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Objective: To compare body fat-muscle and visceral obesity indices that can be measured with thorax computed tomography (CT) between reverse transcriptase-polymerase chain reaction (RT-PCR) positive and negative patients. Material(s) and Method(s): This ret-rospective, comparative study included 141 PCR (+) and 150 PCR (-) patients who applied to our hospital with flu-like symptoms without having the comorbid diseases and undergone thoracic CT between April 1, 2020-July 1, 2020. For the each patient, the ratio of thoracic subcutaneous adipose tissue thickness to pectoralis major muscle thickness (TSAT/PMJ), epicardial adipose tissue thickness (EAT), liver density (LD), abdominal subcutaneous adipose tissue thickness to psoas major muscle thickness ratio (ASAT/ PSM), subcutaneous abdominal adipose tissue thickness to erector spinae muscle thickness ratio (ASAT/ESM) was measured. The comparison was made between the subgroups in terms of age, gender, and measured parameters. Result(s): Statistically significant difference was found between PCR (+) and (-) individuals in terms of EAT mean (p<0.05). TSAT/PMJ, ASAT/PSM and ASAT/ESM ratios were higher in women (p <0.05). The mean EAT in men was increased in the PCR (+) group (p<0.05). In PCR (+) group, LD decreased, EAT increased with increasing age (p<0.05). PCR (+) and PCR (-) groups didn't show significant difference (p>0.05) in terms of TSAT/PMJ, ASAT/PSM, LD, ASAT/ESM. Conclusion(s): Higher EAT values can increase the risk of getting coronavirus disease-2019 (COVID-19) infection. Peripheral fat-muscle indices don't increase the risk of contracting COVID-19 infection.Copyright © 2023 by Turkiye Klinikleri.
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Coronary artery disease (CAD) is widely considered a chronic inflammatory disorder, and dysfunction of epicardial adipose tissue could be an important source of the inflammation. Amino-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a known marker of cardiovascular disorders of cardiac origin. Recent studies show that inflammatory stimuli may influence its secretion. Our purpose was to evaluate NT-proBNP serum concentration in relation to immune cell ratios in epicardial adipose tissue (EAT), and cytokine levels in the patients with stable CAD. Patients with stable CAD and heart failure classified into classes II-III, according to the New York Heart Association (NYHA) scale, scheduled for the coronary artery bypass graft (CABG) surgery, were recruited into the study (n = 10;59.5 (53.0-65.0) y. o.;50% males). The EAT and subcutaneous adipose tissue (SAT) specimens were harvested in the course of CABG surgery. Immunostaining with anti-CD68, anti-CD45, anti-IL-1β and anti-TNFα monoclonal antibodies was performed to evaluate cell composition by differential counts per ten fields (400 magnification). Fasting venous blood was obtained from patients before CABG. Blood was centrifuged at 1500g, aliquots were collected and stored frozen at -40 °С until final analysis. Concentrations of NT-proBNP, IL-1β, IL-6, IL-10, TNFα were determined in serum samples by enzyme-linked immunosorbent assay (ELISA). We have found increased production of IL-1β and TNFα cytokines in EAT compared to SAT. Concentrations of NT-proBNP exceeded 125 pg/ml in 4 patients, and correlations between the CD68+ macrophage counts in both EAT and SAT samples (rs = 0.762;p = 0.010 and rs = 0.835;p = 0.003, respectively). NT-proBNP levels showed positive relations with CD45+ leukocyte counts (rs = 0.799;p = 0.006), and with IL-1β+ cell numbers (rs = 0.705;p = 0.023) in EAT samples only. As for the serum biomarkers, NT-proBNP levels showed negative correlation with fasting glucose levels (rs = -0.684;p = 0.029), and positive correlation with serum IL-6 concentrations (rs = 0.891;p = 0.001). Increased serum concentrations of NT-proBNP in CAD patients correlate with accumulation of macrophages in EAT, which is associated with increased production of IL-1β in EAT and correlates with some metabolic parameters.
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Objective: There is no study in the literature investigating the association of hepatic steatosis both gynecomastia and epicardial fat thickness together. We determined the correlations between hepatic steatosis through liver density, gynecomastia and epicardial fat thickness in patients undergoing computed tomography (CT) scans due to suspected coronavirus disease-2019 (COVID-19) symptoms. Methods: A total of 599 male patients who underwent chest CT scans because of a presumed diagnosis of COVID-19 in our radiology clinic were included in the study. Patients’ age, diameters of the subareolar glandular tissues of the right and left breasts, the right retroareolar fatty tissue, liver and spleen density, epicardial fat thickness and biochemical parameters were recorded and analyzed. Laboratory analyses were performed according to the standard methods. Results: The mean age of the patients was 47.21±15.00 years. The left subareolar tissue thickness and the right retroareolar fatty tissue thickness that are used to indicate gynecomastia were significantly correlated with liver density in the negative direction (r=-0.137, p<0.001;r=-0.172, p<0.001;respectively). Epicardial fat thickness was statistically significantly correlated with right subareolar tissue thickness (r=0.085, p=0.037), left subareolar tissue thickness (r=0.101, p=0.014) and right retroareolar fatty tissue thickness (r=0.148, p<0.001). Conclusion: The results of this study showed that gynecomastia was significantly correlated with both age and hepatic steatosis. Epicardial fat thickness is also associated with hepatic steatosis. We demonstrated the significant correlations between epicardial fat thickness and gynecomastia for the first time. Nevertheless, our results need to be confirmed by further comprehensive studies.
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Aim. To evaluate epicardial adiposity (EA), verified on the basis of epicardial adipose tissue (EAT) thickness according to echocardiography, as a possible predictor of the severity of coronavirus disease 2019 (COVID-19) course in overweight and obese patients in a retrospective analysis of data. Material and methods. We analyzed data on 165 patients (age, 45,2±4,7 years;men, 67,9%;body mass index, 31,4±3,5 kg/m2) who received outpatient or inpatient treatment for symptomatic COVID-19 in period from March 2020 to November 2021. Patients with diabetes, stage III-V chronic kidney disease and/or cardiovascular disease were excluded from the analysis, with the exception of hypertension. EA was verified in the case of EAT thickness ≥4,8 mm for persons aged 35-45 years and ≥5,8 mm for persons 46-55 years old. Results. Patients with EA were characterized by higher hospitalization rates (52,2% vs 9,0%, p<0,01), moderate (56,5% vs 19,7%, p<0,01), high and very high severity (17,4% vs 3,3%, p<0,01) of disease course, lung injury of CT-1, CT-2 and CT-3 (32,6% vs 9,8% (p<0,01), 21,7% vs 7,4% (p<0,05), and 15,2% vs 2,5% (p<0,01), respectively), invasive ventilation (8,7% vs 0,8%, p<0,05) and C-reactive protein >10 mg/l (69,6% vs 21,3%, p<0,01). Predictors of hospitalization for symptomatic COVID-19 according to multivariate logistic regression analysis were age, fasting glycemia, systolic blood pressure, EAT thickness, which was characterized by the highest standardized regression coefficient among other predictors (0,384, p<0,001). Conclusion. EAT thickness may be one of the predictors of COVID-19 severity in overweight and obese patients. Persons with EA in the case of COVID-19 need more careful monitoring and measures to prevent severe course and complications.
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Background: Coronavirus Disease 2019 (COVID-19) impacted public health systems, overwhelming the intensive care units(ICU)(1).Epicardial adipose tissue (EAT) thickness is a potential novel parameter, which can be assessed using standard computer tomography(CT) for the prediction of worse prognosis in COVID-19(2,3). Purpose: We aimed to investigate the association of right ventricle (RV)-EAT thickness with the need for invasive mechanical ventilation, vasopressor support or ICU admission and in-hospital mortality in COVID-19. Methods: We analyzed 310 consecutive hospitalized patients with confirmed COVID-19 by RT-PCR, between March and April 2020.EAT thickness was assessed during the acute setting of the disease using low dose non-contrast chest CT.Maximal EAT thickness was determined on axial image series at the level of the RV free wall perpendicular to the surface of the heart(Figure 1).Intra-and interobserver reproducibility for the RV-EAT thickness measurement was assessed in 20 random patients after two weeks, by the primary and a second investigator. Data included demographics, clinical evaluation, comorbidities, treatment and complications.Peak lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) were defined as the highest level during hospitalization.The primary combined endpoint was ICU admission, invasive mechanical ventilation and vasopressor therapy.The secondary outcome was in-hospital mortality. Results: Median age was 64 years (interquartile range:53 to 79 years,58.1% males).106(34.2%) patients reached the primary endpoint.Inhospital mortality rate was 19.5% (59 patients).Among patients with combined endpoint, the mortality rate was 35.8% (38 patients).RV-EAT thickness was higher in patients with combined endpoint (5.0 ±2.6 mm versus 4.3 ± 2.2 mm, p = 0.021).Additionally, patients with the composite endpoint had more diabetes mellitus (p = 0.028) and history of coronary artery disease (p = 0.020).Multivariable analysis showed that RV-EAT thickness predicted the primary endpoint, irrespective of risk factors and disease severity (p = 0.014, OR 1.157,95%CI 1.030-1.300;p = 0.031, OR 1.146,95%CI 1.013-1.298, respectively)(Figure 2).Moreover, peak CRP and peak LDH were associated with both endpoints( Figure 2).However, RV-EAT thickness was not predictive for mortality (p = 0.561, OR 1.039, 95%CI 0.913-1.183). Intraobserver and interobserver reproducibility were good:0.88 (95%CI 0.66-0.95) and 0.86 (95%CI 0.65-0.94). Conclusion: RV-EAT thickness, easily and rapidly assessed by standard low dose non-contrast chest CT was associated with higher incidence of ICU admission, need for mechanical ventilation and vasopressor support in hospitalized COVID-19 patients.Although no independent association between RV-EAT and in-hospital mortality was found, RV-EAT thickness may serve as surrogate marker of severity, before the rise of inflammatory biomarkers and may reflect inflammation changes within the myocardium in COVID-19.
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Background. Epicardial adipose tissue (EAT) is a highly inflammatory depot of fat, with high concentrations of IL-6 and macrophages, which can directly reach the myo-pericardium via the vasa vasorum or paracrine pathways. TNF-α and IL-6 diminish cardiac inotropic function, making EAT inflammation a potential cause of cardiac dysfunction. Methods. A retrospective cohort study assessing EAT Thickness and Density from CT scans, without contrast, from adult patients during index admission for COVID-19 infection at Mount Sinai Medical Center from March 2020 to January 2021. A total of 1,644 patients were screened, of which 148 patients were included. Follow-up completed until death or discharge. The descriptive analysis was applied to the general population, parametric test of normality for comparisons between groups. Kaplan survival analysis was conducted after survival distribution was confirmed significant. It was followed by the assumption of normality by Q-Q Plot, prior to performing a multiple regression analysis in the vulnerable group using a K-Matrix input for cofounders. A log-rank test was conducted to determine differences in the survival distributions for the different ranges of EAT thickness. Results. A total of 148 Participants were assigned to two groups based on epicardial adipose tissue in order to classify them as increased or decreased risk of cardiovascular risk: >5mm (n = 99), < 5mm (n = 49). The survival percentage was higher in the group with no EAT inflammation compared to the group with EAT inflammation (95.0% and 65%, respectively). Participants with EAT >5mm had a median day of hospital stay of 18 (95% CI, 16.86 to 29.92). The survival distributions for the two categories were statistically significantly different, χ2(2) = 6.9, p < 0.01. A Bonferroni correction was made with statistical significance accepted at the p < 0.025 level. There was a statistically significant difference in survival distributions for the EAT >5 mm vs EAT < 5 mm, χ2(1) =6.953, p = 0.008. Conclusion. There was an association with increased EAT thickness and increased mortality. These findings suggest that EAT thickness can be used as a prognostic factor and as a risk factor for increased mortality in patients with COVID-19.
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Intro: Cardiac involvement in COVID-19 infection is common. Epicardial adipose tissue functions as an inflammatory depot, and a thickness (EAT-T) >5mm is associated with increased cardiovascular risk. The present study assessed the significance of increased EAT-T in patients with COVID-19. Methods: A retrospective cohort study of 149 consecutive patients diagnosed with COVID-19 between March 2020 to January 2021 was performed. Inclusion criteria were lab-confirmed COVID19 infection and having a Chest CT scan without contrast during hospitalization. EAT-T was measure in right ventricle free wall (Figure 1). Characteristic of patients and comparisons were analyzed by T-Test and Chi-square. Log-linear analysis and cumulative logistic regression was carried out to predict effect between EAT-T and mortality Results: The mean age was 67 ± 15 years, 65% were male, and time from onset of symptoms was 7 ± 5 days. Forty-seven (31.5%) patients required mechanical ventilation, and 34 (22.8%) required vasopressors. Medical therapy included convalescent plasma (36%), Remdesivir (28%), Tocilizumab (46%), Enoxaparin (64%), and Dexamethasone (39%). There were 36 (24.2%) inhospital deaths, with a greater incidence amongst patients with an EAT-T > 5 mm versus ≤ 5 mm (95 vs 5%, p=.001). Notably, age was not significantly different on patients with in-hospital mortality (69 vs 66 years, p=0.5), and higher EAT-T by 2.17 mm on patient with acute respiratory distress syndrome (p=.001) and 10.9 mm in myocardial infarction (p=.02). In multivariable analysis an EAT-T >5mm was associated with an increased risk of mortality (OR 12.3, 95% CI 3-55, p=.001). In the presence of EAT-T > 5 mm, no effect was observed by chronic kidney disease, hypertension, coronary artery disease, dyslipidemia, or body mass index (p >0.5). Conclusions: In patients with COVID-19, an EAT-T > 5 mm is associated with increased risk of inhospital mortality and may provide important risk stratification.