Epicardial Fat Thickness Research Articles

Comparative assessment of echocardiographic parameters in persons without diagnosed chronic non-communicable diseases depending on body mass index

Aim: To compare the indicators of structural remodeling and intracardiac hemodynamics in people without previously diagnosed chronic non-communicable diseases, depending on body mass index (BMI).Material and Methods. We analyzed the data of 123 people aged 21 to 59 years who did not have chronic non-infectious diseases and did not take any drug therapy that affects the indicators of central and peripheral hemodynamics, as well as lipid, carbohydrate and fat metabolism. All the examined persons were divided depending on the BMI into 2 groups, comparable in sex, but with age differences. The first group consisted of 60 people (75% women) with a BMI < 30 kg/m2, whose median age was 40 years (Q1–Q3: 35–48 years). The second group included 63 subjects (76.1% women) with BMI ≥ 30 kg/m2 at the age of 48.5 years (Q1–Q3: 38–54 years). Structural and functional parameters of the heart were assessed during transthoracic echocardiography, which was performed on the Philips EPIQ CVx 2D ultrasound machine by one specialist.Results. In the group of persons with increased BMI, the average values of the left ventricular relative wall thickness (RWT LV) were higher – 0.37 [0.34; 0.40] versus 0.41 [0.37; 0.47], p = 0.01; left ventricular mass index (LVMI) – 64.0 [53.0; 76.5] g/m2 and 27.0 [23.1; 30.9] g/m2,7 vs. 82.0 [70.0; 92.0] g/m2 and 38.1 [34.5; 46.5] g/m2,7, p = 0.01; epicardial fat (EF) – 5 [4; 6] mm vs. 8 [5; 10] mm, p = 0.01, left ventricular global longitudinal strain (LV GLS) –21.8 [–23.6…–19.7]% vs. –19.2 [–21.2…–18.2] %, p = 0.01. Statistically direct correlations of BMI with LVMI g/m2,7 (ρ = 0.746; p = 0.01), EF (ρ = 0.563; p = 0.01), LV GLS (ρ = 0.418; p = 0 .01), RWT (ρ = 0.438; p = 0.01). With an increase in BMI by 1 kg/m2, one should expect an increase in the thickness of EF by 0.172 mm, longitudinal deformation of the LV by 0.151%, RWT by 0.003, LVMI, g/m2 by 1.200, LVMI g/m2,7 by 1.116.Conclusion. The increase in BMI is associated with changes in structural remodeling and systolic function of the LV. In individuals with increased BMI, to determine structural remodeling and changes in the geometry of the heart chambers, it is necessary to use growth indexing, to determine indicators of GLS LV, to determine the thickness of EF in order to detect intracardiac hemodynamic disorders in the early stages and timely prevention of complications.

The correlation between epicardial fat thickness and longitudinal left atrial reservoir strain in patients with type 2 diabetes mellitus and controls

BackgroundDiabetes mellitus (DM) has been documented among the strongest risk factors for developing heart failure with preserved ejection fraction (HFpEF). The earliest imaging changes in patients with DM are the left atrial (LA) functional and volumetric changes. The aim of this study was to determine the correlation between epicardial fat thickness (EFT) and longitudinal LA reservoir strain (LARS) in patients with type 2 DM (T2DM), as compared with non-diabetic controls.ResultsThe study samples in this case-control study comprised of consecutive patients with T2DM (n=64) and matched non-diabetic controls (n=30). An echocardiography was performed on all patients and EFT, volumetric and longitudinal LARS, left ventricular (LV) global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e′) and peak systolic (s') velocities were obtained. The study results demonstrated that the patients with T2DM had thicker EFT (5.96±2.13 vs. 4.10±3.11 mm) and increased LA volume index (LAVI) (43.05± 44.40 vs. 29.10±11.34 ml/m2) in comparison with the non-diabetic ones (p-value: 0.005 and 0.022, respectively). On the other hand, a direct association was observed between EFT and the E/e′ ratio, and an inverse correlation was established between EFT and LARS in patients with T2DM (r=0.299, p-value=0.020 and r=− 0.256, p-value=0.043, respectively). However, regression analysis showed only LV mass index (LVMI) (β=0.012, 95% CI 0.006–0.019, p-value<0.001), LAVI (β=− 0.034, 95% CI − 0.05–0.017, p-value<0.001), and EFT (β=− 0.143, 95% CI − 0.264–− 0.021, p-value=0.021) were independently correlated with LARS.ConclusionsLARS is considered as an important early marker of subclinical cardiac dysfunction. Thickened epicardial fat may be an independent risk factor for decreased LA reservoir strain. Diabetics are especially considered as a high risk group due to having an increased epicardial adipose tissue thickness.

Epicardial fat in patients with metabolic syndrome: A systematic review and meta-analysis

PurposeAbnormally increased epicardial fat appears to be associated with an additional risk of major adverse cardiovascular events (MACEs) in the context of metabolic syndrome (MetS). However, evidence on the relationship between epicardial fat volumes (EFVs), epicardial fat thickness (EFT) and MetS remains inconsistent. MethodsSpecific searches of electronic databases from 1 January 2000 to 31 October 2022 were independently performed by two researchers. In this study, two quantification measures of epicardial fat were included: comparison of total computed tomography–based EFVs and EFT between two groups (individuals with and without MetS), estimating standardized mean difference (SMD) with corresponding 95 % confidence intervals (CIs) through a random-effects model analysis. The heterogeneity in the included studies was explored by meta-regression and subgroup analyses. ResultsThe EFVs were significantly increased in MetS subjects compared with non-MetS subjects (SMD: 1.07, 95 % CI: 0.69–1.45, p < 0.001), and the EFT was also significantly larger in MetS patients than in the Non-MetS (SMD: 1.12, 95 % CI: 0.84–1.41, p < 0.001). We compared the Caucasian and American subgroups with the Asian and African subgroups, and the EFT was greater in the former subgroups (SMD: 1.32, 95 % CI: 0.44–2.20, p < 0.001). When comparing the EFT among the age subgroups, there was a significant SMD between adolescents and adults or elderly individuals (SMD: 1.21, 95 % CI: 0.84–1.52, p < 0.001). ConclusionsMetS patients tend to present greater EFT near the right ventricular free wall and greater total EFVs. Increased epicardial fat, an imaging biomarker, independently affects the onset of MetS.

The Relationship between Visceral Adiposity Form of Non-Alcoholic Fatty Liver Disease and Increased Epicardial Adipose Tissue Mass with Coronary Artery Disease

Abstract Background Cardiovascular disease is the largest cause of death in the world, and coronary artery disease (CAD) makes up the greatest proportion of those deaths that may enable more sensitive measures for risk stratification, or offer novel therapeutic targets for the prevention and treatment of coronary vascular disease. Aim of the Work to determine the association between visceral adiposity form of non-alcoholic fatty liver and increased Epicardial adipose tissue mass with coronary artery disease severity. Patients and Methods This study was conducted on fifty patients presented with signs and symptoms of coronary artery disease who were coming for elective coronary angiography at cardiovascular outpatient clinic in the internal medicine hospital, Ain Shams University from March 2018 to October 2018. Results In two patients with severe steatosis (Grade 3) the average thickness of long and short axes was detected 9.600 ± 0.141 mm. Average of 12 patients with no steatosis, Epicardial fat thickness was 6.323 ± 0.754 mm. In our study, Non critical coronary artery disease (below the 50% stenosis) was detected in eight patients (16 %). While critical coronary artery disease (Above the 50% stenosis) was detected in forty two patients (84%). According to the severity of coronary artery disease, in patients who do not have significant stenosis, EAT mean thickness was found 5.600± 0.400 mm measured. In patients with severe stenosis coronary artery disease, this value was measured as 7.857 ± 0.707 mm. In our study, Hypertension, diabetes mellitus and dyslipidemia (represented by LDL-c) were found to have statistically significant relations and correlation with EAT, but it was found that there was no statistically significant relationship between NAFLD fibrosis scoring system and FIB-4 with CAD. In this study, it was found a statistically significant relationship between the severity of NAFLD and CAD and a similar relationship between EAT and CAD. Conclusion Epicardial fat deposition is part of the same metabolic disorders associated with the development of fatty liver in individuals with insulin resistance and metabolic syndrome. High EAT may represent a marker of the severity of visceral adiposity as well as an independent predictor of cardiovascular and coronaries diseases risk.

A multilocus genetic risk score for obesity: Association with BMI and metabolic alterations in a cohort with severe obesity.

Genome wide association studies have identified numerous single nucleotide polymorphisms (SNPs) associated with obesity, yet effect sizes of individual SNPs are small. Therefore, the aim of our study was to investigate whether a genetic risk score (GRS) comprising risk alleles of SNPs identified in the GIANT consortium meta-analyses shows association with body mass index (BMI) and other BMI related metabolic alterations in a cohort with an extreme phenotype. Genotyping of 93 SNPs was performed in 314 obese individuals (mean BMI 40.5 ± 7.8 kg/m², aged 45 ± 12 years), participating in a standardized weight reduction program, and in 74 lean controls (mean BMI 24.6 ± 3.3 kg/m², aged 41.7 ± 13.4 years). Allele numbers of all 93 SNPs were added to a GRS. Anthropometric parameters, parameters of glucose/insulin and lipid metabolism were assessed standardized after a 12 hours fast. GRS was significantly different between controls and obese individuals (unweighted GRS: 86.6 vs 89.0, P = .002; weighted GRS: 84.9 vs 88.3, P = .005). Furthermore, linear regression analysis showed significant associations of GRS with BMI ( P < .0001), weight ( P = .0005), waist circumference ( P = .0039), fat mass ( P < .0001) and epicardial fat thickness ( P = .0032), yet with small effect sizes ( r ² < 0.06). In conclusion, in our study GRS could differentiate between extreme obese and lean individuals, and was associated with BMI and its related traits, yet with small effect sizes.

Prognostic Significance of Cardiac Fat Deposits in Patients with Coronary Heart Disease

INTRODUCTION: Obesity is one of the leading risk factors for the development of cardiovascular diseases. At present, of the greatest scientific interest are local deposits of adipose tissue as a possible morphological substrate for the development of this group of diseases. Along with the traditional risk factors, one more risk factor for a poor prognosis of cardiovascular disease can be a change in the thickness of the epicardial fat (EF) and of the interatrial septum (IAS) in case of its lipomatosis.&#x0D; AIM: To study the significance of EF and of IAS thickness as markers of cardiovascular risk in coronary heart disease.&#x0D; MATERIALS AND METHODS: The study involved 116 individuals with coronary heart disease (55 men (47%) and 61 women (53%), mean age 68 [61; 72] years). Thickness of EF and IAS was evaluated by the method of echocardiography. The frequency of poor outcomes was evaluated using KaplanMeier method, ROC-curve analysis. The differences were considered statistically significant at p 0.05.&#x0D; RESULTS: In the group of patients with unstable angina, the threshold value of IAS thickness was 0.7 cm (p 0.001), and of EF thickness 0.8 cm (2 = 10.89, p = 0.001), in the group of patients with myocardial infarction 0.7 cm (p 0.001) and 0.8 cm (p 0.001), respectively. In the group of patient with unstable angina, IAS thickness 0.7 cm (2 = 10.3, p = 0.0013) and EF thickness 0.8 cm (2 = 10.89, p = 0.001) demonstrate a poor prognosis in comparison with the parameters below the threshold values. In the group of patients with myocardial infarction, IAS thickness 0.7 cm (2 = 8.4, p = 0.005) and EF 0.8 cm (2 = 9.66, p = 0.0019) demonstrate poor prognosis in comparison with the parameters below the threshold values.&#x0D; CONCLUSION: In unstable angina and myocardial infarction, the value of IAS thickness 0.7 cm (p = 0.0013 and p = 0.005, respectively) and of EF thickness 0.8 cm (p = 0.001 and p = 0.0019, respectively) present a poor prognosis compared to lower values. It is recommended that EF and IAS thickness be determined in echocardiography as an additional marker for a poor prognosis in coronary heart disease.

Effect of Smokeless Tobacco (Maras Powder) on the Epicardial Fat Thickness and Ventricular Repolarization Parameters.

Background and Objectives: Smokeless tobacco (ST) use has recently become an alternative to cigarettes, and it has been concluded that ST is at least as harmful as cigarettes. ST use is thought to play a role in the pathogenesis of arrhythmia by affecting ventricular repolarization. In this study, we aimed to examine the relationships of Maras powder (MP), one of the ST varieties, with epicardial fat thickness and new ventricular repolarization parameters, which have not previously been described. Materials and Methods: A total of 289 male individuals were included in this study between April 2022 and December 2022. Three groups, 97 MP users, 97 smokers, and 95 healthy (non-tobacco), were compared according to electrocardiographic and echocardiographic data. Electrocardiograms (ECG) were evaluated with a magnifying glass by two expert cardiologists at a speed of 50 m/s. Epicardial fat thickness (EFT) was measured by echocardiography in the parasternal short- and long-axis images. A model was created with variables that could affect epicardial fat thickness. Results: There were no differences between the groups regarding body mass index (p = 0.672) and age (p = 0.306). The low-density lipoprotein value was higher in the MP user group (p = 0.003). The QT interval was similar between groups. Tp-e (p = 0.022), cTp-e (p = 0.013), Tp-e/QT (p =0.005), and Tp-e/cQT (p = 0.012) were higher in the MP user group. While the Tp-e/QT ratio did not affect EFT, MP predicted the epicardial fat thickness (p < 0.001, B = 0.522, 95%CI 0.272-0.773). Conclusions: Maras powder may play a role in ventricular arrhythmia by affecting EFT and causing an increase in the Tp-e interval.

Repurposing the Incidental Detection of Internal Hemorrhoids as an Independent Predictor of Coronary Artery Disease Risk

The relationship between anal canal hemorrhoids and cardiovascular diseases has been demonstrated in retrospective population-based studies. Despite the etiological similarities, the real-time correlation between hemorrhoids and cardiovascular risk is not known yet. We aimed to investigate the importance of incidentally detected internal hemorrhoids in predicting cardiovascular risk as determined by Carotid Intima-Media Thickness (CIMT) and Epicardial Fat Thickness (EFT) measurements. Totally, 269 patients who underwent colonoscopy for benign reasons were enrolled in this single-center cross-sectional study. The groups with and without hemorrhoids were compared for CIMT, EFT, and other risk factors. Independent predictors for increased CIMT and EFT values were evaluated by regression analysis. The mean age of the patients was 43.5±13.9 years and 34.6% were female. The prevalence of internal hemorrhoids was 30.5% (n=82). The presence of hemorrhoids was one of the independent predictors for increased CIMT along with hypertension and smoking (OR: 4.29, 2.63, and 2.36, respectively). The independent predictors of increased EFT were female gender, high body mass indexes, and high platelet levels (OR: 2.27, 1.47, and 1.01 respectively). Incidentally diagnosed internal anal canal hemorrhoids, albeit for other reasons, can be a useful predictor for the risk of atherosclerosis and cardiovascular diseases.

Fetal epicardial fat thickness in non-severe idiopathic polyhydramnios: Its impact on fetal cardiac function and perinatal outcomes.

This study aimed to evaluate fetal epicardial fat thickness (EFT) along with fetal myocardial performance index (MPI) and its effects on perinatal outcomes in non-severe idiopathic polyhydramnios (IP). This prospective study included 92 participants, 32 diagnosed with non-severe IP, and 60 healthy pregnant women. Amniotic fluid indices (AFI), umbilical and middle cerebral artery Doppler, EFT, and MPI measurements were performed for all patients. The fetal EFT and MPI values were statistically higher in the non-severe IP group than in the control group (p = 0.0001, p = 0.014, respectively). The optimal fetal EFT cutoff value for predicting non-severe IP disease was found as 1.3 mm with a specificity of 81.7% and sensitivity of 59.4%. The EFT cutoff for predicting cesarean section in non-severe IP cases was 1.25 mm (p = 0.038). Apgar scores, neonatal intensive care unit, respiratory distress syndrome, and stillbirth rates were not different between groups. In this study, EFT and MPI were found to be higher in non-severe IP cases compared to controls. It was observed that the increase in MPI and EFT was associated with the increase in cesarean rates, but not with adverse fetal outcomes.

Structural and functional state of postinfarction myocardium and vascular endothelial growth factor: is there a connection?

Purpose of the study. To reveal the relationship between the serum concentration of vascular endothelial growth factor and the structural and functional state of the myocardium in patients in the post-infarction period at the stage of rehabilitation.Materials and methods. We examined 94 patients at the outpatient stage of rehabilitation after ad hoc stenting 6 weeks after myocardial infarction, 10 healthy volunteers without somatic pathology. All participants in the study underwent standard transthoracic echocardiography with assessment of thickness of epicardial fat, assessment of the concentration of vascular endothelial growth factor (VEGF) in peripheral blood by ELISA.Results and discussion. VEGF values above the median values were associated with lower left ventricular ejection fraction and left ventricular fraction shortening, which indirectly may indicate a more pronounced expression of VEGF in patients with left ventricular systolic dysfunction. Assessing the parameters of LV diastolic dysfunction in groups with different levels of VEGF, no significant differences were found in patients after myocardial infarction. Correlation relationships between the content of VEGF and the thickness of epicardial adipose tissue were not found either among patients or in the control group.Conclusions. Elevated VEGF values in patients with coronary artery disease at the 6th week of rehabilitation were accompanied by left ventricle systolic dysfunction, in contrast to diastolic dysfunction. There was no direct correlation between the thickness of epicardial fat and the concentration of VEGF in the blood serum in patients with coronary artery disease.

Epicardial obesity and left atrial mechanical dispersion in hypertensive patients with paroxysmal and persistent atrial fibrillation

Aim. To compare the epicardial fat thickness (EFT) in right ventricular anterior wall (RVAW) and left atrial mechanical dispersion (LAMD) in hypertensive (HTN) patients without arrhythmias and with various types of recurrent atrial fibrillation (AF).Material and methods. This observational cross-sectional single-center study included 383 patients with HTN, of which 251 did not have AF, 61 patients had paroxysmal, and 71 patients — persistent AF. Echocardiography performed against the background of sinus rhythm assessed the EFT in RVAW. In addition, using speckle-tracking echocardiography, the LAMD was determined, equal to the percentage of the standard deviation of the time to peak global longitudinal LA strain in the reservoir phase to duration of cardiac cycle.Results. In HTN patients without AF, with paroxysmal and persistent AF, the EFT was 6,70 [5,80; 8,00], 8,20 [7,10; 9,93] and 8,70 [7,93; 10,0] mm (р&lt;0,0001), LAMD — 0,72 [0,58; 0,93], 2,87 [2,40; 3,28] and 2,67 [2,11; 3,15]% (p&lt;0,0001), respectively.Conclusion. In HTN patients with paroxysmal and persistent AF, the EFT in RVAW and LAMD is significantly greater than in patients without arrhythmias. In patients with persistent AF, EFT is greater than in paroxysmal AF, while LAMD practically does not differ.

Abstract 366: Utilizing epicardial fat thickness as an indicator of cardiac cachexia in resectable pancreatic ductal adenocarcinoma

Abstract Objective: Pancreatic adenocarcinoma (PDAC) is a highly aggressive malignancy with high mortality. A significant component of PDAC is cachexia, or cancer-related muscle wasting. While there are many studies analyzing skeletal muscle cachexia, there is limited data regarding cardiac muscle degradation (cardiac cachexia) in PDAC patients. Prior studies in heart failure patients have utilized epicardial fat thickness (EFT) as a marker for cardiac cachexia. The objective of this study was to determine if there is a relationship between skeletal muscle cachexia and cardiac cachexia in resectable PDAC patients. Methods: Adult patients with resectable PDAC from 2011-2021 were identified from a single institution. Patients were included in this study if they had available CT Chest and Abdominal scans of adequate quality within one year of their PDAC resection. Scans were acquired from various time points in the pre- and post-operative phases. The patient’s skeletal muscle index (SMI) at the L3 vertebral level was calculated using the software SliceOMatic. Using the SMI and the patient’s BMI, a determination of cachexia was made using criteria established by by Martin et al [2]. EFT was measured on the CT Chest scans by measuring the perpendicular distance of epicardial fat from the base of the right coronary artery the outer border of the epicardium on an axial view. Comparisons were made using t-test or Fisher's exact test with p-value of 0.05 for significance. Results: Overall, 22 patients met inclusion criteria. EFT was compared to SMI values across all patients and there was no correlation (R2=0.049). There was also no significant difference in EFT between cachectic and non-cachectic patients (2.52 cm vs .2.36 cm, p=0.42). Given the impact of obesity on visceral fat composition, we performed additional analysis after excluding patients with BMI &amp;gt; 25. In this subset, there was a significant difference in EFT between cachectic and non-cachectic patients (2.30 cm vs. 1.90 cm, p=0.03). Race was also a significant factor, with African American patients having lower EFT compared to Caucasians (1.57 cm vs. 2.31 cm, p=0.02). Conclusion: Although there was no direct correlation between EFT and skeletal muscle cachexia, EFT may be an important predictor of cachexia in PDAC patients with low to normal BMI. Furthermore, the racial difference in EFT demonstrates a possible disparity in cardiac cachexia and function. To establish this parameter as a marker of cachexia, the patient cohort will be expanded to include more time points and those with unresectable/metastatic disease. This will also need to be explored prospectively with functional imaging such as cardiac MRI to determine if there is a relationship between EFT and cardiac function. Citation Format: Vignesh Vudatha, Devon Freudenberger, Christopher Liu, Jose Trevino. Utilizing epicardial fat thickness as an indicator of cardiac cachexia in resectable pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 366.

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?

Evaluation of the fetal myocardial performance ındex and Epicardial fat thickness in pregnant women with preterm prelabor rupture of membranes

Objective To assess the epicardial fat thickness (EFT) and modified myocardial performance index (Mod-MPI) measurements in fetuses at pregnant women with preterm prelabor rupture of membranes (pPROM) and compare them to healthy pregnant women’s fetuses. Methods Forty patients who presented to our clinic at 24–36 + 6 gestational weeks and were diagnosed with pPROM were included in the patient group. During the same period, 40 healthy pregnant women at similar gestational weeks were randomly selected as the control group. Results The pPROM and control groups were similar in terms of demographics. In the pPROM group, EFT, Mod-MPI, and isovolumetric contraction(ICT) and relaxation times(IRT) were significantly higher and ejection time (ET) was significantly lower compared to the control group. In addition, Mod-MPI z-scores, IRT z-scores, ICT z-scores were significantly higher and ET z-scores was significantly lower in the pPROM. According to the ROC analysis, the optimal cutoff value of EFT was calculated as 1.55 mm, with 68% sensitivity and 71% specificity (AUC: 0.718, 95% CI: 0.550–0.786, p = .018) for predicting NICU requirement and the optimal cutoff value of EFT was calculated as 1.55 mm with 72% sensitivity and 73% specificity (AUC: 0.726, 95% CI: 0.556–0.896, p = .015) for predicting medication use in the pPROM group. Conclusion This study revealed differences in the EFT and Mod-MPI measurements of the fetuses of pregnant women with pPROM. Considering that EFT is an important energy source for the myocardium, as well as an endocrine structure in which inflammatory and anti-inflammatory markers are secreted, it is recommended to be evaluated in inflammatory conditions such as pPROM.

Performance of an Irrigated Bipolar Radiofrequency Ablation Clamp on Explanted Human Hearts

BackgroundBipolar radiofrequency (RF) clamps are commonly used during surgical ablation for atrial fibrillation (AF). This study examined the efficacy of an irrigated bipolar RF clamp to create transmural lesions in an ex vivo human heart model. MethodsTen donor hearts, turned down for transplantation, were explanted and arrested with cold cardioplegia. The ablations of the Cox Maze IV procedure were performed using the Cardioblate LP (Medtronic, Inc) irrigated bipolar RF clamp. In the first 5 hearts, each lesion was created with a single application of RF, whereas in the remaining 5 hearts, each lesion was created with a double application of RF without unclamping. Each lesion was cross-sectioned and stained with 2,3,5-triphenyl-tetrazolium chloride to assess ablation depth and transmurality. ResultsA total of 100 lesions were analyzed. In the single-ablation group, 222 of 260 sections (85%) and 37 of 50 lesions (74%) were transmural. The efficacy improved significantly in the double-ablation group, in which 348 of 359 sections (97%, P < .001) and 46 of 50 lesions (92%, P = .017) were transmural. Overall, in nontransmural lesions, the epicardial fat thickness was significantly greater (1.69 ± 0.70 mm vs 0.45 ±0.10 mm, P < .001) than the transmural lesions. ConclusionsA single ablation on human atrial tissue with an irrigated bipolar RF clamp was insufficient to reliably create transmural lesions, but a double ablation significantly increased the lesion and section transmurality. Nontransmural lesions were associated with significantly thicker layers of epicardial fat, which likely decreased tissue energy delivery due to the higher resistance of fat to current flow.

Fetal Epicardial Fat Thickness: Its Role as Marker for Gestational Diabetic Mellitus.

Background There are very few studies on the association between fetal epicardial fat thickness (EFT) and gestational diabetes mellitus (GDM). Aims To evaluate the role of fetal epicardial fat thickness as a marker and use it in pregnancies to screen for GDM. Settings and Design A cross-sectional analytical study was conducted in the Department of Radiodiagnosis and Imaging at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, after the due clearance from the institutional research and ethics committee. Materials and Methods The study included pregnant patients at 24 + 0/6 to 28 + 0/6 weeks of gestation scheduled for a 75 g oral glucose tolerance test from December 1, 2020 to March 30, 2022. Antenatal ultrasound was performed on Voluson E8 Expert BT12 (Wipro GE) ultrasound machine. Out of 180 patients, 60 patients were selected, that is, 30 patients with raised 75 g OGTT results (cases of GDM) and 30 patients with normal 75 g OGTT results. Statistical Analysis The collected data were transformed into variables, coded, and entered into Microsoft Excel. Data were analyzed using the Shapiro-Wilk normality test, student's t -test or Mann-Whiney U test, chi-square test, or Fisher's exact test and statistically evaluated using the SPSS-PC-25 version. Results Fetal EFT was found to be significantly more in the GDM group in comparison to controls without GDM, and the increased fetal EFT was positively associated with 2-hour OGTT serum glucose values. The mean fetal epicardial fat thickness (EFT) in mothers with GDM was significantly larger, i.e., 0.17 ± 0.02 cm than in mothers without GDM, i.e., 0.12 ± 0.01 cm ( p < 0.001). The receiver operating characteristic (ROC) curve plotted from values calculated from our results shows high sensitivity (i.e., 96.67%) and specificity (i.e., 90%) of fetal EFT as a predictor for GDM with an AUROC value of 0.96 and 95% confidence interval of 0.92 to 1.0. Conclusions EFT was significantly higher in fetuses of diabetic versus nondiabetic mothers. The mean difference in EFT of GDM cases and controls was relatively small but was statistically significant. The study concluded that measuring the epicardial fat thickness in fetuses can serve as a novel marker in GDM.

Association of increased fetal epicardial fat thickness with maternal pregestational and gestational diabetes

Objective To evaluate the changes of fetal epicardial fat thickness (EFT) in pregnancies with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) and to identify the diagnostic effectiveness of fetal EFT in differentiating PGDM and GDM from normal pregnancies. Methods The study was conducted with pregnant women who admitted to perinatology department between October 2020 and August 2021. Patients were grouped as PGDM (n = 110), GDM (n = 110), and control (n = 110) for comparison of fetal EFT. EFT was measured in all three groups at 29 weeks of gestation. Demographic characteristics and ultrasonographic findings were recorded and compared. Results The mean fetal EFT was significantly higher in PGDM (1.47 ± 0.083 mm, p < .001) and GDM (1.40 ± 0.082 mm, p < .001) groups compared to control group (1.19 ± 0.049 mm) and was also significantly higher in PGDM group than GDM group (p < .001). Fetal EFT was significantly positively correlated with maternal age, fasting, 1st hour, 2nd hour glucose values, HbA1c, fetal abdominal circumference, and deepest vertical pocket of amniotic fluid (p < .001). Fetal EFT value of 1.3 mm diagnosed PGDM patients with a sensitivity of 97.3% and a specificity of 98.2%. Fetal EFT value of 1.27 mm diagnosed GDM patients with a sensitivity of 94% and a specificity of 95%. Conclusions Fetal EFT is greater in pregnancies with diabetes than in normal pregnancies, and also greater in PGDM than in GDM. In addition, fetal EFT is strongly correlated with maternal blood glucose levels in diabetic pregnancies.

Potential impact of epicardial fat thickness, pentraxin-3, and high-sensitive C-reactive protein on the risk of non-proliferative diabetic retinopathy.

We tried to clarify the potential association between systemic inflammatory markers like high-sensitive C-reactive protein (Hs-CRP), pentraxin-3 (PTX3), and epicardial fat thickness (EFT) with the non-proliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes mellitus (T2D). Previous studies dealt with diabetic retinopathy as a whole entity rather than early stages of diabetic retinopathy. Early detection of various determinants of NPDR is prioritized in clinical practice. A case-control study was conducted at Mansoura University Hospital, included 207 Egyptian subjects divided into 3 groups; 69 diabetic patients without retinopathy, 69 diabetic patients with NPDR, and 69 healthy control subjects. Participants were subjected to clinical history taking, physical examination, and laboratory assessment of Hs-CRP and plasma PTX3. Transthoracic echocardiography was applied to estimate EFT. Hs-CRP, PTX3, and EFT were significantly higher in patients with T2D without retinopathy than control cohort (p = 0.033, p < 0.00 and p < 0.00, respectively). Moreover, patients with NPDR showed significantly higher values of Hs-CRP, PTX3, and EFT than diabetic comparators without retinopathy (p = 0.002, p = 0.012, and p < 0.001, respectively). Although, NPDR was positively correlated with Hs-CRP, PTX3, and EFT (p < 0.001), Hs-CRP was not an independent determinant of NPDR meanwhile, EFT (OR = 1.094, 95%CI: 1.036-1.154, P = 0.001) and PTX3 (OR = 16.145, 95%CI: 1.676-155.551, P = 0.016) were. Plasma pentraxin-3 and epicardial fat thickness showed more significant association with NPDR than high-sensitive C-reactive protein in patients with type 2 diabetes mellitus.

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

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

Possibilities for managing the left ventricular diastolic dysfunction risk in obese patients

Aim. To study the factors preventing the LVDD in obese patients.Material and methods. The study included 101 obese men who initially did not have LVDD. After 4,7±0,3 years, anthropometric parameters (body mass index (BMI), hip circumference (HC), waist circumference (WC)) and LV diastolic function were reassessed. All patients at the time of enrollment were assessed for the level of neurohumoral (leptin, adiponectin, leptin receptor), pro-inflammatory (tumor necrosis factor-α, interleukin-6, -10, C-reactive protein) and profibrotic factors (collagen type I and III, matrix metalloproteinase-3, vascular endothelial growth factor, transforming growth factor β).Results. During 4,7±0,3 years of follow-up, 26,7% of the total number inclu­ded in the study registered a decrease in body weight. A tendency to a de­crease in epicardial fat thickness (EFT) by 0,5 mm (7,49 (6,00; 9,00) mm at the time of inclusion and 7,04 (6,00; 9,00) mm over time (p=0,13)). According to echocardiography, LVDD was detected in 20 patients (19,8% after 4,7±0,3 years). Comparative analysis of baseline anthropometric parameters, EFT and after 4,7±0,3 years in groups of patients with (DD+) and without (DD-) LVDD revealed a significant decrease in body weight (p=0,03), BMI (p=0,02), WC (p=0,04) and EFT (p=0,002) only in the DD- group. Patients who developed LVDD initially had increased tumor necrosis factor-α (p=0,02), interleukin-6 (p=0,01), free fatty acids (p=0,001), type I collagen (p=0,001), type III collagen (p=0,02) and a decrease in adiponectin level (p=0,001).Conclusion. Thus, in patients with a decrease in weight, BMI, WC and EFT during the follow-up period of 4,7±0,3 years, LVDD did not develop, which is associated with a reduced risk of myocardial lipotoxicity against the background of epicardial obesity.