ABSTRACT
The present study aimed to compare echocardiography measurements of epicardial adipose tissue (EAT) thickness and other risk factors regarding their ability to predict adverse cardiovascular outcomes in patients with coronary artery disease (CAD). Outcomes of 107 patients (86 males, 21 females, mean age 63.6 years old) submitted to diagnostic echocardiography and coronary angiography were prospectively analyzed. EAT (measures over the right ventricle, interventricular groove and complete bulk of EAT) and left ventricle ejection fraction (LVEF) were performed by echocardiography. Coronary complexity was evaluated by Syntax score. Primary endpoints were major adverse cardiovascular events (MACE's), composite of cardiovascular death, myocardial infarction, unstable angina, intra-stent re-stenosis and episodes of decompensate heart failure requiring hospital attention during a mean follow up of 15.94 ± 3.6 months. Mean EAT thickness was 4.6 ± 1.9 mm; and correlated with Syntax score and body mass index; negatively correlated with LVEF. Twenty-three cases of MACE's were recorded during follow up, who showed higher EAT. Diagnostic ability of EAT to discriminate MACE's was comparable to LVEF (AUROC > 0.5); but higher than Syntax score. Quartile comparison of EAT revealed that measurement of the complete bulk of EAT provided a better discrimination range for MACE's, and higher, more significant adjusted risk (cutoff 4.6 mm, RR = 3.91; 95% CI 1.01-15.08; p = 0.04) than the other risk factors. We concluded that echocardiographic measurement of EAT showed higher predicting ability for MACE's than the other markers tested, in patients with CAD. Whether location for echocardiographic measurement of EAT impacts the diagnostic performance of this method deserves further study.
Subject(s)
Adipose Tissue/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Pericardium/diagnostic imaging , Aged , Cardiovascular Diseases/diagnostic imaging , Cardiovascular Diseases/etiology , Coronary Angiography , Echocardiography , Female , Humans , Longitudinal Studies , Male , Middle Aged , Predictive Value of Tests , Risk FactorsABSTRACT
Objective To evaluate the relationship between pro-atherogenic biomarkers and epicardial adipose tissue (EAT) thickness in patients with cardiovascular risk factors. Methods Plasma nitric oxide (NO), soluble intercellular adhesion molecule-1 and malondialdehyde (MDA) levels, EAT thickness, flow-mediated dilation (FMD) and carotid intima media thickness (CIMT) were determined in patients aged >18 years who were referred for echocardiography for heart ischemia or non-ischemic diseases. Cardiovascular risk factors (Framingham score [FS] ≥ 20) were weighted. Results Hypertension, dyslipidaemia and type 2 diabetes mellitus were prevalent (≥55% of 40 patients). Patients with FS ≥ 20 ( n = 21) showed significantly higher EAT and CIMT values. Globally, MDA, CIMT, age, waist circumference, high-density lipoprotein cholesterol (HDL-C) and FS were associated with EAT thickness. EAT was significantly associated with NO in patients with FS ≥ 20. Significant differences in EAT thickness were found between patients stratified by NO value, FMD, age, smoking status, dyslipidaemia, type 2 diabetes mellitus and FS. An EAT-associated atherogenic risk (CIMT ≥ 1 mm) model was statistically significant when MDA and type 2 diabetes mellitus were included. Conclusion EAT thickness was associated with MDA, CIMT, age, waist circumference, HDL-C and FS globally, but with NO only in patients with FS≥20. EAT may be used to identify vascular damage stage, possibly influenced by MDA and type 2 diabetes mellitus.
Subject(s)
Adipose Tissue/pathology , Atherosclerosis/pathology , Carotid Intima-Media Thickness , Pericardium/pathology , Adipose Tissue/diagnostic imaging , Adult , Aged , Aged, 80 and over , Atherosclerosis/diagnostic imaging , Biomarkers/metabolism , Demography , Female , Humans , Logistic Models , Male , Middle Aged , Pericardium/diagnostic imaging , Risk FactorsABSTRACT
Millions of people die every year due to cardiovascular diseases. The objective against these diseases is primary prevention, but secondary prevention is the major goal in those individuals who already suffered an event. The order of the cardiovascular complication is the next one: arrhythmia, heart failure, myocardial infarction or stroke, and death. Approximately between 1 and 2 % of adults present heart failure, but this percentage rises to more than 10 % in adults over 70 years. Therefore, it is necessary to diagnose and to treat this complication. Left ventricular ejection fraction is the most important prognosis factor in these patients, because it decreases in 50 % of them. Almost 50 % of patients with heart failure have a conserved systolic function, but a decreased diastolic function. Treatment must improve the structural and functional heart abnormalities. Echocardiography is a useful tool in these patients due to its exactitude, accessibility, safety, and low cost. It provides information about the characteristics of the cardiac chambers and its volumes, the diameter in the walls, and about the diastolic, systolic and valvular function. Recently, echocardiography evolved to third dimension techniques, which seem to be more exact. In the next years, we will have more evidence about this diagnostic modality.
Cada año mueren millones de personas por enfermedades cardiovasculares. El objetivo principal en la lucha contra estas enfermedades en las personas que no han sufrido un evento debe ser la prevención primaria, pero en las que ya lo sufrieron es importante la prevención secundaria. La escalada de las complicaciones cardiovasculares es la siguiente: arritmias, insuficiencia cardiaca, infarto de miocardio o cerebral, y muerte. Aproximadamente entre 1 y 2 % de los adultos tiene insuficiencia cardiaca y más de 10 % de los adultos mayores de 70 años, por lo que es fundamental diagnosticarla y establecer tratamiento. En el pronóstico de la insuficiencia cardiaca es crucial la fracción de eyección del ventrículo izquierdo, ya que está disminuida en 50 % de los casos. Casi 50 % de los pacientes con insuficiencia cardiaca tiene la función sistólica conservada y la diastólica deteriorada. El tratamiento debe mejorar las alteraciones cardiacas estructurales y funcionales. La ecocardiografía es útil en el diagnóstico por su exactitud, disponibilidad, seguridad y costo bajo; provee información sobre las características de las cavidades cardiacas, sus volúmenes, el diámetro de sus paredes, de las funciones diastólica, sistólica y valvular. Recientemente, la ecocardiografía evolucionó hacia la tercera dimensión, que al parecer es más exacta, por lo que se espera que en pocos años existan más evidencias a partir de esta modalidad ecocardiográfica.
