Echocardiographic Epicardial Adipose Tissue Thickness Research Articles

The relationship between epicardial adipose tissue thickness and coronary artery disease progress.

The relationship between epicardial adipose tissue and inflammatory events has been shown in many studies. Because it is an inflammatory process in coronary progression, it is aimed to examine the relationship between coronary artery disease progression and epicardial adipose tissue thickness. Our research was conducted with 50 patients (33 men, 17 women) who underwent planned or emergency coronary angiography, by evaluating the coronary artery disease progression from the coronary angiography images together with the echocardiographic epicardial adipose tissue thickness measurement. Patients were examined in two groups according to their tissue thickness, 17 patients with less than 0.55 cm were defined as group 1 and 33 patients with ≥ 0.55 were determined as group 2. There was no significant difference between the groups in terms of gender, diabetes, age, hypertension. In addition, a significant relationship was found with epicardial adipose tissue thickness (> 0.5 cm), ejection fraction and smoking in the group with coronary progression. Patients without stenotic changes were found to be statistically significantly lower p < 0.005. An independent relationship was found between epicardial adipose tissue and coronary artery progression. In the light of these findings, it can be concluded that epicardial adipose tissue residue is effective in the development of coronary artery stenosis and calcific-atherosclerotic changes in the coronary arteries. In the light of the information obtained, a positive correlation was determined between epicardial adipose tissue thickness and coronary artery disease (Tab. 3, Fig. 2, Ref. 15). Text in PDF www.elis.sk Keywords: coronary artery disease, epicardial adipose tissue, progression.

The value of echocardiographic measurement of epicardial adipose tissue in heart failure patients.

AimsEpicardial adipose tissue (EAT) is increasingly recognized as an important factor in the pathophysiology of heart failure (HF). Cardiac magnetic resonance (CMR) imaging is the gold‐standard imaging modality to evaluate EAT size, but in contrast to echocardiography, CMR is costly and not widely available. We investigated EAT thickness on echocardiography in relation to EAT volume on CMR, and we assessed the agreement between observers for measuring echocardiographic EAT.Methods and resultsPatients with HF and left ventricular ejection fraction >40% were enrolled. All patients underwent CMR imaging and transthoracic‐echocardiography. EAT volume was quantified on CMR short‐axis cine‐stacks. Echocardiographic EAT thickness was measured on parasternal long‐axis and short‐axis views. Linear regression analyses were used to assess the association between EAT volume on CMR and EAT thickness on echocardiography. Intraclass correlation coefficient (ICC) was used to assess the interobserver agreement as well as the intraobserver agreement. EAT on CMR and echocardiography was evaluated in 117 patients (mean age 71 ± 10 years, 49% women and mean left ventricular ejection fraction 54 ± 7%). Mean EAT volume on CMR was 202 ± 64 mL and ranged from 80 to 373 mL. Mean EAT thickness on echocardiography was 3.8 ± 1.5 mm and ranged from 1.7 to 10.2 mm. EAT volume on CMR and EAT thickness on echocardiography were significantly correlated (junior‐observer: r = 0.62, P < 0.001, senior‐observer: r = 0.33, P < 0.001), and up to one‐third of the variance in EAT volume was explained by EAT thickness (R 2 = 0.38, P < 0.001). The interobserver agreement between junior and senior observers for measuring echocardiographic EAT was modest [ICC, 0.65 (95% confidence interval (CI) 0.47–0.77], whereas the intraobserver agreement was good (ICC 0.98, 95% CI 0.84–0.99).ConclusionsThere was a modest correlation between EAT volume on CMR and EAT thickness on echocardiography. Limited agreement between junior and senior observers for measuring echocardiographic EAT was observed. EAT thickness on echocardiography is limited in estimating EAT volume.

Prognostic significance of epicardial adipose tissue in heart failure with preserved and reduced ejection fraction

Abstract Background Increased epicardial adipose tissue (EAT) thickness correlates with metabolic syndrome, insulin resistance, microvascular dysfunction and enhanced pericardial restraint. Purpose We measured echocardiographic EAT thickness in heart failure (HF) patients with reduced (HFrEF) or preserved (HFpEF) ejection fraction to determine whether EAT could bear prognostic significance at clinical follow-up. Methods We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) referred to our hospital due to dyspnoea and/or effort intolerance. We performed a resting clinical and biohumoral evaluation, followed by combined cardiopulmonary-echocardiography exercise stress. A composite of cardiovascular death and HF-related hospitalization was chosen as endpoint during follow-up. Results Patients with HFpEF displayed higher EAT thickness (median 8 mm, interquartile range [IQR] 4–12 mm) than HFrEF (median 3 mm, IQR 2–6 mm; p&amp;lt;0.0001). During a median follow-up of 20.9 months (IQR 15–25 months), we reported 34 cardiovascular deaths and 146 HF hospitalizations, with no significant differences between the two HF subsets. EAT predicted adverse events independently from body mass index and well-established markers of poor prognosis (e.g., NT-proBNP, peak oxygen consumption). The risk of adverse events increased with increasing EAT thickness in HFpEF and with EAT thinning in HFrEF. Kaplan-Meier analyses for the composite endpoint showed that in HFpEF, the survival probability was significantly lower in patients with thicker EAT than those with thinner EAT. In HFrEF, conversely, patients with thicker EAT had a higher survival probability than those with reduced EAT thickness (Figure 1). Conclusion EAT accumulation is more marked in HFpEF than HFrEF and carries different prognostic meanings in the two subsets. In HFpEF, EAT thickening portends adverse outcome, which may be due to increased mechanical restraint and secretion of pro-inflammatory and pro-atherogenic adipokines. In HFrEF, greater EAT thickness seems to have a protective role, while EAT thinning is associated with a worse prognosis, likely reflecting a catabolic state (i.e. cardiac cachexia). Larger studies will clarify whether EAT is a bystander or an active player in the different HF phenotypes. Funding Acknowledgement Type of funding sources: None. Figure 1

Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure.

We evaluated the impact of echocardiographic epicardial adipose tissue (EAT) on cardiovascular haemodynamics, metabolic profile and prognosis in heart failure (HF) using combined cardiopulmonary-echocardiography exercise stress. We analysed EAT thickness of HF patients with reduced (HFrEF, n=205) and preserved (HFpEF, n=188) ejection fraction, including 44 controls. HFpEF patients displayed the highest EAT, while HFrEF patients had lower values than controls. EAT showed an inverse correlation with natriuretic peptides, troponin T and C-reactive protein in HFrEF, while having a direct association with troponin T and C-reactive protein in HFpEF. EAT was independently associated with peak oxygen consumption (VO2 ) and peripheral extraction (AVO2 diff), regardless of body mass index. EAT was inversely correlated with peak VO2 and AVO2 diff in HFpEF, while a direct association was observed in HFrEF, where lower EAT values were associated with worse left ventricular systolic dysfunction. In HFpEF, increased EAT was related to right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) uncoupling. After 21 months of follow-up, 146 HF hospitalizations and 34 cardiovascular deaths were recorded in the HF population. Cox multivariable analysis supported an independent differential role of EAT in HF cohorts (interaction P=0.01): higher risk of adverse events for increasing EAT in HFpEF [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.37] and for decreasing EAT in HFrEF (HR 0.75, 95% CI 0.54-0.91). In HFpEF, EAT accumulation is associated with worse haemodynamic and metabolic profile, also affecting survival. Conversely, lower EAT values imply higher left ventricular dysfunction, global functional impairment and adverse prognosis in HFrEF.

Increased epicardial adipose tissue thickness is associated with microalbuminuria in hypertensive patients with left ventricular hypertrophy

ABSTRACT Objective Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been previously reported. Microalbuminuria (MA) is associated with target-organ damage, especially in patients with hypertension with left ventricular hypertrophy (LVH) and suggest endothelial dysfunction. This study aimed to investigate the relationship between echocardiographic EAT thickness and presence of MA in patients with hypertension. Methods A total of 297 newly diagnosed hypertension patients who applied to the outpatient clinic were enrolled consecutively in this study. Patients were divided into two groups regarding the presence of LVH in echocardiography. An age and gender matched control group was set including 156 healthy patients without HT. All subjects underwent transthoracic echocardiography for the measurement of EAT thickness. Spot urine samples were collected for the assessment of MA. Results In hypertensive patients with LVH, the EAT thicknesses (6.6 ± 1.8 vs 5.3 ± 1.5 vs 5.1 ± 1.3, p < .001; respectively) and prevalence of MA (41.2 vs 20.1 vs 3.2%; p < .001 respectively) were significantly higher than the other two groups. In hypertensive patiens without LVH, no relationship was found between the presence of MA and EAT thickness. In multivariate regression analyses, EAT thickness (OR: 3.141, 95%CI: 2.425–6.123, p < .001) and left ventricular mass index (OR: 1.339, 95%CI: 1.145–2.143, p = .003) were determined as independent predictors for MA development in hypertensive patients with LVH. Conclusion Measurement of EAT thickness may help to identify high-risk hypertensive patients for target-organ damage especially among patients with LVH.

Epicardial adipose tissue thickness as a potential predictor of gestational diabetes mellitus: a prospective cohort study

BackgroundGestational diabetes mellitus (GDM) is the most common metabolic disorder that can occur during pregnancy and is associated with a long-term risk of both maternal and neonatal comorbidities. This study aimed to investigate the association between echocardiographic epicardial adipose tissue (EAT) and the risk for GDM during the early second trimester of pregnancy.MethodWe recruited all singleton pregnancies between January 2014 and December 2018 at 16 weeks + 0 days to 19 weeks + 6 days. We then used generalized linear models to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for EAT as a potential predictor for GDM. Receiver-operating-characteristic (ROC) analysis was then conducted to investigate the discriminative capacity of any individual maternal factor for the prediction of GDM.ResultsIn total, our study involved 314 pregnant women with GDM and 1832 pregnant women without GDM. Multivariate regression analysis revealed that EAT thickness (OR = 2.87; 95% CI: 2.49–3.31) was significantly associated with the presence of GDM (P < 0.001). Furthermore, EAT thickness was also significantly associated with a range of adverse outcomes in the GDM group, including large size for gestational age, neonatal hypoglycemia, admission to the neonatal intensive care unit, preterm delivery, and hyperbilirubinemia (P < 0.001). ROC analysis revealed that the area under the curve was 0.790 (95% CI: 0.768–0.812). When the cutoff value for EAT thickness was set to 5.49 mm, the sensitivity was 95.2% and the specificity was 50.5%.ConclusionsEchocardiographic EAT thickness is positively and significantly associated with both the risk of GDM and adverse outcomes related to GDM. Echocardiographic EAT has the potential to predict GDM prior to actual clinical diagnosis.

Echocardiographic Epicardial Adipose Tissue Thickness for Risk Stratification of Patients With Heart Failure.

Background and AimsEpicardial adipose tissue (EAT) has been shown to be involved in the pathogenesis and progression of heart failure (HF). In this study we aimed to explore the predictive value of echocardiographic EAT thickness on prognosis of a selected population of HF patients.MethodsThe patient population included n. 69 consecutive patients with systolic HF referred to implantable cardioverter defibrillator (ICD) implantation for primary or secondary prevention. At the time of enrolment, echocardiographic EAT thickness was assessed in all patients along with demographic and clinical data. The study had a median follow-up time of 49.8 months. We assessed the prognostic predictive value of EAT thickness on a composite clinical and arrhythmic outcome including HF related deaths, new hospital admissions for HF worsening, and atrial and life threatening ventricular arrhythmic events. Clinical and arrhythmic outcomes were also evaluated separately.ResultsAt univariate analysis, EAT thickness significantly predicted all the three outcomes considered. Of interest, at multivariate analysis, after adjusting for known risk factor, EAT remained significantly associated to the composite [HR 1.18 (1.09–1.28); p < 0.001], arrhythmic [HR 1.14 (1.03–1.25); p = 0.008], and clinical [HR 1.14 (1.03–1.27); p = 0.010] outcomes.ConclusionEchocardiographic assessment of EAT can predict outcome of HF patients and it is significantly associated with both arrhythmic and clinical events. These preliminary findings pave the way for future and larger studies aimed to definitively recognize the prognostic value of this novel risk marker in HF.

A new measurement site for echocardiographic epicardial adipose tissue thickness and its value in predicting metabolic syndrome.

Echocardiographic epicardial adipose tissue (EAT) thickness is defined as the thickness of the low-isoechoic area on the free wall of the right ventricle in the parasternal long-axis and short-axis views. Recent studies have suggested that it might support current risk stratification strategies in identifying an increased risk of metabolic syndrome. The aim of this study is to explore a new measurement site which can better reflect EAT thickness and to assess its value in predicting metabolic syndrome. A total of 975 Chinese adults were measured for EAT thickness on the right ventricular anterior free wall (EAT-rv) and on the anterior interventricular groove (EAT-ivg) with echocardiography. The correlation between EAT thickness and metabolic syndrome was analyzed, as was the agreement between epicardial adipose volume (EAV) and EAT thickness. Independent risk factors of EAT thickness were identified and the predictive value of EAT thickness was assessed. Epicardial adipose tissue thickness was higher in older participants and those with obesity, diabetes, hypertension, hypertriglyceridemia, and metabolic syndrome, and it was lower in male participants. The EAT-ivg was higher in the participants with hypo-high-density-lipoprotein cholesterolemia than in those without the disorder, but the EAT-rv values were not statistically different. The kappa value was 0.524 between EAT-rv and EAV, and 0.783 between EAT-ivg and EAV. Advanced age, large waist circumference and female gender were independent risk factors of high EAT-ivg, while high-density-lipoprotein (HDL) cholesterol was a protective factor. The EAT-ivg was associated with metabolic syndrome. The area under the curve of EAT-ivg applied in predicting metabolic syndrome was greater than that of EAT-rv (0.715 vs 0.648). The EAT-ivg was more consistent with EAV than EAT-rv, was independently associated with metabolic syndrome and had a higher value in predicting metabolic syndrome than EAT-rv. Therefore, the anterior interventricular groove can serve as a new measurement site which better reflects EAT thickness.

Effect of Echocardiographic Epicardial Adipose Tissue Thickness on Success Rates of Premature Ventricular Contraction Ablation

Background:Idiopathic premature ventricular contractions are frequently detected ventricular arrhythmias, and radiofrequency ablation is an effectively treatment for improving symptoms and eliminating premature ventricular contractions. Studies have reported a relationship between an elevated epicardial adipose tissue thickness and myocardial structural pathologies. However, the association between epicardial adipose tissue thickness and success rates of premature ventricular contraction ablation has not yet been investigated.Aims:To assess the relationship between epicardial adipose tissue thickness and success rates of premature ventricular contraction ablation.Study Design:Retrospective case-control study.Methods:This study enrolled a total of 106 consecutive patients who have had a high premature ventricular contraction burden of >10,000/24-h assessed using ambulatory Holter monitorization and underwent catheter ablation. A frequency of premature ventricular contractions of more than 10,000/day was defined as frequent premature ventricular contraction. Epicardial adipose tissue thickness was measured using 2D transthoracic echocardiography. A successful ablation was defined as >80% decrease in pre-procedural premature ventricular contraction attacks with the same morphology during 24-h Holter monitorization after a 1-month follow-up visit from an ablation procedure.Results:Successful premature ventricular contraction ablation was achieved in 87 (82.1%) patients. Epicardial adipose tissue thickness was significantly higher in patients with unsuccessful ablation (p<0.001). Procedure time, total fluoroscopy time, and radiofrequency ablation time were statistically higher in the unsuccessful group (p<0.001). Stepwise multivariate logistic regression analysis showed that epicardial adipose tissue thickness and pseudo-delta wave time were independently associated with procedural success (both p values <0.001). In the receiver-operating curve analysis, epicardial adipose tissue thickness was found to be an important predictor for procedural success (area under the receiver-operating characteristic curve= 0.85, p=0.001), with a cutoff value of 7.7 mm, a sensitivity of 92%, and a specificity of 68%.Conclusion:Epicardial adipose tissue thickness is higher in patients with premature ventricular contraction ablation failure, which may be indicative of procedural success.

Correlation between Echocardiographic Epicardial Fat Thickness and Angiographic Severity of Coronary Artery Disease

Background: Epicardial adipose tissue (EAT) is a visceral adipose tissue surrounding the heart and the coronary arteries. Because of its endocrine and paracrine activity, secreting pro-inflammatory and antiinflammatory cytokines and chemokines, it has been suggested to influence coronary atherosclerosis development.Objectives: To identify the relationship between echocardiographic epicardial fat thickness and the extent of coronary artery disease (CAD). Methods: Considering the inclusion and exclusion criteria, a total 87 patients with established or suspected coronary artery disease admitted for coronary angiogram were included in this study. After taking written consent, initial evaluation of the patients was done by history, clinical examination and relevant investigation. Variables, risk factors for CAD and investigation reports were recorded in data sheet. Echocardiography and coronary angiography were done. EAT thickness measurements by echocardiography were compared with coronary angiographic findings.Results: Echocardiographic EAT thickness was significantly higher in patients with CAD in comparison to those with normal coronary arteries 7.14±1.81 mm vs 4.08±1.06mm (p &lt;0.001). Furthermore, EAT thickness increase with the severity of CAD. EAT is 4.08±1.06 mm in patients with normal/non-significant CAD (n=20), 5.75±0.96 mm in single vessel CAD (n=24), 6.54±1.09 mm in double vessel CAD (n=16) and 8.75±1.45 mm in patients with triple vessel CAD (n=27).Conclusions:EAT thickness was significantly higher in patients with angiographically detected CAD in comparison to those with normal coronary arteries. Furthermore, EAT thickness increased with the severity of CAD; i.e. it was thicker in multivessel coronary artery disease than in single vessel or non-significant coronary artery disease.Bangladesh Heart Journal 2018; 33(1) : 47-53

Effect of aerobic exercise on echocardiographic epicardial adipose tissue thickness in overweight individuals.

BackgroundEpicardial adipose tissue thickness (EATT) measured by echocardiography is a reliable indicator of visceral adipose tissue in the body and metabolic syndrome. The objective of this work was to study the effect of 12-week aerobic exercise training on echocardiographic epicardial adipose tissue thickness (EEATT), body composition and other metabolic parameters in asymptomatic overweight adults.MethodsA total of 170 overweight and mild obese individuals were randomly allocated to 12-week aerobic exercise program (intervention group) or no supervised exercise (control group). The body fat percentage and visceral fat levels were measured by bioelectric impedance analyzer, and blood tests were conducted to measure lipids, fasting blood sugar (FBS) and high-sensitivity C-reactive protein (Hs-CRP). The participants also underwent transthoracic echocardiography to measure EATT. All the outcomes were measured after 12 weeks. Repeated measures were analyzed using ANOVA and Mann–Whitney U-test were used to analyze the data.ResultsEEATT values significantly reduced by −16.24% (3.12±1.18 to 2.70±1.04, p<0.05) following 12 weeks of aerobic exercise along with a reduction in weight by 2.96% (80.66±12.12 to 78.27±12.31, p<0.05), body mass index by 3.11% (29.20±2.71 to 28.29±2.81, p<0.05) and waist circumference by 2.29% (94.82±7.23 to 92.64±7.33, p<0.05) and improved Hs-CRP values.ConclusionThe 12-week aerobic exercise was found to be effective in reducing EEATT in overweight and mild obese individuals. There was significant improvement in body composition, blood lipids, FBS, Hs-CRP and exercise capacity in intervention group compared to control group.

Correlation of Epicardial Adipose Tissue with Body Composition, Lipids and C-reactive Protein in Asian-Indians

Background: Echocardiographic epicardial adipose tissue (EEAT) is an indicator of visceral fat in the body and is also well known as a risk factor of cardiovascular diseases. EEAT thickness (EEATT) and its association with risk of diseases is influenced by age, gender and ethnicity. There is limited literature on EEATT values and associated risk factors in Asian-Indian population. The objective of the study was to study the correlation of EEATT with body fat percentage, visceral fat levels, lipid profile and fasting blood sugar levels in Asian-Indian population. Methodology: 195 overweight Asian-Indian individuals with body mass index between 25 to 35 and with no known medical conditions voluntarily agreed to participate in the study. The preliminary screening of the participants in this cross-sectional study included body composition assessment and blood test. All the participants also underwent 2D Echocardiography to measure EEATT in parasternal view. The EEATT values were correlated with body weight, body mass index, visceral fat levels, body fat percentage, waist circumference, fasting blood sugar values and blood lipids. The results were analysed using Descriptive statistics and Pearson's correlation test. Results: EEATT showed a positive correlation with body weight (r=0.47, p= < 0.005), body mass index (r=0.52, p= < 0.005), waist circumference(r=0.72, p= < 0.005), total body fat percentage (r=0.46, p= < 0.005), visceral fat levels (r=0.77, p= < 0.005), fasting blood sugar levels (r=0.35, p= < 0.005), total cholesterol(r=0.29, p= < 0.005), Low Density Lipoprotein Cholesterol (r=0.33, p= < 0.005), Triglycerides (r=0.31, p= < 0.005) and high sensitive C-reactive protein (r=0.47, p= < 0.005) < /p> < p> Conclusion: Epicardial adipose tissue thickness measured by echocardiography, a reliable indicator of visceral fat and a marker of cardiovascular diseases showed good correlation with indicators of abdominal adiposity and visceral fat measured by Bio-impedance analysis in Asian- Indian population. The significant association with metabolic parameters and C-reactive protein indicate that epicardial adipose tissue is a reliable marker for cardiovascular diseases in overweight Asian-Indian population.

Echocardiographic Epicardial Adipose Tissue Thickness Is Associated with Symptomatic Coronary Vasospasm during Provocative Testing

Epicardial adipose tissue (EAT) is the ectopic visceral fat surrounding the heart, which plays an important role in atherosclerosis of the coronary arteries via endothelial damage. Several studies have also suggested that vasospasm with angina (VSA) causes endothelial dysfunction in the coronary arteries. The aim of this study was to evaluate the thickness of EAT in the anterior interventricular groove (EAT-AIG) using echocardiography in patients who had no obstructive coronary artery disease and were suspected of having VSA. Sixty-five patients who underwent intracoronary acetylcholine provocation testing for clinical indicationswere prospectively enrolled. VSA was diagnosed by coronary artery stenosis increase of >90% and the presentation of chest pain with ischemic changes on electrocardiography. Subjects were divided into two groups, with and without significant coronary spasm (VSA group, 30 patients; non-VSA group, 35 patients), consistent with acetylcholine provocation testing. EAT-AIG thickness was significantly greater in the VSA group than in the non-VSA group (8.2±2.7 vs 6.1±2.5mm, P=.002). By receiver operating characteristic analysis, EAT-AIG thickness had a high C statistic (area under the curve=0.81, P<.001) after adjustment for conventional risk factors (smoking, diabetes mellitus, and dyslipidemia). EAT-AIG thickness had incremental diagnostic value over other conventional risk factors (area under the curve=0.81 vs 0.64, P for comparison=.020). EAT-AIG thickness, which is noninvasively and easily measured using transthoracic echocardiography, can be one of multiple clinical variables associated with VSA.

The relationship between echocardiographic epicardial adipose tissue thickness and non dipper hypertension

Objective To investigate the correlation between epicardial fat thickness and non dipper hypertension. Methods A total of 150 subjects was included in the study, of which 50 were in the non dipper hypertension group, the same in the non dipper hypertension group and the healthy control group. History collection and routine laboratory tests, ultrasonic measurement of epicardial fat thickness, and 24 hour ambulatory blood pressure monitoring were carried on all subjects. Epicardial fat thickness between groups was compared to primarily analyze the correlation of epicardial fat thickness and non dipper type hypertension. The optimal screening positive value in epicardial fat thickness of non dipper type primary hypertension was obtained by receiver operating characteristic (ROC) curve and maximum Youden index. Results When non dipper hypertension group and non-dipper hypertension group were compared, epicardial fat thickness was significantly increased [(6.30±0.94)mm vs (5.92±0.75) mm, P<0.05], as compared dipper hypertension group to healthy group, the epicardial fat thickness was significantly increased [(5.92±0.75)mm vs (5.50±0.13)mm, P<0.05]. Epicardial fat thickness and non dipper type primary hypertension were linearly related (r=0.43, P<0.05), and epicardial fat thickness in diagnosis of non dippers primary hypertension optimal screening positive value was 6.01 mm. Conclusions There is a close relationship of epicardial fat thickness and non dipper hypertension. Key words: Ultrasonography; Pericardium; Adipose tissue; Hypertension/PP

Increased Epicardial Adipose Tissue Volume Correlates With Cardiac Sympathetic Denervation in Patients With Heart Failure.

It has been reported that epicardial adipose tissue (EAT) may affect myocardial autonomic function. The aim of this study was to explore the relationship between EAT and cardiac sympathetic nerve activity in patients with heart failure. In 110 patients with systolic heart failure, we evaluated the correlation between echocardiographic EAT thickness and cardiac adrenergic nerve activity assessed by (123)I-metaiodobenzylguanidine ((123)I-MIBG). The predictive value of EAT thickness on cardiac sympathetic denervation ((123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score) was tested in a multivariate analysis. Furthermore, catecholamine levels, catecholamine biosynthetic enzymes, and sympathetic nerve fibers were measured in EAT and subcutaneous adipose tissue biopsies obtained from patients with heart failure who underwent cardiac surgery. EAT thickness correlated with (123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score, but not with left ventricular ejection fraction. Moreover, EAT resulted as an independent predictor of (123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score and showed a significant additive predictive value on (123)I-MIBG planar and single-photon emission computed tomography results over demographic and clinical data. Although no differences were found in sympathetic innervation between EAT and subcutaneous adipose tissue, EAT showed an enhanced adrenergic activity demonstrated by the increased catecholamine levels and expression of catecholamine biosynthetic enzymes. This study provides the first evidence of a direct correlation between increased EAT thickness and cardiac sympathetic denervation in heart failure.

Abstract 12678: Clinical Utility of Echocardiographic Epicardial Adipose Tissue Thickness Measured Using a High-frequency Linear Probe in Patients With Coronary Artery Disease

Introduction: Epicardial adipose tissue(EAT), which is thought to be an ectopic adipose tissue, has been paid attention in association with coronary artery disease (CAD). Hypothesis: We hypothesized that EAT in anterior interventricular groove (AIG) obtained by echocardiography can be an additional marker over classical risk factors for prediction of CAD. Methods: We enrolled 311 patients (mean age 67±11 yrs, 208 men) who underwent coronary angiography between December 2011 and December 2013 at our hospital. We measured EAT thickness on the AIG and right ventricular free wall (EAT-RV) using high-frequency linear probe. Subjects were divided into 2 groups with and without significant coronary stenosis (≧75%) from coronary angiography. The performance of clinical risk factors (including age, male gender, body mass index (BMI), diabetes mellitus, hypertension, dyslipidemia, and smoking) plus various combinations of EAT thickness measurements for predicting CAD was assessed using the area under the curve (AUC) in ROC analysis. Results: The EAT-AIG thickness was significantly greater in the CAD group than that in the non-CAD group (8.3±3.0 vs. 6.3±2.5 mm, p&lt;0.001), and there as also significant difference in the EAT-RV between the two groups (5.0±2.1 vs. 4.4±2.3 mm, p=0.009). Adding the EAT-AIG thickness over classical risk factors improved prediction of presence CAD (AUC 0.692 vs. 0.788, p&lt;0.001), while the EAT-RV did not (AUC 0.692 vs. 0.704, p=0.343). Conclusions: Echocardiographic EAT-AIG thickness was greater in the CAD group than the non-CAD group. This non-invasive index may have clinical potential as a maker for predicting coronary atherosclerosis.

New inflammatory markers for prediction of non-dipper blood pressure pattern in patients with essential hypertension: Serum YKL-40/Chitinase 3-like protein 1 levels and echocardiographic epicardial adipose tissue thickness

The aim of the present study was to investigate whether YKL-40 levels and epicardial adipose tissue (EAT) thickness were associated with non-dipping pattern in essential hypertension (HT). Age- and sex-matched 40 dipper hypertensive patients and 40 non-dipper hypertensive patients were included in the study. Non-dippers had significantly increased EAT thickness and higher YKL-40 and high-sensitivity C-reactive protein levels than dippers. Multivariate logistic regression analysis showed that the EAT thickness and serum levels of YKL-40 and high-sensitivity C-reactive protein were independent predictors of non-dipping pattern in essential HT. In essential HT, presence of non-dipping pattern is associated with increased inflammatory response.

Echocardiographic Epicardial Adipose Tissue Thickness as a Marker of Insulin Resistance

Objective. The main objective of this study is to determine if epicardial fat thickness can be an early marker of insulin resistance. The specific objectives are to determine the specific thickness of epicardial fat that will correlate with insulin resistance and to correlate epicardial fat thickness with co-morbidities, anthropometric measurements and other clinical variables. Methodology. Patients were enrolled into the study by purposive sampling. Insulin assay, fasting blood sugar (FBS) and 2D echocardiogram measuring the epicardial fat were requested. HOMA-IR was computed and correlated with epicardial fat thickness. SPSS version 19 and Epi info v3.5.1 were used for statistical analysis. Linear regression analysis was performed on all variables to identify correlates with epicardial fat thickness. Results. A total of 22 subjects were included in the study. Insulin resistance determined using HOMA-IR, as well as BMI and fasting insulin level showed significant correlation with epicardial fat thickness (p-value <0.01). Based on the analysis, 9.5 mm was found to be the most sensitive and specific measurement for epicardial fat thickness that is correlated to insulin resistance with sensitivity of 100% and specificity of 86%. Conclusions. Epicardial fat thickness through routine 2D echocardiogram is significantly directly correlated with insulin resistance and 9.5 mm is the cut–off value for predicting insulin resistance.

Increased epicardial adipose tissue thickness is linked to aortic stiffness in patients with primary hypertension

Aims. In patients with hypertension (HT), increased aortic stiffness is related to higher cardiovascular morbidity and mortality. Recent investigations have shown that epicardial adipose tissue (EAT) is a new potential cardiometabolic risk factor. The aim of our study was to examine the relation between echocardiographically measured EAT thickness and aortic stiffness in patients with primary HT. Methods. The study included 144 newly diagnosed and untreated essential hypertensive outpatients. Transthoracic echocardiographic EAT thickness and aortic stiffness measurements were performed for all study participants. Afterwards patients were divided in two groups according to their median EAT thickness values. The patients with EAT thickness of < 7 mm were included in group 1 and patients with EAT thickness of ≥ 7 mm were included in group 2. Results. Aortic strain and distensibility parameters of group 2 were lower than in group 1. The aortic stiffness index of group 2 was found to be higher than group 1. Multivariate regression analysis revealed that EAT thickness was the only independent variable for all three parameters of aortic stiffness index, aortic strain and aortic distensibility. Conclusion. In patients with newly diagnosed primary HT, increased EAT thickness was significantly linked to impaired aortic elastic properties independently of other conventional adiposity measurements.

Echocardiographic epicardial adipose tissue thickness in anterior interventricular groove is a marker for the presence and severity of coronary artery disease

Echocardiographic epicardial adipose tissue thickness in anterior interventricular groove is a marker for the presence and severity of coronary artery disease