Association Of Epicardial Fat Thickness Research Articles

Correlation of Epicardial Fat Thickness with Angiographic Severity and LDL Cholesterol Level in CAD

Background: Epicardial fat is independently related to coronary artery disease (CAD). Clinical imaging research has established a robust direct correlation between epicardial fat and abdominal visceral adiposity. This study aimed to assess the association of epicardial fat thickness (EFT) with CAD in patients. Objective: To find the association between EFT, Low-density lipoprotein (LDL) cholesterol levels, and angiographic severity by SYNTAX score. Methods: This prospective observational study involved 321 patients with suspected CAD patients undergoing catheter coronary angiography. Epicardial fat thickness was measured by means of transthoracic echocardiography within 90 days after coronary angiography. The severity of coronary atherosclerotic lesions become evaluated from at least 3 projections in all of the sufferers. The angiographic characteristics of the coronary atherosclerotic lesion have been defined using the SYNTAX score. Results: 321 patients took part in this study; the sex distribution has 259 male subjects (80.7%) and 62 female subjects (19.3%). LDL cholesterol levels <100 mg/dl are present in 75.1% (241 subjects) of the study population. The categories and variables were analyzed, and they show a significant correlation between epicardial fat thickness and SYNTAX score with a p-value of <0.0001. A significant correlation has been observed between LDL cholesterol levels and the angiographic severity of CAD by the SYNTAX score. Conclusion: This study suggests that there is a significant correlation between LDL cholesterol levels, EFT and angiographic severity, and complexity of the coronary lesions by the SYNTAX score. Keywords: Body Fat; Coronary Artery Disease; Epicardial Fat Thickness; CAD

Evaluation of Patients with Angiographically-Confirmed Coronary Artery Disease to Investigate the Association Between Epicardial Fat Thickness and Atrial Fibrillation.

BackgroundEpicardial fat thickness (EFT) is increasingly recognized as an independent risk factor of the presence, severity, and recurrence of atrial fibrillation (AF). We investigated the associations between EFT and AF prevalence and identified its correlation with other risk factors.Material/MethodsA total of 199 participants who underwent coronary angiography and had confirmed coronary artery disease (CAD) were enrolled in this study.The EFT was measured by echocardiography and the association of EFT with other AF risk factors was evaluated by multivariate logistic regression analysis.ResultsThe EFT was significantly higher in patients with comorbidity of AF and CAD than those with CAD alone (6.86±1.96 mm vs 5.91±1.71 mm, P<0.001). Logistic regression analysis indicated that EFT was a predictive factor of the occurrence of AF in CAD, after adjusting for body mass index (BMI), systolic blood pressure (SBP), left circumflex artery (LCX) stenosis, LA diameter, B-type natriuretic peptide (BNP), creatinine (Cr), and blood urea nitrogen (BUN). LA diameter, SBP, and LCX stenosis are also independent risk factors for CAD complicated by AF. Correlation analysis revealed significant positive linear correlations between EFT and BMI (P<0.01), EFT, and LA diameter (P<0.05), as well as positive correlations between LA diameter and BNP, Cr, or BUN.ConclusionsEpicardial fat thickness is a strong predictor for AF prevalence in patients with CAD, independent of other AF risk factors such as LA diameter, BMI, and SBP, while LA diameter, SBP, and LCX stenosis are also independent AF risk factors for CAD.

Association of epicardial fat thickness assessed by echocardiography with the severity of coronary artery disease.

Introduction: Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD. Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion. Results: PLAX (EFTS) (EFT in systole) and PLAX (EFTd) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS) (P = 0.05), PLAX (EFTd) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score. Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

The association of epicardial fat thickness and disease severity among Fabry patients

Aim: Patients with Fabry disease frequently die due to cardiovascular causes. There are numerous findings of cardiovascular involvement in patients with Fabry disease. Epicardial fat thickness is a surrogate for various cardiovascular diseases. In this study, we evaluated epicardial fat thickness and parameters of diastolic dysfunction among Fabry patients as a possible indicator of disease severity.Materials and Methods: We enrolled 14 patients with Fabry disease who receive enzyme replacement therapy. Detailed echocardiographic examination was performed including diastolic functions and measurement of epicardial fat thickness. Disease severity was assessed using DS3 scoring system. Based on DS3 scores, patients are grouped into mild (10 points), moderate (10-28 points) and severe (29-32 points) disease.Results: There were two female and twelve male patients with Fabry disease. Patients were classified into three groups based on DS3 scores. Epicardial fat thickness was significantly increased among patients with advanced disease compared to patients with mild disease (p:0.002). Also, epicardial fat thickness had significant positive correlation with average E/E’ ratio (p:0.014), left atrial volume (p:0.004) and left atrial volume index (p:0.022).Conclusion: Epicardial fat thickness seems as a promising new marker of disease severity among patients with Fabry disease.Keywords: Fabry’s disease; inflammation; echocardiography.

Epicardial fat thickness and severity of coronary heart disease in patients with diabetes mellitus type II.

BACKGROUNDClinical imaging studies have demonstrated a strong direct correlation between epicardial fat and abdominal visceral adiposity. There are several studies about positive correlation of epicardial fat and atherosclerotic coronary disease in general population. This study aimed to evaluate the association of epicardial fat thickness with atherosclerotic coronary disease in patients with diabetes mellitus type II.METHODSThis cross-sectional observational study involved 80 patients with diabetes mellitus type II. The patients were chosen using simple sampling method from patients with diabetes mellitus who were referred for angiography because of suspected coronary artery disease. The severity of coronary atherosclerotic lesions was evaluated using modified Gensini scoring system. Epicardial fat thickness was measured by transthoracic echocardiography within 90 days after coronary angiography. Multiple linear regression method was used to evaluate the association between mean epicardial fat thickness and Gensini score.RESULTSAfter adjustment for the effects of body mass index (BMI), age, angina, and sex, there was a significant association between Gensini score and epicardial fat thickness (β = 0.825; P < 0.001). Patients with higher blood pressure and higher body mass index also had a higher Gensini score (P < 0.010).CONCLUSIONIn patients with diabetes mellitus type II, there is a positive association between epicardial fat thickness and severity of coronary artery disease. So, by echocardiography evaluation of epicardial fat thickness, we could have an estimation of the severity of coronary arteries diseases before using more invasive techniques.

HEART REMODELING IN OVERWEIGHT AND OBESITY WITH CARDIAC COMORBIDITIES

Aim. To assess structural geometric and functional disorders of the heart in males with coronary heart disease (CHD) comorbid with arterial hypertension (AH) and with visceral abdominal obesity, and to evaluate the grade of association of epicardial fat thickness (EFT) with cardiometabolic risk factors (RF). Material and methods. Totally, 90 in-patients included, males with AH and CHD and with metabolically unhealthy phenotype (MUP) at the age 61,2±1,7 y. o. with normal bodyweight (n=29) — 1 group, overweight (n=21) — 2 group, and obese (n=30) — 3 group, and 30 persons with metabolically healthy phenotype. All patients underwent anthropometric screening, calculation of visceral obesity index (VAI) and insulin resistance (HOMA-IR); lipid profile was assessed, and by the data from echocardiography the myocardial mas index (MMI) was evaluated, and EFT, the characteristics of the left ventricle hypertrophy (LVH) were counted and of diastolic dysfunction (DD). Results. The presence of obesity led to increase of metabolic RF in obese patients. Most informative were indexes as VAI (4,47±0,27; p<0,001) and НОМА-IR (5,12±0,32; p<0,001). In obese patients there was association of MMI and EFT (r=0,81, p<0,001), predominance of concentric LVH with formation of restrictive DD. Regardless the level of abdominal obesity, there was increase of EFT in MUP patients, and the relation was confirmed to the main metabolic RF, as with structural geometric parameters of the heart. Conclusion. Cardiological patients with AH and CHD in MUP had increased levels of markers of anomalous phenotype, the values increased with obesity. In obese patinents (groups II, III) as a predominant trend there was concentric LVH, restrictive DD, significant increase of preload and left atrium volume. The significance of EFT was confirmed as a marker of visceral obesity. Study results show that obesity in comorbidity patients with cardiac pathology does influence the increase of cardiometabolic RF, worsens the remodeling of the heart and negatively influences cardiac muscle function.

Maximal pericoronary adipose tissue thickness is associated with hypertension in nonobese patients with acute or chronic illness.

Background/AimsRecent studies have shown an association of epicardial fat thickness with diabetes and hypertension (HTN) in asymptomatic populations. However, there is lack of information as to whether there is similar association between pericoronary adipose tissue (PAT) and HTN in the patients who have acute or chronic illness.MethodsThis study included 214 nonobese patients hospitalized with acute or chronic noncardiogenic illness. PAT thicknesses were measured from fat tissues surrounding left and right coronary arteries in enhanced, chest computed tomography scans, yielding the maximal PAT value from left and right coronary arteries was used for analysis. Baseline data from hypertensive (n = 81) and normotensive (n = 133) patients were collected and compared.ResultsPAT is positively correlated with age (r = 0.377, p <0.001), body mass index (BMI; r = 0.305, p < 0.001), systolic blood pressure (r = 0.216, p = 0.001), and total cholesterol (r = 0.200, p = 0.006). The hypertensive group was older (69.58 ± 11.69 years vs. 60.29 ± 14.98 years), and had higher PAT content (16.30 ± 5.37 mm vs. 13.06 ± 5.58 mm) and BMI (23.14 ± 3.32 kg/m2 vs. 20.96 ± 3.28 kg/m) than the normotensive group (all p < 0.001). Multivariate analysis showed that age (odds ratio [OR], 2.193; p = 0.016), PAT thickness (OR, 1.065; p = 0.041), and BMI (25 ≤ BMI < 30 kg/m2 ; OR, 6.077; p = 0.001) were independent risk factors for HTN.ConclusionsIn nonobese patients with noncardiogenic acute or chronic illness, PAT thickness is independently correlated with HTN, age, and BMI.

Impact of Gender on the Association of Epicardial Fat Thickness, Obesity, and Circadian Blood Pressure Pattern in Hypertensive Patients.

This study aimed to investigate the effects of gender on the association between epicardial fat thickness (EFT) and circadian blood pressure (BP) changes in patients with recently diagnosed essential hypertension (EH). A total of 441 patients with EH (male/female: 236/205, mean age: 50.7 ± 13.8) and 83 control patients underwent 24-hour ambulatory BP monitoring and echocardiography. Obese EH patients had higher circadian BP profile with BP variability, wall thickness, and left ventricular mass than nonobese EH patients and controls (all p's <0.05) without gender differences. EFT was higher in female than in male patients (7.0 ± 2.5 versus 5.9 ± 2.2 mm, p < 0.001) and higher in the obese female EH group (7.5 ± 2.6 mm) than in the control (6.4 ± 2.8 mm) or nonobese EH group (6.7 ± 2.8 mm) among women, whereas EFT did not vary among males (5.9 ± 1.9 versus 6.0 ± 2.7 versus 5.9 ± 2.4 mm, p = 0.937). Multivariate logistic regression analysis demonstrated that the 24-hour mean BP variability was associated with SBP (p = 0.018) and EFT (p = 0.016) in female patients, but not in male patients. The relationships among circadian BP variability, obesity, and EFT were affected by gender in different manners. EFT may be a more valuable parameter in the evaluation of BP severity and obesity in women than in men.

Association of epicardial fat thickness with TIMI risk score

We read the article“Association of epicardial fat thickness with TIMI risk score in NSTEMI/USAP patients” by Ozcan et al. [1] with great interest. The authors aimed to investigate the association between TIMI risk score and epicardial fat thickness (EFT) in patients with non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (USAP). They concluded that EFT is independently associated with TIMI risk score and may be an emerging risk factor for adverse events in NSTEMI/USAP patients. We thank the authors for their contribution of the present study, which is successfully designed and documented. EFT measurement with echocardiography has several advantages, including its low cost, easy accessibility, rapid applicability, and good reproducibility. EFT has a three-dimensional distribution, and two-dimensional echocardiography cannot give an adequate window of all cardiac segments, especially in obese subjects, and is highly dependent on acoustic windows [2]. It is widely recognized that an accumulation of EFT is strongly related to coronary artery disease (CAD). EFT amount may contribute to systemic inflammation beyond traditional cardiovascular risks and body fat composition. EFT measured by echocardiography has been known to be associated with metabolic syndrome [3]. Additionally, echocardiography-based EFT measurement was related to several metabolic abnormalities and independently associated with fatty liver disease [4]. Also, the duration of hormone therapy (HT) may be different in these patients. We think that the results of the study would be more robust if the authors had mentioned these factors including the duration of HT and liver function tests. EFT can also be affected by atherosclerotic risk factors such as alcohol consumption, hypothyroidism [5], and higher inflammatory status [3], for example, an inflammatory disease, cardiac syndrome X, and infection [6]. In the present study, the authors did not mention these possibly contributing factors. It would have been better if the authors had given information about these factors. Furthermore, the severity of CAD was evaluated by calculation of Gensini scores in the present study. However, the SYNTAX score (SS) may also be used for grading of coronary complexity based on angiographic visual assessment. The addition of clinical risk factors to the SS has been shown to potentially further augment its utility in the objective evaluation of the severity of CAD. The Logistic Clinical SXscore consisting of four continuous variables including SXscore, age, creatinine clearance, and left ventricular ejection fraction substantially enhances the risk stratification of CAD patients for the outcome of long-term all-cause death compared with the SXscore in isolation. The Logistic Clinical SXscore was able to accurately distinguish patients with or without a clinical outcome and could accurately predict individual patient risk without underor over-estimating risk [7]. Second, we strongly believe that it would be better to give interobserver and intraobserver variability for CAD severity in the current study. Finally, EFT itself without other inflammatory markers may not provide information to clinicians about systemic inflammation. Therefore, we think that it should be evaluated together with other serum inflammatory markers. We believe that these findings will help evaluate the results of further studies on EFT and TIMI risk score in acute coronary syndrome patients.

Epicardial Fat Thickness Is Independently Associated with Psoriasis

Background: Several studies have showed an association between psoriasis and cardiovascular (CV) diseases and metabolic syndrome (MS). Assessment of CV risk in patients with psoriasis has become an important issue. Epicardial fat thickness (EFT) is an emerging cardiometabolic risk factor and has been shown to be related to atherosclerosis. EFT has not been studied in the context of psoriasis. Objective: To compare the EFT in psoriasis patients with that in control subjects. Methods: 31 patients with psoriasis and 32 control subjects were included in this case-control study. EFT was evaluated by two-dimensional transthoracic echocardiography. Results: EFT was significantly higher in psoriasis patients compared to controls (p = 0.027). Multiple linear regression analysis showed that the association of EFT with psoriasis was independent of MS and age. Conclusion: EFT, which has been suggested as a cardiometabolic risk factor in various diseases, is also independently associated with psoriasis.

Association of Epicardial Fat Thickness with TIMI Risk Score in NSTEMI/USAP Patients

Background The association of epicardial adipose tissue (EAT) with coronary artery disease has been shown in previous studies. Furthermore, the relationship between EAT and acute coronary syndrome was studied recently. Herein, we investigated the relationship between EAT thickness and the thrombolysis in myocardial infarction (TIMI) risk score for non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (USAP).

Association of epicardial fat thickness with TIMI risk score in NSTEMI/USAP patients

The association of epicardial adipose tissue (EAT) with coronary artery disease has been shown in previous studies. Furthermore, the relationship between EAT and acute coronary syndrome was studied recently. Herein, we investigated the relationship between EAT thickness and the thrombolysis in myocardial infarction (TIMI) risk score for non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (USAP). The study included 144 patients with NSTEMI/USAP. The study population was divided into two subgroups according to TIMI risk scores as group I (≤ 4, n = 86) and group II (> 4, n = 58). Stepwise multivariable logistic regression analysis was used to assess the independent association of clinical parameters with TIMI risk score. EAT thickness was higher in group II than in group I (8.2 ± 2.1 vs. 6.2 ± 2.2, p < 0.001). Moreover, patients in group II had higher rates of multivessel disease and Gensini score (p < 0.001). In univariate linear regression analysis, EAT was positively correlated with TIMI risk score and Gensini score. Multivariate regression analysis showed that EAT thickness (OR: 1.56, 95 % CI: 1.17-2.08, p = 0.003), LVEF (OR: 0.93, 95 % CI: 0.85-0.98, p = 0.03), and Gensini score (OR: 1.36, 95 % CI: 1.24-1.98, p = 0.002) were independently associated with a higher TIMI risk score. In conclusion, EAT thickness is independently associated with TIMI risk score and may be an emerging risk factor for adverse events in NSTEMI/USAP patients.

Association of epicardial fat thickness with the severity of obstructive sleep apnea in obese patients

BackgroundThe correlation between obesity and severity of obstructive sleep apnea (OSA) is controversial. Although fat excess is a predisposing factor for the development of OSA, it has not been determined whether fat distribution rather than obesity per se is associated with OSA severity. Epicardial fat thickness (EFT) is an independent index of visceral adiposity and cardiometabolic risk. We investigated the relation between fat distribution and cardiometabolic risk factors, including EFT and common carotid intima-media thickness (cIMT), with the severity of OSA in obese patients. MethodsOne hundred and fifteen obese patients (56 males, 59 females) with polysomnographic evidence of OSA (≥5 apnea/hypopnea events per hour) of various degrees, without significant differences in grade of obesity as defined by body mass index (BMI), were evaluated. The following parameters were measured: BMI, body composition by dual energy X-ray absorptiometry, EFT, right ventricular end-diastolic diameter (RVEDD) and cIMT by ultrasound, and parameters of metabolic syndrome (waist circumference, arterial blood pressure, fasting glucose, HDL-cholesterol and triglycerides). ResultsEFT, RVEDD, cIMT and trunk/leg fat mass ratio showed a positive correlation with OSA severity in univariate analysis (r=0.536, p<0.001; r=0.480, p<0.001; r=0.345, p<0.001; r=0.330, p<0.001, respectively). However, multiple linear regression analysis showed that EFT was the most significant independent correlate of the severity of OSA (R2=0.376, p=0.022). ConclusionsThe present study suggests that, in obese patients, EFT may be included among the clinical parameters associating with OSA severity. The association of EFT with OSA, both cardiovascular risk factors, is independent of obesity as defined by classical measures.

The Association of Epicardial Fat Thickness with Blunted Heart Rate Recovery in Patients with Metabolic Syndrome

Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. Epicardial fat thickness (EFT) and blunted heart rate recovery (HRR) are newly identified cardiovascular risk factors in patients with metabolic syndrome (MS). The objective of this study is to evaluate the association between EFT and HRR in patients with MS. Forty patients with MS and 36 healthy controls were included in the study. Echocardiographic EFT and HRR at 1min after exercise termination (HRR-1) are measured and compared between the two groups. HRR-1 equal to or lower than 18 beats is considered as blunted HRR. EFT was increased (7.2 ± 2 vs. 5.6 ± 1.8 mm; p = 0.001) and HRR-1 was significantly reduced in patients with MS compared to control group (21 ± 8 vs. 26 ± 9; p = 0.006). Among the MS patients, subjects with blunted HRR had increased EFT compared to patients without blunted HRR (8.5 ± 2.0 vs. 5.9 ± 1.1 mm, p < 0.001). In multivariate analysis, EFT was the only independent predictor of blunted HRR in patients with MS (95% confidence interval = 1.42-3.87, OR = 2.34, p = 0.001). Furthermore, EFT of equal to or thicker than 5.5 mm was associated with the blunted HRR with 84% sensitivity and 52% specificity (ROC area under curve: 0.84, 95% confidence interval = 0.70-0.96, p < 0.001). In conclusion, EFT is an independent predictor of blunted HRR, a novel cardiovascular risk factor, in patients with MS.