Abstract
BackgroundEpicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. This study aimed to evaluate whether EAT volume was associated with stress-induced myocardial ischemia in asymptomatic people living with diabetes—independently of confounding factors—and whether it could predict this condition.MethodsWe included asymptomatic patients with diabetes and no coronary history, who had undergone both a stress a myocardial scintigraphy to diagnose myocardial ischemia, and a computed tomography to measure their coronary artery calcium (CAC) score. EAT volume was retrospectively measured from computed tomography imaging. Determinants of EAT volume and asymptomatic myocardial ischemia were evaluated.ResultsThe study population comprised 274 individuals, including 153 men. Mean (± standard deviation) age was 62 ± 9 years, and 243, 23 and 8 had type 2, type 1, or another type of diabetes, respectively. Mean body mass index was 30 ± 6 kg/m2, and mean EAT volume 96 ± 36 cm3. Myocardial ischemia was detected in 32 patients (11.7%). EAT volume was positively correlated with age, body mass index and triglyceridemia, but negatively correlated with HbA1c, HDL- and LDL-cholesterol levels. Furthermore, EAT volume was lower in people with retinopathy, but higher in men, in current smokers, in patients with nephropathy, those with a CAC score > 100 Agatston units, and finally in individuals with myocardial ischemia (110 ± 37 cm3 vs 94 ± 37 cm3 in those without myocardial ischemia, p < 0.05). The association between EAT volume and myocardial ischemia remained significant after adjustment for gender, diabetes duration, peripheral macrovascular disease and CAC score. We also found that area under the ROC curve analysis showed that EAT volume (AROC: 0.771 [95% confidence interval 0.683–0.858]) did not provide improved discrimination of myocardial ischemia over the following classic factors: gender, diabetes duration, peripheral macrovascular disease, retinopathy, nephropathy, smoking, atherogenic dyslipidemia, and CAC score (AROC 0.773 [0.683–0.862]).ConclusionsEAT may play a role in coronary atherosclerosis and coronary circulation in patients with diabetes. However, considering EAT volume is not a better marker for discriminating the risk of asymptomatic myocardial ischemia than classic clinical data.
Highlights
Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease
In this context, using a large cohort of asymptomatic patients living with diabetes, the present study aimed to evaluate whether EAT volume was associated with asymptomatic myocardial ischemia, and whether it could help discriminate patients with this condition better than classic risk markers
Parameters associated with EAT volume EAT volume was positively correlated with age, Body mass index (BMI) and triglyceridemia, but negatively correlated with HbA1c, HDL- and LDL-cholesterol level (Table 2)
Summary
Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. It has been suggested that the visceral fat tissues located adjacent to the coronary arteries—especially epicardial adipose tissue (EAT)—are one of the elements linking diabetes with cardiovascular disease [3, 4] for two primary reasons: first, diabetes is accompanied by an expansion of EAT and pericardial adipose tissue [4]. These tissues secrete inflammatory factors and lipid metabolites, and may be determinants of accelerated atherosclerosis [3,4,5,6]. Detecting diabetic patients with a very high risk of asymptomatic coronary disease is clinically relevant as they could benefit from specific prevention interventions [13,14,15]
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