Epicardial Fat Thickness Values Research Articles

Relationship of epicardial fat thickness and nonalcoholic fatty liver disease to coronary artery calcification: From the CAESAR study

Epicardial fat and nonalcoholic fatty liver disease (NAFLD) are associated with subclinical atherosclerosis; however, the combined effect of both EAT and NAFLD on coronary artery calcium (CAC) is unclear. The present study was performed to evaluate the association of both epicardial fat thickness (EFT) and NAFLD with CAC. Among 2277 individuals enrolled in the CArdiometabolic risk, Epicardial fat, and Subclinical Atherosclerosis Registry (CAESAR) Study, 1473 individuals (1242 men, mean age, 44±9years) were included for analysis. Echocardiographic EFT and ultrasonographic fatty liver were measured. Individuals were divided into 4 groups according to EFT and NAFLD (group I: low EFT and without NAFLD; group II: low EFT and with NAFLD; group III: high EFT and without NAFLD; and group IV: high EFT and with NAFLD). The median EFT value (interquartiles) was 3.17mm (2.58mm, 3.85mm), and the prevalence of NAFLD and CACS >0 was 46.0% and 16.8%, respectively. The prevalence of CACS >0 was 7.9%, 16.8%, 18.0%, and 26.0% in group I, II, III, and IV, respectively (P<.001). On multivariate regression after adjusting for variables with a univariate relationship (P<.20), group IV had a significantly higher OR for CACS >0, and the OR in group III was marginally significant, compared to group I (1.458 [0.795, 2.672], 1.744 [0.999, 3.046], and 1.864 [1.041, 3.337] for groups II, III, and IV, respectively). This study shows that both increased EFT and presence of NAFLD are associated with coronary artery calcification, and that increased EFT is more strongly related to CAC than NAFLD, in spite of NAFLD having greater cardiometabolic risk than EFT.

A RESISTANCE TO LEPTIN IN DEVELOPMENT OF DIFFERENT OBESITY PHENOTYPES

The underlying process of visceral obesity (VO) is frequently the resistance to regulating action of leptin on the patients food related behavior. There is ongoing research on the role of soluble leptin receptors (SLR) in the leptin signal transmittance and leptin resistance development (LR). Aim. To study the relation of leptin metabolism parameters with insulin resistance (IR) in men with various obesity phenotypes. Material and methods. Totally, 110 males included of the age 44-67 y.o., with arterial hypertension, absence of atherosclerosis of any area signs, and diabetes. The participants were selected to two groups according to metabolic obesity phenotype by the value of epicardial fat thickness (EFT) and body mass index. In groups we assessed the levels of insulin, HOMA-IR, serum leptine (SL), SLR and free leptin index (FLI) calculated as SL/SLR, lipid profile including apoproteines A1 and B (ApoA1, ApoB). EFT was measured via echocardiography. Results. It has been shown, that leptin metabolism disorders and LR might lead to metabolically stout phenotype (MSP) and its main complication — IR. The regression equation is formulated that links FLI with HOMA-IR. Conclusion. Leptin metabolism disorder is related to the development of VO and IR. FLI can be used as laboratory marker of LR, as an early marker of IR risk and, possibly, further cardiometabolic complications.

Previous gestational diabetes history is associated with impaired coronary flow reserve

Background Gestational diabetes mellitus (GDM) is a prediabetic state that is known to increase the risk of cardiovascular diseases. We have investigated coronary flow velocity reserve (CFVR) and epicardial fat thickness (EFT), and left ventricular diastolic function in patients with a history of previous GDM (p-GDM).Methods Ninety-three women with GDM history and 95 healthy women without GDM history were recruited. We used transthoracic Doppler echocardiography to assess CFVR, EFT, and left ventricular diastolic function. Insulin resistance of each subject was assessed with homeostasis model assessment insulin resistance (HOMA-IR). Hemoglobin A1c and high-sensitivity C-reactive protein (hsCRP) were also measured in all patients.Results CFVR values were significantly lower (2.34 ± 0.39 versus 2.80 ± 0.24, p < 0.001) and EFT values were significantly higher in patients with p-GDM than the control group (5.5 ± 1.3 versus 4.3 ± 1.1, p < 0.001). E/E' ratio (7.21 ± 1.77 versus 6.53 ± 1.38, p = 0.003), hemoglobin A1c (5.2 ± 0.4 and 5.0 ± 0.3, p = 0.001), HOMA-IR (2.8 ± 1.4 versus 1.7 ± 0.9, p = 0.04), and hsCRP levels were significantly higher in the p-GDM group than the control group. Multivariate analysis revealed that gestational diabetes history is independently associated with CFVR.Conclusion Women with a GDM history may be at more risk regarding coronary microvascular dysfunction compared to the healthy ones.Key MessagesWhat is already known about this subject?Impairment of CFVR reflects coronary microvascular dysfunction and has been shown to be an early manifestation of atherosclerosis and coronary artery disease.Several studies have shown an association between p-GDM and atherosclerosis by measuring intima-media thickness.What are new findings?This preliminary study on coronary microvascular function of patients with p-GDM revealed that CFVR is significantly impaired in p-GDM patients.Although the number of patients included in this study is limited, these results suggest that impaired CFVR may be an early manifestation of coronary vascular involvement in patients with p-GDM.How might it impact on clinical practice in the foreseeable future?In patients with p-GDM, the presence of impaired CFVR should render the clinician aware of the development of coronary artery disease.

Is serum Klotho protective against atherosclerosis in patients with type 1 diabetes mellitus?

ObjectiveKlotho deficiency is associated with several metabolic disorders. Two dimensional (2D) longitudinal strain (LS) of left ventricle (LV), carotid artery intima–media thickness (CIMT), flow-mediated dilation (FMD) of brachial artery and epicardial fat thickness (EFT) have been reported to be early predictors of atherosclerosis. We aimed to investigate the relationship between serum Klotho levels and these early predictors of atherosclerosis in patients with type 1 diabetes mellitus (DM). MethodsThe study included 45 type 1 diabetic patients and 35 controls. Serum Klotho levels were determined by ELISA method. The patient group was also divided into two subgroups according to serum Klotho levels: high (HK) and low Klotho (LK) groups. EFT, CIMT and FMD were measured according to appropriate recommendations. Speckle tracking analysis was performed using the Echopac software. ResultsThe patient group had significantly lower serum Klotho (p=0.001), FMD (p<0.001) and LS of LV (p<0.001) values, but larger EFT (p<0.001) and CIMT (p<0.001) values than controls. LK subgroup had also significantly lower FMD (p<0.001) and LS of LV (p<0.001) but larger EFT (p=0.002) and CIMT (p<0.001) values than HK subgroup. ConclusionSerum Klotho may have a protective effect against atherosclerosis and endothelial dysfunction in type 1 DM.

A comparative study of epicardial fat thickness and its association with abdominal visceral fat thickness in obese and nonobese type 2 diabetes subjects

Context:The concept of visceral fat and its role in various metabolic disorders is well-known. Epicardial fat (EF) is also visceral fat, and very few studies are done, especially in the Indian subcontinent.Aims:To study and establish the relationship of EF thickness (EFT) and abdominal visceral fat thickness (VAT) in obese and nonobese type 2 diabetics and to evaluate the usefulness of EFT as a marker of visceral adiposity.Settings and Designs:This cross-sectional study was carried out in the Department of Medicine, JSS Hospital, Mysore, India, between October 2012 and October 2014.Materials and Methods:A total of 68 patients were studied. Patients underwent transthoracic echocardiography and ultrasound abdomen. EFT and VAT were measured.Statistical Analysis:SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) was used. T-test used for comparing quantitative variables. Correlation analysis was done using Pearson correlation test. P ≤ 0.05 was considered statistically significant. Kruskal-Wallis and Mann-Whitney test were used for analysis.Results:The mean value of EFT was 5.92 mm, 7.43 mm, 12.97 mm, 11.27 mm, and 13.8 mm for nonobese, obesity Grade I, II, III, and morbid, respectively (P < 0.0001). The mean EFT between nonobese and obese diabetics was 5.92 mm and 10.2 mm, respectively (P < 0.0001). The mean VAT between nonobese and obese diabetics was 16.58 mm and 38.53 mm, respectively. EFT was significantly correlating with VAT in obese diabetics.Conclusion:EFT and VAT were significantly correlated among obese diabetics while not significantly correlated among nonobese diabetics, suggesting obesity is an independent risk factor for visceral adipose tissue deposition both in abdomen as well as in epicardial surface.

Low Serum Level of Klotho Is an Early Predictor of Atherosclerosis.

The Klotho gene, identified as an 'aging suppressor' gene, encodes a single-pass transmembrane protein. The extracellular domain of Klotho is cleaved and released in the blood stream, where it may function as a vasculoprotective hormone. Carotid artery intima-media thickness (CIMT), flow-mediated dilation (FMD) of the brachial artery and epicardial fat thickness (EFT) have been reported as early predictors of atherosclerosis. We aimed to investigate the relationship between serum Klotho levels and early atherosclerotic predictors, including EFT, FMD and CIMT in healthy adults. Fifty healthy volunteers were enrolled in this study, consisting of 21 males and 29 females with median age of 32 years. They were free of known risk factors for cardiovascular diseases. Serum Klotho levels were determined by the ELISA method. The study population was divided into two groups (n = 25 for each) according to the median serum Klotho level (459.4 pg/mL): higher Klotho (HK) group (613.6 pg/mL; ranges of 501.2-772.6 pg/mL) and lower Klotho (LK) group (338.7 pg/mL; ranges of 278.8-430.3 pg/mL). EFT was measured by transthoracic echocardiography, and CIMT and FMD were measured with standard procedures. The LK group showed lower values of FMD (p = 0.012) and larger values of EFT (p = 0.01) and CIMT (p < 0.001), compared to the HK group. Thus, the low serum Klotho levels were associated with increased EFT and CIMT and with the decreased FMD in the study population. We propose that the lower serum Klotho level is a newly identified predictor of atherosclerosis.

Epicardial fat thickness in stable coronary artery disease: its relationship with high-sensitive cardiac troponin T and N-terminal pro-brain natriuretic peptide.

Epicardial adipose tissue is related to coronary atherosclerosis, left ventricle hypertrophy, myocardial dysfunction, cardiomyopathy, and inflammation, which produces a variety of cytokines that influence key pathogenic mechanisms of atherogenesis. The main goal of this study is to examine the relationship between epicardial fat thickness (EFT) and cardiovascular risk markers as well as the complexity of coronary artery disease (CAD) in patients with stable CAD. We prospectively included 439 stable CAD patients undergoing coronary angiography in the present study (mean age: 62.2±10.7 years). Patients were divided into two groups (EFTlow and EFThigh groups) according to their median EFT values. EFT was evaluated by two-dimensional echocardiography before angiography. The SYNTAX score was calculated in all patients. N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP), high-sensitive cardiac troponin T (hs-cTnT), uric acid, and other biochemical markers were also measured. Age, SYNTAX score, frequencies of diabetes, hyperlipidemia, and hypertension, NT-proBNP, hs-CRP, hs-cTnT, and uric acid levels were higher in EFThigh group compared with the EFTlow group (P<0.05 for all). EFT was associated independently with age (β=-0.102, P=0.001), diabetes (β=-0.083, P=0.011), SYNTAX score (β=0.352, P<0.001), hs-CRP level (β=0.217, P<0.001), hs-cTnT level (β=0.197, P<0.001), and NT-proBNP level (β=0.300, P<0.001) in multivariate analysis. EFT obtained by echocardiograpy may not only be an easy tool but also an important tool for early detection of increased cardiac risk as well as the extent and complexity of CAD in patients with stable CAD.

Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness

Objective: Non-alcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and reduced vascular compliance. The purpose of this study was to examine the relationships between arterial stiffness measures, the histological severity of NAFLD, and epicardial fat thickness (EFT). Methods: A total of 100 patients with biopsy-proven NAFLD and 50 age- and sex-matched controls were enrolled. The histological severity was assessed in all NAFLD patients. Measurements of arterial stiffness [pulse-wave velocity (PWV) and augmentation index (AIx)] were carried out using a Mobil-O-Graph arteriograph system. EFT was assessed by means of echocardiography. Results: Compared with controls, NAFLD patients had significantly higher PWV and AIx values. Stepwise linear regression analysis demonstrated that the liver fibrosis score and EFT were independent predictors of both PWV and AIx values in NAFLD patients. Conclusions: Patients with NAFLD have an increased arterial stiffness, which reflects both the severity of liver fibrosis and increased EFT values.

New inflammatory markers in pre-eclampsia: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio

Background: Increased epicardial fat thickness (EFT) has been proposed as a new cardiometabolic risk factor. The neutrophil/lymphocyte ratio (NLR) has predictive and prognostic value in several cardiovascular diseases. The aim of this study was to explore the association between EFT and NLR in patients with pre-eclampsia.Methods: Hundred and eight pregnant patients with a mean age of 30.6 ± 6.3 years were included in the study. Patients were divided into two groups based on the presence of pre-eclampsia. All participants underwent transthoracic echocardiography imaging, and complete blood counts were measured by an automated hematology analyzer. Statistical analysis was performed using the Chi-square, Mann–Whitney U, correlation and logistic regression tests, and receiver operating characteristic (ROC) analysis.Result: The mean EFT value of the pre-eclampsia group was significantly higher than the control group (6.9 ± 0.6 versus 5.6 ± 0.6; p < 0.001), and the NLR value of the pre-eclampsia group was also significantly higher than the control group (7.3 ± 3.5 versus 3.1 ± 1.1; p < 0.001). Multivariate analysis showed that increased levels of NLR and echocardiographic EFT are independent predictors of pre-eclampsia. In the receiver operating characteristic analysis, a level of EFT ≥ 6.2 mm and NLR ≥ 4.1 predicted the presence of pre-eclampsia with 77.8% sensitivity, 79.6% specificity and 83.3% sensitivity, 81.5% specificity, respectively.Conclusion: Unlike many other inflammatory markers and bioassays, NLR and echocardiographic EFT are inexpensive and readily available biomarkers that may be useful for risk stratification in patients with pre-eclampsia.

Relation of Epicardial Fat Thickness and Brachial Flow-Mediated Vasodilation with Coronary Artery Disease

Abstract Objective The purpose of this study is to investigate the presence of a statistical association between epicardial fat thickness (EFT) and coronary artery disease (CAD) and between flow-mediated vasodilation (FMD) and CAD. Methods We measured the EFT and FMD in 64 subjects with suspected stable angina pectoris. The patients were separated into two groups according to their coronary angiography results: 34 patients with CAD and 30 patients with normal coronary arteries (NCA). Results EFT was significantly higher in the patients with CAD than the NCA group (6.43 ± 0.90 mm vs. 5.35 ± 0.75 mm, p p = 0.015). No significant correlation was found between EFT and FMD. After adjustment for EFT, FMD, age, sex, ejection fraction, glucose, and low-density lipoprotein cholesterol through multivariate logistic regression analysis, EFT (odds ratio: 6.325, 95% confidence interval 2.289–17.476, p p = 0.032) remained significant predictors of CAD. A cut-off value of EFT ≥ 5.8 mm predicted the presence of CAD with 77% sensitivity and 70% specificity. Conclusion An echocardiographic EFT assessment is independently associated with the presence of CAD. Thus, EFT may be helpful in cardiometabolic risk stratification and therapeutic interventions.

Relation of epicardial fat thickness and brachial flow-mediated vasodilation with coronary artery disease

ObjectiveThe purpose of this study is to investigate the presence of a statistical association between epicardial fat thickness (EFT) and coronary artery disease (CAD) and between flow-mediated vasodilation (FMD) and CAD. MethodsWe measured the EFT and FMD in 64 subjects with suspected stable angina pectoris. The patients were separated into two groups according to their coronary angiography results: 34 patients with CAD and 30 patients with normal coronary arteries (NCA). ResultsEFT was significantly higher in the patients with CAD than the NCA group (6.43±0.90mm vs. 5.35±0.75mm, p<0.001) while FMD was significantly lower in the patients with CAD than those in the NCA group (6.41±2.51% vs. 8.33±3.45%, p=0.015). No significant correlation was found between EFT and FMD. After adjustment for EFT, FMD, age, sex, ejection fraction, glucose, and low-density lipoprotein cholesterol through multivariate logistic regression analysis, EFT (odds ratio: 6.325, 95% confidence interval 2.289–17.476, p<0.001) and age (odds ratio: 1.093, 95% confidence interval 1.008–1.185, p=0.032) remained significant predictors of CAD. A cut-off value of EFT≥5.8mm predicted the presence of CAD with 77% sensitivity and 70% specificity. ConclusionAn echocardiographic EFT assessment is independently associated with the presence of CAD. Thus, EFT may be helpful in cardiometabolic risk stratification and therapeutic interventions.

Relationship between Epicardial Fat Measured by Echocardiography and Coronary Atherosclerosis: A Single‐Blind Historical Cohort Study

There are conflicting theories regarding the accuracy of echocardiography for determining the value of epicardial fat thickness in cardiovascular risk assessment. The aim of this study was to determine the relationship. A historical cohort study was conducted on 143 patients, 40 to 87 years old, admitted for coronary angiography. The patients underwent transthoracic echocardiography and measurement of epicardial fat thickness in parasternal long-axis view at end-systole for 3 cardiac cycles. Both procedures were performed within a week before performing coronary angiography. Epicardial fat thickness was significantly correlated with the existence and severity of coronary artery disease (P-value <0.001). There was also a trend toward lower high-density lipoprotein in males with thicker epicardial fat. Epicardial fat thickness equal to or more than 7 mm may identify an individual with higher probability of having coronary atherosclerosis.

Association Between Epicardial Fat Thickness and Weight Homeostasis Hormones in Patients With Noncachectic Heart Failure

The relationship between echocardiographically measured epicardial fat thickness (EFT) and plasma concentrations of leptin, ghrelin, and adiponectin has not been evaluated in patients with noncachectic heart failure (HF). Patients with noncachectic HF and age- and sex-matched controls did not differ significantly in EFT, whereas EFT values showed significant positive correlation with body mass index (BMI) in both groups and were negatively related with brain natriuretic peptide and positively with log leptin values in the HF group. In the control group, a positive correlation with high-sensitivity C-reactive protein (hsCRP) and a negative correlation with log ghrelin were found. In multivariable analysis, log leptin was a significant predictor of EFT in patients with HF, but this effect was not retained after adjusting for BMI. In contrast, log ghrelin and hsCRP were significant predictors of EFT in controls even after adjusting for BMI.

Echocardiographic epicardial fat thickness is related to altered blood pressure responses to exercise stress testing

Objective. Hypertensive response at peak exercise and blunted blood pressure (BP) recovery, altered BP responses obtained from exercise stress testing, have been suggested as risk factors for future onset of hypertension in previous studies. Epicardial fat, a new cardiometabolic risk factor, has been linked to hypertension in some recent studies. In this study, we tested the primary hypothesis suggesting that the epicardial fat thickness (EFT) is related to altered BP responses to treadmill exercise testing. We also evaluated the sensitivity and specificity of the EFT as a predictor of hypertensive response to peak exercise. Methods. Normotensive subjects underwent to treadmill stress testing and transthoracic echocardiography. Hypertensive response to peak treadmill exercise testing was defined as ≥ 210/105 mmHg and ≥190/105 mmHg at peak exercise in males and females, respectively. BP recovery index (BPRI) was defined as the ratio of the BP at the 3rd minute of the recovery phase to BP at peak exercise. EFT was measured by echocardiography. Thirty-two subjects with hypertensive response to peak exercise constituted Group 1 and 48 subjects with normal response constituted Group 2. Results. The mean EFT of subjects in Group 1 was significantly higher (8.2 ± 1.1 mm vs 5.1 ± 1.5 mm; p = 0.0001) than subjects in Group 2. In correlation analysis performed in Group 1, EFT was found to be significantly correlated with BPRI (r = 0.51, p < 0.003). An EFT of ≥6.5 mm predicted the hypertensive response to peak exercise test with 68.8% sensitivity and 87.5% specificity (receiving operator characteristic area under curve: 0.879, 95% CI 0.793–0.965, p < 0.001). Patients with EFT ≥6.5 mm showed a significantly increased BPRI (0.89 ± 0.07 vs 0.74 ± 0.09, p < 0.0001) and peak systolic BP (198.4 ± 15.3 mmHg vs 169.4 ± 19.8 mmHg, p < 0.0001). There were significant differences in metabolic equivalents, maximum heart rate, homeostatic model assessment of insulin resistance, high-density lipoprotein-cholesterol, waist circumference and age values between two patients groups dichotomized according to the cut-off value of EFT. BPRI was the only independent variable related to EFT in the multivariate analysis (odds ratio = 1.4, 95% CI 2.75–7.16, p = 0.001). Conclusions. EFT was found to be related to altered BP responses to exercise stress testing. The echocardiographic measurement of EFT may serve as a useful non-invasive indicator of heightened risk of future hypertension.

Mathematical Modeling of Epicardial RF Ablation of Atrial Tissue with Overlying Epicardial Fat

The efficacy of treating atrial fibrillation by RF ablation on the epicardial surface is currently under question due to the presence of epicardial adipose tissue interposed between the ablation electrode and target site (atrial wall). The problem is probably caused by the electrical conductivity of the fat (0.02 S/m) being lower than that of the atrial tissue (0.4-0.6 S/m). Since our objective is to improve epicardial RF ablation techniques, we planned a study based on a two-dimensional mathematical model including an active electrode, a fragment of epicardial fat over a fragment of atrial tissue, and a section of atrium with circulating blood. Different procedures for applying RF power were studied, such as varying the frequency, using a cooled instead of a dry electrode, and different modes of controlling RF power (constant current, temperature and voltage) for different values of epicardial fat thickness. In general, the results showed that the epicardial fat layer seriously impedes the passage of RF current, thus reducing the effectiveness of atrial wall RF ablation.

Threshold Values of High‐risk Echocardiographic Epicardial Fat Thickness

Echocardiographic epicardial adipose tissue is a new index of cardiac and visceral adiposity with great potential as a diagnostic tool and therapeutic target. In this study, we sought to provide threshold values of echocardiographic epicardial fat thickness associated with metabolic and anthropometric risk factors. Epicardial fat thickness was measured in 246 consecutive white subjects (120 women, 126 men, median age 46 years (30-65), median BMI 32 kg/m(2) (22-52), median waist circumference 100.5 cm (85-140)), who underwent routine transthoracic echocardiogram for standard clinical indications. Metabolic syndrome (MetS), Insulin resistance, BMI, and waist circumference categories were identified and epicardial fat was calculated. Among 246 subjects, 58% had MetS. These subjects showed median values of epicardial fat thickness of 9.5 and 7.5 mm (in men and women, respectively), significantly higher than those found in subjects without MetS (no MetS) (P < 0.001). Receiver operating characteristics (ROC) analysis showed that epicardial fat thickness of 9.5 and 7.5 mm maximize the sensitivity and specificity to predict MetS, in men and women, respectively. In separate analyses, median epicardial fat thickness values of 9.5 and 7.5 mm were cutoff points associated with high abdominal fat in men and women, respectively. When insulin sensitivity was considered separately, epicardial fat thickness of 9.5 mm was associated with insulin resistance. Median values of 9.5 and 7.5 mm should be considered the threshold values for high-risk echocardiographic epicardial fat thickness in white men and women, respectively. Echocardiographic epicardial fat measurement may be of help for cardiometabolic risk stratification and therapeutic interventions targeting the fat.