Echocardiographic Epicardial Fat Thickness Research Articles

Does Echocardiographic Epicardial Fat Thickness Associate with The Severity of Coronary Artery Disease?

Does Echocardiographic Epicardial Fat Thickness Associate with The Severity of Coronary Artery Disease?

Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke: a prospective study.

Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. Prospective study in a tertiary-care university hospital in Antalya, Turkey. Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.

Reversal of metabolic syndrome with weight loss decreases epicardial fat more than weight loss alone in women with obesity.

In this study, we aimed to investigate the impact of weight loss with diet and exercise on echocardiographically measured epicardial fat thickness (EFT) in women with obesity and whether the change in EFT can be different between the groups whose metabolic syndrome (MetS) status has changed or remained the same with weight loss. Seventy four women with obesity who were scheduled for a one-year weight reduction (WR) program were prospectively enrolled in the study. Anthropometric, laboratory, clinical, and echocardiographic parameters were assessed at baseline and after one year for twenty eight women who completed the program and had weight reduction. At the end of one year, all the participants were divided into two groups on the basis of whether their MetS status had changed or remained the same. Body mass index was significantly reduced from 37.17±5.94 to 31.61±5.55 kg/m2 (p<0.001) after the one-year WR program. A significant reduction in EFT was noted after weight loss compared with baseline measurements (0.51±0.15 cm to 0.39±0.14 cm, p=0.001). The decrease in EFT was significantly higher in the patient group with reversal of MetS than in the group whose MetS status did not change with weight loss (0.16±0.68 cm vs. 0.09±0.07 cm, p=0.018, respectively). Reversal of MetS was found to be an independent predictor of the change in EFT. Long-term, sustained weight loss can significantly reduce echocardiographic EFT, and EFT can be used as an indicator of metabolic profile for WR interventions in women with obesity.

Epicardial fat thickness as carotid atherosclerosis predictor in normotensive patients with abdominal obesity

Background and Aims: Objective: As the etiopathogenetic basis of obesity induced atherosclerosis is predominantly visceral obesity (VO), direct criteria of VO including echocardiographic epicardial fat thickness (EFT) may become its additional predictor. The aim was to assess the role of echocardiographic EFT as an additional predictor of carotid atherosclerosis (CA) in normotensive patients with abdominal obesity (AO).

The relationship between epicardial fat thickness and high-grade varicocele.

Varicocele is abnormal dilation of testis veins. The precise mechanism of varicocele is not fully understood despite some hypothesis were suggested in the literature. Disequilibrium between constrictor and dilatator mechanism of the veins have been shown to cause varicocele. High-grade varicoceles have been also linked to endothelial dysfunction and increased vasoconstriction. We hypothesized that epicardial fat thickness (EFT), flow-mediated dilatation (FMD) and aortic stiffness (AS) could be associated with varicocele. In the present study, we aimed to compare vascular parameters such as FMD, EFT and AS in healthy subjects and high-grade varicocele patients. The study population consisted of 35 men with high-grade varicocele and 32 age- and sex-matched control subjects younger than 45 years old. This is a cross-sectional study conducted at Bolu Abant Izzet Baysal University Hospital between May to October 2018. EFT, aortic diastolic diameters (AoDD) and EFT/BMI ratio were significantly higher in control group than in patients with high-grade (p=0.012, p=0.044, p=0.026, respectively). EFT and EFT /BMI ratio were significantly and inversely correlated with presence of varicocele (r=-0.422, p=0.009; r=-0.38, p=0.026, respectively). The present study suggests that high-grade varicocele may be associated with decreased echocardiographic EFT but not with aortic stiffness and FMD.

Epicardial fat thickness as arterial hypertension predictor in normotensive patients with abdominal obesity

Abstract Objective Arterial hypertension (HTN) is one of the most common diseases associated with obesity. Visceral obesity (VO) with dysfunctional visceral adipose tissue plays the main role in obesity induced HTN. Direct criteria of VO including echocardiographic epicardial fat thickness (EFT) may become an additional predictor of HTN. Purpose The aim was to assess the role of echocardiographic EFT (EEFT) as a predictor of HTN in normotensive patients with abdominal obesity (AO). Methods 526 normotensive men (according to ambulatory blood pressure monitoring (ABPM) without therapy) with AO (waist circumference (WC) &amp;gt;94 cm) and SCORE &amp;lt;5%, without cardiovascular diseases and diabetes mellitus were examined (age 45.1±5.0 years). The lipid and glucose profiles, creatinine, uric acid and C-reactive protein blood levels, albuminuria evaluation, echocardiography, carotid ultrasound, bifunctional ABPM were performed. The values of EEFT ≥75 percentile for persons 35–45 years and 46–55 years were 4.8 mm and 5.8 mm respectively. These values used as epicardial VO criteria. Patients with subclinical carotid atherosclerosis due to the lipid-lowering therapy administration (n=98) were excluded from the follow-up. Re-examination with ABPM was conducted on average through 46.3±5.1 months. Data were summarized as mean ± standard error, statistical analysis conducted with paired two-tailed t-tests, Pearson χ2 criterion and multivariate regression analysis. Results Data of 406 persons were available for analysis. HTN as average daily blood pressure ≥130/80 mm Hg was detected in 157 (38.7%) patients. These patients were characterized by initially higher values of age (45.9±4.6 years vs 44.3±4.9 years, p&amp;lt;0.001), waist circumference (106.9±7.3 cm vs 104.2±7.3 cm, p&amp;lt;0.001), body mass index (BMI) (32.0±3.3 kg/m2 vs 30.9±3.2 kg/m2, p&amp;lt;0.001), average daily systolic and diastolic blood pressure (120.7/74.5±4.6/3.4 mm Hg vs 118.2/73.2±5.5/3.9 mm Hg, p&amp;lt;0.001), EEFT (5.2±0.7 mm vs 4.4±1.0 mm, p&amp;lt;0.001). The epicardial VO was initially detected in 95 (23.3%) patients. In patients with HTN the initial prevalence of epicardial VO was greater (58.0% vs 23.3%, p&amp;lt;0.001). As predictors for the multivariate regression analysis the clinical and laboratory examinations data and EEFT were evaluated. According to the results a mathematical model for estimating the probability HTN was obtained: 0.696*fasting blood glucose + 0.198*systolic BP + 2.844*EFT – 40.166 (constant). Among these predictors EEFT was characterized by the highest standardized regression coefficient (0.302, p&amp;lt;0.001) (0.295, p&amp;lt;0.01 for fasting blood glucose, 0.035, p&amp;lt;0.001 for systolic BP). The Hosmer-Lemeshow test value was 0.863, the total percentage of correct classifications was 86%, the area under the ROC-curve was 0.913. Conclusions EEFT (4.8 mm for persons 35–45 years and 5.8 mm for persons 46–55 years) may be an additional predictor of HTN in normotensive patients with AO. Funding Acknowledgement Type of funding source: None

Relationship between Echocardiographic Epicardial Fat Thickness and Different Body Fat Distribution

Relationship between Echocardiographic Epicardial Fat Thickness and Different Body Fat Distribution

Association of Echocardiographic Epicardial Fat Thickness and Carotid Intima Media Thickness with the Severity of Coronary Artery Disease

Background: Coronary artery disease remains the main cause of death despite several preventive programs. Epicardial adipose tissue is a visceral fat depot of the heart located along the large coronary arteries and on the surface of ventricles and apex. Intima media thickness is commonly recognized as the initial stage in the development of atherosclerosis. The development of ultrasound machines, advances in echocardiographic devices and high resolution transducers facilitate comprehensive analysis of epicardial fat thickness (EFT) and carotid –intima media thickness (C-IMT).Aim: To investigate the relationship of echocardiographic epicardial fat thickness (EFT) and carotid –intima media thickness (C-IMT) with the severity of coronary artery disease.Methods: A cross sectional multicenter diagnostic accuracy study carried out at Ibn Al-Nafis Cardiovascular Hospital, Ibn Al- Bitar Cardiology Center and Ghazi Al-Hariri Hospital –Iraqi Center for Cardiology during the period between October 2016 and May 2017 assessing. History regarding demographic data and risk factors was taken. Two dimensional transthoracic echocardiographic measurements were done. EFT was measured from parasternal long axis view perpendicular to the right ventricular free wall. C-IMT was measured according to that recommended by the American society of echocardiography (ASE).Results: The current study demonstrated that the EFT has a direct and significant correlation with the number of involved vessels (P value ˂ 0.001, r= 0.770). The validity of EFT to discriminate between multiple vessels disease and no vessel involvement is excellent (AUC= 0.984, cut point &gt; 8mm, sensitivity=92.9%, specificity= 93.3%). There is inverse and significant correlation between ejection fraction (EF) and three vessels disease (P value ˂ 0.001, r= -0.507). Also there is a direct and significant correlation between C-IMT and severity of CAD. ROC analysis for validity of C-IMT to discriminate between multiple vessels disease and no vessel involvement is excellent (AUC= 0.961, cut point &gt; 1.04mm, sensitivity=92.9%. specificity=86.7%). C-IMT is fair to discriminate between single vessel disease and no vessel involvement (AUC=0.738, cut point ˃ 0.84mm, sensitivity 100%), so if correlated with age, C-IMT above 0.84 can be used as a cut off point for the prediction of CAD. Finally, EFT and C-IMT are more likely to reflect severity of CAD than their ratio.Conclusions: C-IMT and EFT are simple and reproducible parameters that can be used as a screening tool for the presence and severity of CAD especially before symptoms appearance in high risk patients

Study of correlation between epicardial fat thickness and severity of coronary artery disease

Epicardial fat thickness (EFT) reflects visceral adiposity and is associated with coronary artery disease (CAD). This study aimed to assess the correlation of echocardiographic EFT with the severity of CAD and to determine the EFT cut-off to predict CAD. EFT was measured in 503 patients undergoing coronary angiogram. Mean EFT was significantly higher in the CAD group than control group (5.55 ± 1.21 mm vs 3.25 ± 1.15 mm, p < 0.0001). EFT correlated with Gensini score (r = 0.906, p < 0.001). EFT cut-off ≥ 4.75 mm had 87% sensitivity and 63% specificity for prediction of significant CAD (AUC: 0.831, p < 0.001).

Neutrophil-to-lymphocyte ratio independently predicts the epicardial fat thickness in diabetic patients

Purpose: The aim of this study was to investigate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and epicardial fat thickness (EFT) in diabetic and non-diabetic patients, and to determine the factors affecting EFT in diabetic patients.Materials and Methods: In this cross-sectional study, 92 diabetic patients and 40 healthy volunteers without diabetes, admitted to our outpatient clinic, were included. Demographic data, anthropometric measurements, biochemical and hematological results, echocardiography findings and EFT were recorded. NLR and PLR were calculated. These values were compared statistically between the two groups.Results: The two groups were similar in terms of age, gender, smoking status, diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein and PLR. Body mass index (BMI), frequency of hypertension, systolic blood pressure, serum glucose, HbA1C, serum creatinine, triglyceride, total cholesterol/HDL, NLR and EFT were significantly higher in the diabetic group than the control group. Ejection fraction was significantly lower in diabetic group than the controls. NLR and BMI were independent predictors of EFT in diabetic patients.Conclusion: We suggest that echocardiographic EFT measurement, NLR and BMI might be useful in the evaluation of cardiovascular risk in diabetic patients.

Elevated epicardial fat thickness and plasma free fatty acid are associated with ischemic stroke with atrial fibrillation

Recently, a relationship between the thickness of epicardial adipose tissue and the incidence and severity of atrial fibrillation (AF) has been reported. However, the potential association between epicardial fat thickness (EFT) and plasma free fatty acid (FFA) level in ischemic stroke with or without AF has not been previously investigated. The objective of this study was to assess the performance of EFT and plasma FFA level in identifying patients with ischemic stroke and AF. We retrospectively included 214 patients (mean age, 66.8 ± 12.3 years; 39.7% women) with acute ischemic stroke who were admitted within 3 days of symptom onset to a single university hospital. EFT was measured perpendicular from the free wall of the right ventricle at end-systole in three cardiac cycles. The ischemic stroke with AF group showed significantly higher plasma FFA level (1,379.7 ± 717.5 vs. 757.8 ± 520.5 uEq/L, p<0.001) and EFT (6.5 ± 1.2 vs. 5.3 ± 1.2 mm, p < 0.001) and poorer prognosis than the group without AF. In addition, plasma FFA level was significantly correlated with EFT and plasma FFA level and EFT were independently associated with stroke with AF. According to the final model, which was selected in stepwise fashion, both EFT (adjusted odds ratio [OR], 2.031; 95% confidence interval [CI], 1.454-2.938; p < 0.001) and FFA (adjusted OR, 1.002; 95% CI, 1.001-1.002; p < 0.001) were independent predictor factors associated with ischemic stroke with AF after adjusting for age. Echocardiographic EFT and plasma FFA levels could facilitate the identification of patients with ischemic stroke with AF.

Aortic Stiffness Index And Carotid Intima-Media Thickness Are Independently Associated With The Presence Of Microalbuminuria In Patients With Type 2 Diabetes Mellitus.

PurposeMicroalbuminuria is a premature and widely used indicator of diabetic nephropathy and is reported to be related with a higher cardiovascular risk in diabetic patients. We aimed to examine whether the echocardiographic parameters, such as epicardial fat thickness (EFT), carotid intima-media thickness (CIMT) and aortic stiffness index (ASI) are associated with microalbuminuria in patients with diabetes mellitus type 2 (T2DM).Patients and methodsA total of 272 consecutive patients were enrolled and after the exclusion criteria, the data of 180 patients with T2DM were used in this cross-sectional study. Patients were divided into two groups: 82 patients with microalbuminuria and 98 patients without microalbuminuria (normoalbuminuria). The laboratory results and echocardiographic EFT, CIMT and ASI parameters were noted.ResultsCompared with the normoalbuminuria group, EFT, CIMT and ASI were significantly higher in the microalbuminuria group (p<0.05 for all). In logistic regression analysis; CIMT (OR: 3.15, p=0.024) and ASI (OR: 4.19, p=0.016) were independently associated with microalbuminuria in patients with T2DM.ConclusionIn addition to CIMT, as a novel finding, ASI which is an indicator for the elastic properties of the aortic root was independently associated with microalbuminuria. CIMT and ASI measurement by echocardiography may be helpful in identifying the accompanying factors in the development of nephropathy.

Epicardial fat: the role of testosterone and lipid metabolism in a cohort of patients with Klinefelter syndrome

ContextKlinefelter syndrome (KS), in which subjects have additional copies of X chromosomes, is the most common male sex chromosome abnormality, with a prevalence of 1 in 660 and an incidence of about 1 in 500–700 newborns. Its sign and symptoms include infertility, generally low testosterone levels, and an increased prevalence of obesity and metabolic syndrome. Epicardial fat thickness (EFT) reflects visceral adiposity rather than general obesity. ObjectiveThe aim of this study was to analyze echocardiographic EFT in a cohort of patients with KS in comparison with non-obese and obese euploid controls, and to evaluate its correlation with biochemical parameters. Design, setting and participantsTwo hundred and twenty-one KS patients referred to our Rare Endocrine Diseases clinic and 77 age-matched controls underwent Doppler echocardiography and a full investigation of anthropometric and body composition, Serum levels of total testosterone (T), estradiol (E2), sex hormone binding globulin (SHBG), fasting plasma glucose, insulin, cholesterol and triglycerides were obtained. All participants underwent dual energy X-ray absorptiometry (DEXA) scan to assess truncal body fat (TrBF). Main outcome measureEFT, body composition and metabolic parameters in KS patients and how they are affected by genotype. ResultsEFT was greater in KS patients than in healthy non-obese (NOb) controls, but lower than in obese (OB) controls. When KS patients were divided into groups (hypogonadal; eugonadal; receiving testosterone replacement therapy [TRT]), EFT was greater in hypogonadal patients than in NOb controls and eugonadal patients, but showed no difference from the OB controls or TRT patients. Hypogonadal patients showed increased TrBF in comparison with NOb controls and eugonadal and TRT patients, and similar TrBF to OB controls. As expected, there was a strong correlation between BMI and EFT in both KS patients and controls (P < 0.0001). In contrast, there was a strong inverse correlation between testosterone and EFT in the control group, but not in KS patients. EFT was significantly correlated with TrBF in both populations (P < 0.0001). Multivariate analyses showed that the major determinants of both EFT and TrBF were BMI and the presence of KS itself. Testosterone and triglycerides were not included as variables in the models. ConclusionEFT in hypogonadal KS subjects was similar to that of the obese eugonadal controls. Even though there was a direct correlation between BMI and EFT in both populations, the influence of TrBF on EFT was stronger. The presence of the supernumerary X chromosome appeared to be one of the strongest determinants of EFT and TrBF, independent of testosterone levels.

The relation between echocardiographic epicardial fat thickness and mitral annular calcification.

Mitral annular calcification (MAC) is associated with several cardiovascular disorders including coronary artery disease (CAD), atrial fibrillation, heart failure, ischemic stroke and increased mortality. Epicardial fat thickness (EFT) has strong correlation with obesity, CAD, insulin resistance, metabolic syndrome, hypertension, diabetes mellitus, and atherosclerosis. There are strong similarities between EFT and MAC from the aspect of risk factors and pathogenesis. In this study we aimed to investigate the EFT in patients with MAC. The study group consisted of 78 patients with MAC. An age, gender and body mass index matched control group consisted of 47 subjects who admitted to echocardiography laboratory due to suspicion of organic heart disease and eventually found to be free of MAC. We measured EFT in patients with MAC and control subjects. EFT was significantly higher in patients with MAC than in control subjects (5.7±0.9 vs. 4.4±0.6 mm respectively; P< 0.001). Correlation analysis indicated that EFT was positively correlated with presence of MAC (p<0.001, r=0.597). We showed that EFT was significantly elevated in patients with MAC and it was positively correlated with MAC.

Is echocardiographic epicardial fat thickness increased in patients with coronary artery disease? A systematic review and meta-analysis.

BackgroundThe relation of epicardial fat thickness (EFT) to coronary artery disease (CAD) has recently been reported in multiple studies. Echocardiography is a safe and relatively inexpensive and accessible approach to assess regional EFT, which can be performed easily in many centers.ObjectiveTo determine the association between echocardiographic EFT and the presence or the absence of CAD.MethodsThis was a systematic review and meta-analysis conducted on literature available in electronic databases up to March 2018. The articles measuring EFT by echocardiography in the right ventricular (RV) free wall were included in the study. The quality of the enrolled items was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. The analyses were performed using the Comprehensive Meta-Analysis version 2 software. Cochran’s Q test and I2 index were used to evaluate heterogeneity.ResultsThis meta-analysis was performed on 13 studies involving 2,436 patients (1,622 with CAD, and 814 without CAD). The maximum EFT reported by echocardiography was 12.9±2.7 mm in the CAD group and 8.4±2.5 mm in the non-CAD group. The minimum EFT reported by echocardiography was 2.2±1.8 mm in the CAD group and 1.8±1.4 mm in the non-CAD group. The heterogeneity was found among the researched studies (I2=91.8%, p=0.000, Q-value=146.43, df [Q] =12) using the random effect model. The patients with CAD had a significantly higher echocardiographic EFT than those without CAD (SMD=1.03, 95% CI= 0.70–1.37, p=0.000).ConclusionAccording to the findings of this meta-analysis, the echocardiographic EFT in the subjects with CAD was significantly higher than that of those without CAD. The measurement of echocardiographic EFT seems to be an acceptable strategy for risk stratification of heart diseases considering ease of use, cost-effectiveness and non-exposure characteristics, compared to other imaging interventions.

Inverse Association of Circulating SIRT1 and Adiposity: A Study on Underweight, Normal Weight, and Obese Patients.

Context: Sirtuins (SIRTs) are NAD+-dependent deacetylases, cellular sensors to detect energy availability, and modulate metabolic processes. SIRT1, the most studied family member, influences a number of tissues including adipose tissue. Expression and activity of SIRT1 reduce with weight gain and increase in conditions of starvation.Objective: To focus on SIRT1 plasma concentrations in different conditions of adiposity and to correlate SIRT1 with fat content and distribution, energy homeostasis and inflammation in under-weight, normal-weight, and obese individuals.Materials and Methods: 21 patients with anorexia nervosa, 26 normal-weight and 75 patients with obesity were evaluated. Body fat composition by dual-energy X-ray absorptiometry, ultrasound liver adiposity, echocardiographic epicardial fat thickness (EFT), inflammatory (ESR, CRP, and fibrinogen), and metabolic (FPG, insulin, LDL- and HDL-cholesterol, triglycerides) parameters, calculated basal metabolic rate (BMR) and plasma SIRT1 (ELISA) were measured.Results: SIRT1 was significantly higher in anorexic patients compared to normal-weight and obese patients (3.27 ± 2.98, 2.27 ± 1.13, and 1.36 ± 1.31 ng/ml, respectively). Linear regression models for each predictor variable adjusted for age and sex showed that SIRT1 concentration was inversely and significantly correlated with EFT, fat mass %, liver fat content, BMR, weight, BMI, WC, LDL-cholesterol, insulin, ESR. Stepwise multiple regression analysis revealed that age and EFT were the best independent correlates of SIRT1 (β = −0.026 ± 0.011, p = 0.025, and β = −0.516 ± 0.083, p < 0.001, respectively).Conclusions: Plasma SIRT1 shows a continuous pattern that inversely follows the whole spectrum of adiposity. SIRT1 significantly associates with EFT, a strong index of visceral fat phenotype, better than other indexes of adiposity studied here.

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

Evaluation of Epicardial Fat Thickness in Young Patients With Embolic Stroke of Undetermined Source.

Epicardial adipose tissue is metabolically active and is an important predictor of metabolic and cardiovascular diseases. This study investigated the echocardiographic epicardial adipose tissue measurement in young patients with embolic stroke of undetermined source (ESUS). We studied 77 volunteers, including 40 patients with ESUS (mean age 43±8 y, 16 female patients) and 37 healthy subjects (mean age 38±7 y, 20 female subjects). All necessary biochemical parameters were analyzed, and epicardial fat thickness (EFT) was measured by echocardiography in all subjects. Additional related diagnostic work-up was conducted in each patient, according to the patients' clinical presentation. The patients with ESUS had a significantly higher EFT than the control group (5.51±0.82 vs. 3.96±0.51; P<0.01). Furthermore, there was a positive correlation between EFT and serum C-reactive protein levels (r=0.284; P<0.05). As an optimal cut-off point, a high-risk EFT value of 4.6 mm was determined to predict ESUS, with an 87.5% sensitivity and an 81.1% specificity. We found that echocardiographic EFT was significantly higher in young patients with ESUS than in healthy individuals. Increased EFT might be a novel risk factor in these patients.

Epicardial Fat Thickness and Bone Mineral Content: The Healthy Twin Study in Korea.

BackgroundThe conventional concept of positive association between general obesity and bone health was challenged in recent studies reporting the different effects of specific fat deposition on bone health. In the present study, we investigated the association between epicardial fat and bone health.MethodsWe measured echocardiographic epicardial fat thickness (EFT) and bone mineral content (BMC) in a twin-family cohort of Koreans (n = 1,198; 525 men, 460 pre- and 213 post-menopausal women). A total 121 pairs of monozygotic twin (MZ) and 404 pairs of dizygotic twin and sibling pairs (DZ/Sib) were included.ResultsEFT was positively associated with BMC in total, as well as in three subgroups (β = 0.107, 0.076, and 0.058 for men, pre-, and post-menopausal women, respectively). The positive association between EFT and BMC remained for DZ/Sib difference analysis, but was absent for MZ comparisons. The positive association between BMI and BMC was consistent for DZ/Sib and MZ difference analysis. After adjusting for the effect of general obesity via BMI, the association between BMC and EFT was statistically non-significant (β = 0.020, 0.000, and −0.009 for men, pre-, and post-menopausal women, respectively).ConclusionOur findings do not support epicardial fat’s beneficial effects on bone health, whereas general adiposity has an osteotropic effect. The association between EFT and BMC is through common genetic component factors.

Epicardial Fat Thickness and Free Fatty Acid Level are Predictors of Acute Ischemic Stroke with Atrial Fibrillation.

BACKGROUNDIncreased epicardial fat is known to be associated with the presence and chronicity of atrial fibrillation (AF). Free fatty acids (FFAs) are major components of epicardial fat; however, their potential association with AF in ischemic stroke has not been investigated. We aimed to assess the performance of echocardiographic epicardial fat thickness (EFT) and plasma FFA level in identifying patients with ischemic stroke and AF.METHODSWe enrolled a total of 214 consecutive patients (mean age, 66.8 ± 12.3 years; 39.7% women) diagnosed with acute ischemic stroke between March 2011 and June 2014. The patients were divided into two groups: ischemic stroke with AF (n = 35, 16.4%) and ischemic stroke without AF (n = 179, 83.6%).RESULTSThe ischemic stroke with AF group showed significantly higher serum FFA level (1379.7 ± 717.5 vs. 757.8 ± 520.5 uEq/L, p < 0.0001) and EFT (6.5 ± 1.2 vs. 5.3 ± 1.2 mm, p < 0.001) than the group without AF. Multivariable logistic regression analysis demonstrated that age (odds ratio [OR], 1.112), serum FFA level (OR, 1.002), and EFT (OR, 1.740) were independently associated with the ischemic stroke group with AF. EFT and FFA significantly improved the goodness-of-fit and discriminability of the simple regression model including age as a covariate (log likelihood difference, 21.35; p < 0.001; c-index difference, 17.9%; p < 0.001).CONCLUSIONSHigh EFT and serum FFA level were associated with ischemic stroke in patients with AF. Echocardiographic EFT and serum FFA level can play a significant role in identifying ischemic stroke with AF.