T2DM, the patients included in the study were divided into the CHD group (45 cases), the T2DM group (44 cases), the T2DM group (42 cases) and the control group (41 cases). The clinical data was measured and recorded such as gender, age, blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other relevant clinical data in each group. EATV was measured by CT post-processing workstation. Compared the differences of related data between groups, it was analyzed the risk factors of diabetes mellitus complicated with coronary heart disease by Logistic regression. The degree of coronary artery stenosis was quantified by Gensini, and analyzed its correlation with EATV. The receiver operating characteristic (ROC) curve was used to determine the suspicious value range of EATV.ResultsIn the CHD group, the diabetes group and the diabetic CHD group, EATV, LDL-C and TC were all higher than those in the control group respectively [(150.10±31.64)cm3, (145.56±37.89)cm3, (167.07±40.00)cm3 vs (115.44±27.95）cm3;（2.44±0.88) mmol/L, (2.47±0.86）mmol/L, （2.50±0.97) mmol/L vs (1.90±0.59) mmol/L; (4.19±0.99) mmol/L, (4.43±0.95）mmol/L,（4.32±1.57）mmol/L vs （3.70±0.59）mmol/L], with statistically significant differences (P<0.05). TG level in the diabetes group was higher than that in the control group [（2.18±1.54）mmol/L vs （1.32±0.61）mmol/L] (P<0.05). Multivariate Logistic regression analysis showed that EATV, age and BMI were independent risk factors for diabetes mellitus with coronary heart disease. The Gensini integral of coronary artery stenosis was positively correlated with EATV (r=0.528, P=0.000). The ROC curve showed that EATV had a high predictive value for coronary heart disease in diabetic patients (AUC=0.767).ConclusionEATV was positively correlated with the severity of coronary heart disease in diabetic patients. The determination of EATV by MSCT has good repeatability and is worthy of clinical promotion.
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ObjectiveEpicardial adipose tissue directly affects coronary arteries and myocardium due to its special anatomical position and physiological function, but its exact effects in patients with type 2 diabetes mellitus (T2DM) have yet to be confirmed. In this paper, the epicardial adipose tissue volume (EATV) was quantitatively measured by Multi-slice spiral computed tomography (MSCT) to evaluate the correlation between EATV and coronary atherosclerosis in patients with T2DM.MethodsThe clinical data of 172 patients with coronary heart disease and coronary artery computed tomographic angiography (CCTA) were retrospectively analyzed in the first affiliated hospital of Anhui medical university from December 2015 to March 2018. According to the diagnostic criteria for CHD and T2DM, the patients included in the study were divided into the CHD group (45 cases), the T2DM group (44 cases), the T2DM group (42 cases) and the control group (41 cases). The clinical data was measured and recorded such as gender, age, blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other relevant clinical data in each group. EATV was measured by CT post-processing workstation. Compared the differences of related data between groups, it was analyzed the risk factors of diabetes mellitus complicated with coronary heart disease by Logistic regression. The degree of coronary artery stenosis was quantified by Gensini, and analyzed its correlation with EATV. The receiver operating characteristic (ROC) curve was used to determine the suspicious value range of EATV.ResultsIn the CHD group, the diabetes group and the diabetic CHD group, EATV, LDL-C and TC were all higher than those in the control group respectively [(150.10±31.64)cm3, (145.56±37.89)cm3, (167.07±40.00)cm3 vs (115.44±27.95）cm3;（2.44±0.88) mmol/L, (2.47±0.86）mmol/L, （2.50±0.97) mmol/L vs (1.90±0.59) mmol/L; (4.19±0.99) mmol/L, (4.43±0.95）mmol/L,（4.32±1.57）mmol/L vs （3.70±0.59）mmol/L], with statistically significant differences (P<0.05). TG level in the diabetes group was higher than that in the control group [（2.18±1.54）mmol/L vs （1.32±0.61）mmol/L] (P<0.05). Multivariate Logistic regression analysis showed that EATV, age and BMI were independent risk factors for diabetes mellitus with coronary heart disease. The Gensini integral of coronary artery stenosis was positively correlated with EATV (r=0.528, P=0.000). The ROC curve showed that EATV had a high predictive value for coronary heart disease in diabetic patients (AUC=0.767).ConclusionEATV was positively correlated with the severity of coronary heart disease in diabetic patients. The determination of EATV by MSCT has good repeatability and is worthy of clinical promotion.
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ABSTRACT Objective: Epicardial adipose tissue (EAT) is a metabolically active tissue and increased thickness is correlated with various cardiovascular diseases. There are various ways to estimate EAT. In this study, we investigated the predictive value of EAT thickness adjacent to the right coronary artery (RCA) for late atrial fibrillation (AF) recurrences in patients treated with cryoballoon ablation (CBA). We propose that this method is simpler than other methods for measurement of EAT on multidetector computed tomography images. Methods: Patients with symptomatic paroxysmal or persistent AF despite one or more anti-arrhythmic drugs who were scheduled for CBA were prospectively recruited. Multidetector computed tomography was performed and epicardial adipose tissue thickness was measured as the fat-thickness from the epicardium to the myocardium around the RCA just after the acute marginal branch. The duration of follow-up was 12 months and AF recurrence was defined as an episode of AF longer than 30 seconds duration occurring three months after CBA. The study population included 72 patients and in 22 patients (30.5%) AF recurrence was observed. Results: Epicardial adipose tissue thickness was significantly higher in patients who had late recurrent AF compared to the patients without late recurrence (12.3 ± 3.2 vs 10.2 ± 3.2, p < 0.01). Highly sensitive C-reactive protein (Hs-CRP) level and left atrial (LA) volume index were significantly higher in the recurrent AF group compared to patients without AF recurrence. Multivariable analysis showed that LA volume index (OR 1.41, 95 % CI:1.15, 1.73, p < 0.01), hs-CRP (OR 1.42, 95% CI:1.02, 1.94, p = 0.04) and EAT thickness (OR 1.34, 95% CI:1.05, 1.71, p = 0.02) remained as independent predictors of AF recurrence in the study population. Conclusion: Epicardial adipose tissue thickness adjacent to the RCA is associated with late AF recurrences in patients treated with CBA. This method of EAT quantification seems to be simpler, less time-consuming and may be an alternative to other methods of EAT measurement.
RESUMEN Objetivo: El tejido adiposo epicárdico (TAE) es un tejido metabólicamente activo y el aumento del grosor se correlaciona con varias enfermedades cardiovasculares. Hay varias maneras de estimar el TAE. En este estudio, investigamos el valor predictivo del grosor del TAE adyacente a la arteria coronaria derecha (ACD) para las recurrencias tardías de la fibrilación auricular (FA) en pacientes tratados con crioablación con balón (CAB). Proponemos que este método es más simple que otros métodos para la medición del TAE en las imágenes de la tomografía computarizada con detectores múltiples. Método: Pacientes con FA paroxística sintomática o persistente - a pesar de uno o más fármacos antiarrítmicos - que estaban programados para CAB, fueron reclutados prospectivamente. Se realizó la tomografía computarizada con detectores múltiples y el grosor del tejido adiposo epicárdico del tejido fue medido como el grosor de la grasa desde el epicardio al miocardio alrededor de la ACD, justamente tras la rama marginal aguda. La duración del seguimiento fue de 12 meses y la recurrencia de FA se definió como un episodio de FA de más de 30 segundos de duración ocurrido tres meses después de la CAB. La población de estudio incluyó 72 pacientes, y en 22 pacientes (30.5%) se observó recurrencia de FA. Resultados: El grosor del tejido adiposo epicárdico fue significativamente mayor en pacientes con FA de recurrencia tardía, en comparación con los pacientes sin recurrencia tardía (12.3 ± 3.2 vs 10.2 ± 3.2, p < 0.01). El nivel de la proteína C reactiva altamente sensible (PCR-as) y el índice del volumen auricular izquierdo (AI) fueron perceptiblemente más altos en el grupo de FA recurrente en comparación con los pacientes sin FA recurrente. El análisis multivariable mostró que el índice de volumen AI (OR 1.41, 95% IC: 1.15, 1.73, p < 0.01), PCR-as (OR 1.42, 95% IC: 1.02, 1.94, p = 0.04) y el grosor del TAE (OR 1.34, 95% IC: 1.05, 1.71, p = 0.02) permanecieron como predictores independientes de la recurrencia de FA en la población de estudio. Conclusión: El grosor del tejido adiposo epicárdico adyacente a la ACD se halla asociado con las recurrencias tardías de FA en pacientes tratados con CAB. Este método de cuantificación de TAE parece ser más simple, consume menos tiempo, y puede ser una alternativa a otros métodos de medición de TAE.
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Humans , Male , Female , Adult , Middle Aged , Aged , Atrial Fibrillation/surgery , Adipose Tissue/diagnostic imaging , Catheter Ablation/methods , Cryosurgery/methods , Recurrence , Tomography, X-Ray Computed , Predictive Value of Tests , Prospective Studies , Risk FactorsABSTRACT
BACKGROUND@#Epicardial adipose tissue (EAT) thickness as a marker of cardiovascular risk has not been extensively studied. Though readily seen in CT images, it is often overlooked due to limited information of its significance. This study aims to determine the correlation of CT EAT thickness with cardiovascular risk using the Framingham Risk Score in adult Filipino patients.@*METHODOLOGY@#This study is a cross-sectional study involving 44 Filipinos, 21 to 70 years, who underwent chest CT scan, CT aortogram, CT calcium score, CT coronary angiogram and CT pulmonary angiogram in our institution from January 2017 to June 2018. After undergoing CT scan, patients are recruited to participate in which their Framingham Risk Score (FRS) was determined. EAT thickness measurements will be measured in the right ventricular anterior free wall along the axial plane. Correlation between EAT thickness and FRS will be analyzed using Pearson's Product - Moment Correlation.@*RESULTS@#Findings suggest that FRS has a moderate correlation with EAT thickness (r = 0.6287, p = <0.001).@*CONCLUSION@#CT measured EAT shows moderate correlation with Framingham Risk Score.
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Objective: To investigate the effects of adiponectin (APN, also known as ADIPOQ) -related miR- 371b-5p with differential expressions in the epicardial adipose tissue (EAT) and plasma in the patients with coronary artery disease CAD) on the secretions of APN, KruppelTike factor 4(KLF4), interleukin-6 (IL-6) and monocyte chemokine 1 (MCP-1), and to elucidate the mechanism of action of miR-371b-5p in CAD. Methods: The EAT and blood samples were collected from the patients with CAD (CAD group, n= 34) and non-CAD (non-CAD group, n=16). Real-time quantitative PCR qRT-PCR) was used to detect the expression levels of miR-371b-5p in the EAT and plasma of the patients in two groups. The successfully induced 3T3-L1 preadipocytes were divided into (without any treatment), miR-371b-5p over-expression group (transfected with miR-371b-5p mimics) and miR- 371b-5p inhibitor group (transfected with miR-371b-5p inhibitor). The relative expression levels of APN, KLF4, IL-6 and MCP-1 mRNA in the 3T3-L1 preadipocytes were detected by qRT-PCR method. The miR-371b-5p was analyzed by bioinformatics. Results: The expression levels of miR-371b-5p in the EAT and plasma of the patients in CAD group were higher than those in non-CAD group (P<0. 01). Compared with blank control group, the expression levels of APN and KLF4 mRNA in 3T3-L1 preadipocytes in miR-371b-5p over-expression group were decreased (P=0. 043, P=0. 045), and the expression levels of IL-6 and MCP-1 mRNA in 3T3-L1 preadipocytes in miR-371b-5p over-expression group were increased (P=0. 037, P=0. 041). Compared with blank control group, the expression levels of APN and KLF4 in 3T3-L1 preadipocytes in miR-371b-5p inhibitor group were increased (P=0. 025, P=0. 027), and the expression levels of IL-6 and MCP-1 mRNA in 3T3-L1 preadipocytes in miR-371b- 5p inhibitor group were decreased (P= 0.039, P= 0.041). The target genes predicted by miR-371b-5p were enriched in multiple biological functions and processes. The KEGG pathway was mainly enriched in the signaling pathways such as adipocytokines The protein interaction results showed that the target genes APN, leptin (LEP) and AKT1 encoded proteins predicted by miR-371b-5p were located at the core of the interaction network. Conclusion: The expression levels of anti-inflammatory factors in the cells with over-expression of miR-371b-5p in EAT of the patients with CAD are decreased, the expression levels of inflammatory factors are increased, and miR- 371b-5p is expected to become a new target for CAD treatment.
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Objective@#To determine the relationship between volume of epicardial adipose tissue (EAT) and atrial fibrillation (AF) .@*Methods@#A total of 207 patients who hospitalized in the Department of Cardiology, Nantong University Affiliated Hospital from January 2016 to June 2018 were included in this study. They were divided into two groups, including AF group (n=125) and sinus rhythm group (n=82). The AF group included 80 paroxysmal AF (PAF) and 45 persistent AF (PeAF) patients. Total EAT and left atrial EAT (LA-EAT) volume were measured using 256 rows of multi-slice spiral CT in all patients. Echocardiographic derived left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) were analyzed. Hospholipase A2 and blood lipids were examined in all patients. The baseline data and EAT volume of all groups were compared. The multivariate logistic regression was used to analyze the risk factors related to the occurrence of AF. The correlation between total EAT volume and LA-EAT volume and LAD were analyzed by Pearson correlation.@*Result@#The volume of total EAT in patients with sinus rhythm, AF, PAF and PeAF were (92.2±32.1), (136.0±46.0), (134.2±46.3) and (140.1±52.6)cm3, respectively. The volume of LA-EAT in patients with sinus rhythm, AF, PeAF and PAF were (27.1±7.5), (39.2±19.2), (35.9± 17.0) and (45.1±21.5)cm3, respectively. Total EAT and LA-EAT volume were significantly larger in PAF and PeAF groups than in sinus rhythm group (all P<0.01). The LA-EAT volume was larger in PeAF group than in PAF group (P<0.01), but total EAT volume was similar between two groups (P>0.05). Logistic regression analysis showed that total EAT volume (OR=1.202, 95%CI 1.083-1.334, P=0.001), LA-EAT volume (OR=1.051, 95%CI 1.003-1.101, P=0.037) and LAD (OR=1.019, 95%CI 1.005-1.032, P=0.006) were the independent related factors of AF. Pearson correlation analysis showed that the total EAT volume was positively correlated with LAD (r=0.466, P<0.01) and LA-EAT volume was positively correlated with LAD (r=0.290, P<0.01).@*Conclusion@#The volume of total EAT and LA-EAT measured by 256-row multi-slice spiral CT is significantly correlated with the incidence of AF.
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Introducción. La fibrilación auricular (FA) es la arritmia más frecuente en la práctica clínica. Estudios sugieren que podría estar asociada con la cantidad de tejido adiposo epicárdico (TAE). Si bien la mayoría de los estudios han utilizado la tomografía axial computada, la resonancia magnética nuclear cardíaca (RMNc) es considerada el patrón oro para medir tejido adiposo. Objetivos. Evaluar si existe asociación entre el grosor de TAE medido con RMNc y prevalencia de FA. Materiales y métodos. Estudio retrospectivo y descriptivo. Se evaluaron RMNc realizadas en el Sanatorio Allende desde 2015 a 2017. Se definió TAE como el tejido adiposo entre la superficie del miocardio y el pericardio visceral. Se realizaron mediciones del grosor de TAE en las proyecciones de eje corto y eje largo, evaluando 11 segmentos. Se analizó la relación FA y la suma de las mediciones de todos los segmentos (TAE total), y con las mediciones de cada segmento en forma individual. Resultados. Se incluyeron un total de 121 pacientes. La edad media fue de 48±18 años y el 71% fue de sexo masculino. Se confirmó FA en 11 pacientes (9%). El promedio de TAE total fue de 94 mm. No se observó diferencia significativa entre el TAE total del grupo FA vs el grupo sin FA (114 mm vs 92 mm; P=0,12). Comparado al grupo sin FA, el grupo con FA tuvo un grosor de TAE significativamente mayor en los segmentos lateral del ventrículo izquierdo (VI) y en la ranura aurículo-ventricular (3,9 ± 1,7 mm vs 5,8 ± 2,8 mm; p<0,03 y 12,9 ± 3,9 mm vs 16,9 ± 5; p<0,01). Las curvas ROC para estas mediciones fueron 0,69 (sensibilidad 58% y especificidad 18%) y 0,72 (sensibilidad 81% y especificidad 45%) respectivamente. Conclusiones. No se demostró una relación entre FA y TAE total, pero los pacientes con FA tuvieron un grosor de TAE significativamente mayor en los segmentos lateral del VI y la ranura aurículo-ventricular izquierda comparado con los pacientes sin FA.
Association between atrial fibrillation and epicardial adipose tissue evaluated with cardiac magnetic resonance Background. Atrial fibrillation (AF) is the most frequent arrhythmia. Several studies suggest that it could be associated with the amount of epicardial adipose tissue (EAT). Most have used computed tomography, but cardiac magnetic resonance imaging (cMRI) is considered the gold standard for measuring visceral adipose tissue. Objectives. To assess whether there is an association between the thickness of EAT measured with cMRI and the prevalence of AF. Materials and methods. Retrospective and descriptive study. RMNc performed at the Sanatorium Allende were evaluated from 2015 to 2017. TAE was defined as the adipose tissue between the surface of the myocardium and the epicardium. Measurements were made in the short axis and long axis view evaluating 11 segments, analyzing the impact of both these individual measurements and the sum of them. Results. 121 patients were evaluated. The mean age was 48 ± 18 years and 71% was male. AF was confirmed in 11 patients (9%). The average EAT was 94 mm. In the group without AF the average was 92 mm versus 114 mm in the group with AF (P=0.12). In the AF group, the EAT was significantly higher in the lateral segments of the left ventricle (LV) and in the atrio-ventricular groove (3.9 ± 1.7 vs 5.8 ± 2.8 mm, p<0.03 and 12.9 ± 3.9 vs 16.9 ± 5, p<0.01). The ROC curves for these measurements were 0.69 (sensitivity 58%, specificity 18%) and 0.72 (81% and 45%, respectively). Conclusions. The average total EAT was 94 mm. A relationship between total EAT and AF was not demonstrated. The lateral segment of the LV and the left atrioventricular groove were statistically significant.
Associação entre fibrilação atrial e tecido adiposo epicárdico avaliado com ressonância magnética cardíaca Introdução. A fibrilação atrial (FA) é a arritmia mais frequente. Estudos sugerem que ela pode estar associadaà quantidade de tecido adiposo epicárdico (TAE). A maioria utilizou a tomografia computadorizada, mas a ressonância magnética nuclear cardíaca (RMNc) é considerada o padrão-ouro para medir o tecido adiposo visceral. Objetivos. Avaliar se existe uma associação entre a espessura do TAE medida com RMNc e a prevalência da FA. Materiais e métodos. Estudo retrospectivo e descritivo. As RMNc realizadas no Sanatório Allende foram avaliadas de 2015 a 2017. O TAE foi definido como o tecido adiposo entre a superfície do miocárdio e o epicárdio. As medições foram feitas no eixo curto e na vista do eixo longo avaliando 11 segmentos, analisando o impacto de ambas as medições individuais e a soma delas. Resultados. Foram avaliados 121 pacientes. A idade média foi de 48 ± 18 anos e 71% foi do sexo masculino. FA foi confirmada em 11 pacientes (9%). A TAE média foi de 94 mm. No grupo sem FA a média foi de 92 mm versus 114 mm no grupo com FA (P=0,12). No grupo FA o TAE foi significativamente maior nos segmentos laterais do ventrículo esquerdo (VE) e o sulco atrioventricular (3,9 ± 1,7 vs 5,8 ± 2,8 mm; p<0,03 e 12,9 ± 3,9 vs 16,9± 5; p<0,01). As curvas ROC para essas medidas foram 0,69 (sensibilidade de 58% e especificidade de 18%) e 0,72 (81% e 45%, respectivamente). Conclusões. A TAE total média foi de 94 mm. Uma relação entre o TAE total e o FA não foi demonstrada. O segmento lateral do VE e o sulco atrioventricular esquerdo foram estatisticamente significantes.
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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)
Subject(s)
Humans , Arrhythmias, Cardiac/etiology , Atrial Fibrillation/etiology , Adipose Tissue , Obesity/physiopathologyABSTRACT
Objective@#This cross-sectional study aimed to address the relationship between the volume of epicardial adipose tissue (EAT) with cardiovascular risk factors and coronary artery calcification(CAC) in the community residents.@*Methods@#Individuals were recruited from the Jidong Community (Tangshan City, Northern China) which mainly comprised employees of the Jidong Co. Ltd. and their family members. From July 2013 to August 2014, 2 647 participants aged ≥40 years were included in this study. The volume of EAT and coronary artery calcification score (CAC score) were determined by a 64-slice CT. Carotid intima-media thickness (CIMT) was measured by a trained sonographer using a high-resolution B-mode topographic ultrasound system. Venous blood samples were analyzed by automated analyzers in the central laboratory. A validated questionnaire specifically designed for this study was used to collect demographic data from all participants by trained doctors. Characteristics of study cohort were compared according to quartiles of EAT volume (n=660, 663, 662, 662, repectively).@*Results@#(1) The mean age of participants was (55.31±7.76) years and 49.94% (n=1 322) were men. The median EAT volume (interquartile) was 129.42 (95.66, 176.51)cm3. (2) Age, BMI, waist circumference and hip circumference, systolic blood pressure, LDL-C, triglycerides, and fasting blood glucose were significantly higher, while HDL-C level was significantly lower in participants with higher EAT volume than participants with lower EAT volume (all P<0.05). Carotid intima-media thicken (CIMT) and higher CAC score were also significantly higher in participants with higher volume of EAT. Furthermore, percentage of diabetes mellitus, hypertension, hyperlipidemia increased in proportion with increasing EAT volume (P<0.05). (3) In the linear regression, significant positive relations were found for age (β=0.019 3, 95%CI 0.017-0.021, P<0.001), waist circumference (β=0.012 7, 95%CI 0.009-0.016, P<0.001), BMI (β=0.022 4, 95%CI 0.013-0.032, P<0.001), LDL-C (β=0.048 4, 95%CI 0.021-0.076, P<0.001), and HDL-C (β=-0.098 1, 95%CI-0.164--0.032, P<0.001) was inversely related to the EAT volume. (4) Logistic regression analysis indicated that EAT volume was an independent risk factor for CAC score>0 (OR=1.233, 95%CI 1.205-1.262, P<0.001) .@*Conclusions@#Our findings indicate that EAT volume is strongly correlated to cardiovascular risk factors and coronary calcification and is an independent risk factor of increased coronary calcification in community residents.
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Resumen Introducción: la acumulación de tejido adiposo epicárdico se asocia con obesidad y aumento en la prevalencia, severidad y recurrencia posteriores a la ablación de la fibrilación auricular. Dentro de los mecanismos implicados se considera un estado proinflamatorio que lleva al remodelamiento estructural de la aurícula y a la alteración en las propiedades electrofisiológicas de los miocitos auriculares. Hasta la fecha no se ha estudiado este fenómeno en Colombia. Objetivo: demostrar esta asociación en un grupo de pacientes de nuestra población a quienes se les realizó ablación de venas pulmonares por radiofrecuencia. Materiales y métodos: se revisaron 170 angiotomografías de corazón realizadas previamente a la ablación de venas pulmonares en pacientes con antecedente de fibrilación auricular. Los pacientes con datos incompletos fueron excluidos para el análisis, 94 fueron analizados. Se cuantificó el grosor del tejido adiposo epicárdico y en conjunto con el índice de masa corporal se analizó su relación con los subtipos de fibrilación auricular, así como recaídas luego de la ablación. Resultados: la mayoría de la población se encontró con sobrepeso y obesidad. Tanto los pacientes obesos como aquellos con sobrepeso, tuvieron significativamente grosor mayor de tejido adiposo epicárdico total respecto a los pacientes con índice de masa corporal normal (p = 0,01). El grosor de la grasa epicárdica fue significativamente mayor en fibrilación auricular persistente respecto a la fibrilación auricular paroxística (p = 0,01). En los pacientes que presentaron recaídas no se observó una diferencia significativa pero sí una tendencia a tener mayor tejido adiposo epicárdico total (p = 0,08). El aumento del tamaño auricular se relacionó en forma significativa con el grosor del tejido adiposo epicárdico (p = 0,05). En el análisis de regresión logística multivariable mantuvo esta relación. Conclusiones: el aumento del tejido adiposo epicárdico se relaciona de manera independiente con el sobrepeso y la obesidad, así como con la severidad y el pronóstico de la fibrilación auricular. Deben hacerse estudios prospectivos de cohortes en los que se evalúe y establezcan valores de corte normales para nuestra población, al igual que seguimiento a largo plazo de la evolución posterior a ablación de venas pulmonares y a intervenciones como disminución de peso.
Abstract Introduction: Accumulation of epicardial adipose tissue is associated with obesity and an increase of prevalence, severity and recurrence following ablation of atrial fibrillation. Within the implicated mechanisms, a proinflammatory state is considered when it leads to the structural remodelling of the atrium and to the alteration of the electrophysiological properties of atrial myocytes. So far this phenomenon has not been studied in Colombia. Motivation: To prove the association in a group of patients of our population who underwent radiofrequency ablation of pulmonary veins. Material and methods: 170 coronary CT angiographies were reviewed prior to the pulmonary vein ablation in patients with a history of atrial fibrillation. Patients with incomplete data were excluded from the analysis, 94 were analysed. Epicardial adipose tissue thickness and body mass index were measured, and their relationship with atrial fibrillation subtypes was assessed, as well as relapses following the ablation. Results: Most participants were overweight or obese. Both obese and overweight patients had a significantly thicker total epicardial adipose tissue than those with a normal body mass index (p = 0.01). The thickness of epicardial fat was significantly higher in persistent atrial fibrillation in comparison with paroxysmal atrial fibrillation (p = 0.01). Patients with relapses did not show a significant difference but they did have a higher tendency to greater total epicardial adipose tissue. The increase in atrial size was significantly relates to the thickness of epicardial adipose tissue (p = 0.05). Multivariate logistic regression analysis kept this relationship. Conclusions: The increase in epicardial adipose tissue is independently related to being overweight and obese, as well as to severity and prognosis of atrial fibrillation. Prospective cohort studies must be conducted where normal cut-off values for our population group are assessed and established, and the long-term progress following pulmonary vein ablation and other procedures such as weight loss surgery is followed.
Subject(s)
Humans , Male , Middle Aged , Atrial Fibrillation , Adipose Tissue , Catheter Ablation , Epicardial MappingABSTRACT
Objective:To research the application value of coronary CT angiography(CTA) detection for epicardial adipose tissue(EAT) and pericardial adipose tissue(PAT) in the diagnosis of coronary stent restenosis.Method:Selected 68 cases coronary atherosclerotic stenosis patients who were treated by coronary stent from June 2012 to June 2013 in hospital. All patients were detected after the operation of CTA within 3 years and they were divided into two groups (coronary stent restenosis positive group included 29 cases, negative group included 39 cases). To analyze the relationship between EAT and PAT through the statistical method and analyze the application value of EAT and PAT in the diagnosis of coronary stent restenosis based on calcification score image measurement of EAT and PAT volume.Results: Correlation analysis results showed there was correlation between EAT volume and PAT volume (r=0.859,P<0.05); through compared CAG and the diagnostic results of coronary artery stent restenosis by EAT and PAT, the sensitivity was 82.87%, specificity was 84.62%, CCTA positive predictive value was 80.00%, negative predictive value was 86.84% and diagnostic accuracy was 83.82% of the stent patency which was evaluated by CAG. The consistency evaluation marker Kappa was 0.554. The analysis of patients with coronary stent restenosis showed that there was significant correlation between Gensini score of coronary stent restenosis and EAT and PAT(P<0.05).Conclusion:There was significant correlation between EAT volume and PAT volume, and they can be used to evaluate the sensitivity and specificity of coronary stent operation restenosis and the results were higher. Besides, its clinical diagnostic value was similar with CAG.
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Objective To investigate the association between atrial fibrillation (AF) and epicardial adipose tissue (EAT) by echocardiography.Methods One hundred and thirty-eight patients of AF in First Affiliated Hospital of Chinese People's Liberation Army General Hospital from March 2014 to June 2016 were divided into two groups,including paroxysmal AF group with 87 casesand persistent AF group with 51 cases,and 112 cases of sinus rhythm were chosen as control group.Epicardial adipose tissue was measured using echocardiography in all patients,and the conventional parameters were recorded.One-way analysis of variance was used to compare the thickness of EAT in patients with paroxysmal AF group,persistent AF group and sinus rhythm group,and LSD-t test was used in further comparison between two groups.Multivariable logistic regression analysis was used to analyze the risk factors of AF.The receiver-operating characteristic (ROC) cure of EAT and left atrium diameter (LAD) were drawn to predict the incidence of AF.The correlation between EAT thickness and LAD was analyzed by Pearson correlation analysis.Results The thickness of EAT in patients with persistent AF,paroxysmal AF and sinus rhythm group were (4.75± 1.83),(4.32 ± 1.76) and (1.38 ± 0.68) mm,respectively.Epicardial adipose tissue was significantly larger in paroxysmal AF and persistent AF patients compared with that of sinus rhythm group,and the differences were statistically significant (t=-9.541,11.439,both P ＜ 0.01).Logistic regression analysis indicated that EAT thickness and LAD were independent risk factors of atrial fibrillation (odds ratio:3.17,95％ confidence interval:1.31-7.68,P ＜ 0.01;odds ratio:2.65,95％ confidence interval 1.69-4.15,P ＜ 0.05).The area under the curve (AUC) of EAT and LAD to predict presence of AF were 0.784 and 0.865,and the best threshold value were 4.45 mm and 40.00 mm,respectively.Pearson correlation analysis showed that the EAT thickness and LAD had significantly positive correlation (r=0.512,P ＜ 0.01).Conclusions The increase of EAT thickness is significantly correlated with the incidence of AF and is independent to traditional risk factors.Therefore,the increase of EAT thickness has certain clinical value to predict AF.
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OBJECTIVE: This study sought to determine whether variables detected on coronary computed tomography angiography (CCTA) would predict plaque progression in non-culprit lesions (NCL). MATERIALS AND METHODS: In this single-center trial, we analyzed 103 consecutive patients who were undergoing CCTA and percutaneous coronary intervention (PCI) for culprit lesions. Follow-up CCTA was scheduled 12 months after the PCI, and all patients were followed for 3 years after their second CCTA examination. High-risk plaque features and epicardial adipose tissue (EAT) volume were assessed by CCTA. Each NCL stenosis grade was compared visually between two CCTA scans to detect plaque progression, and patients were stratified into two groups based on this. Logistic regression analysis was used to evaluate the factors that were independently associated with plaque progression in NCLs. Time-to-event curves were compared using the log-rank statistic. RESULTS: Overall, 34 of 103 patients exhibited NCL plaque progression (33%). Logistic regression analyses showed that the NCL progression was associated with a history of ST-elevated myocardial infarction (odds ratio [OR] = 5.855, 95% confidence interval [CI] = 1.391–24.635, p = 0.016), follow-up low-density lipoprotein cholesterol level (OR = 6.832, 95% CI = 2.103–22.200, p = 0.001), baseline low-attenuation plaque (OR = 7.311, 95% CI = 1.242–43.028, p = 0.028) and EAT (OR = 1.015, 95% CI = 1.000–1.029, p = 0.044). Following the second CCTA examination, major adverse cardiac events (MACEs) were observed in 12 patients, and NCL plaque progression was significantly associated with future MACEs (log rank p = 0.006). CONCLUSION: Noninvasive assessment of NCLs by CCTA has potential prognostic value.
Subject(s)
Humans , Adipose Tissue , Angiography , Cholesterol , Constriction, Pathologic , Coronary Vessels , Follow-Up Studies , Lipoproteins , Logistic Models , Myocardial Infarction , Percutaneous Coronary InterventionABSTRACT
Introduction: Coronary Artery Disease (CAD) risk factors clustering has increases the morbidity and mortality of CAD. These factors are responsible for insulin resistance; it leads to the development of Metabolic Syndrome (MS), which later leads to the development of CAD. Endothelial dysfunction leads to CAD. EAT is the visceral adipose tissue (VAT) around the heart. It plays a major role in the development of MS. The aim of this study was to measure the EAT thickness through echocardiography in healthy adults and coronary artery disease patients and to determine its association with Body Mass Index (BMI) and waist circumference. Methodology: 156 diagnosed cases of CAD and age matched 157 asymptomatic individuals were recruited from Cardiology Department of Ziauddin Hospital for this case control study. Waist circumference and BMI were measured. Echocardiography was done for EAT thickness. Results: CAD group had significantly higher EAT thickness as compared to controls. There was no significant difference of EAT thickness with BMI. A weak positive association of EAT thickness with BMI was found. A significant difference of EAT thickness with waist circumference was found. There was weak association of EAT with waist circumference in CAD. Conclusion: The mean EAT thickness is significantly higher in CAD group of Karachi population. EAT thickness has weak positive association with BMI and waist circumference. Therefore, we can conclude that BMI and Waist Circumference are the indicators of generalized obesity while EAT thickness may be considered to be a true indicator of visceral obesity.
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Objective To evaluate the correlation of epicardial adipose tissue volume (EATV)with coronary plaques in patients with a coronary artery calcium score of zero.Methods 183 patients with a coronary artery calcium score of zero were selected.They were divided into plaque group and control group according to the findings of CT coronary angiography.Independent t test was used to analyze the difference of EATV between two groups.Results ①EATV was significant higher in plaque group than that in control group (P 0.05), while it was significant higher in plaque group than that in control group for male individuals (P <0.05).③EATV was significant higher in plaque group than that in control group for the individuals with age< 50 years (P <0.05 ),meanwhile it was significant higher in plaque group than that in control group in age≥50 years(P <0.05).Conclusion EATV is correlated with coronary plaques in male patients with a coronary artery calcium score of zero while there is no correlation with female patients.EATV is correlated with coronary plaques in different age patients with a coronary artery calcium score of zero.
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Objective To investigate the predictive value of epicardial adipose tissue(EAT) thickness for the recurrence of atrial fibrillation (RAF) after concomitant valve replacement and bipolar radiofrequency ablation.Methods From January 2012 to May 2014,156 patients with permanent atrial fibrillation and organic valvular diseases underwent concomitant valve replacement and successful bipolar radiofrequency ablation in the First People's Hospital of Shangqiu.After 1 year of follow-up,the recurrence of AF was analyzed and the correlation factors were analyzed statistically.Results All patients completed a regular follow-up.During a 12-month follow-up period,RAF was observed in 39 patients (25.0％).Echocardiography-derived regional EAT thickness was significantly greater in RAF patients than that in non-RAF patients((6.9±0.6) mm vs.(5.5±0.7) mm,t=4.649,P＜0.05).The EAT thickness strongly correlated with patients age,body mass index,Ratio of left atrial diameter,mitral diastolic blood flow velocity and early diastolic velocity of mitral annulus,low density lipoprotein-cholesterol and thyroglobulin (r =0.62,0.57,0.68,0.59,0.73,0.76;P ＜ 0.05).Cox multivariable analysis showed that,duration of AF history (95％CI:1.01-1.15,P =0.040),left atrial diameter (95％CI:1.07-1.24,P =0.021) and EAT thickness (95％CI:1.05-1.79,P =0.009) were independent predictors of RAF.Conclusion Echocardiography-derived regional EAT thickness combined with left atrial diameter may serve as effective parameters in identifying patients at the highest risk for RAF.