Epicardial Fat Volume In Patients Research Articles

Low-density lipoprotein- cholesterol and its relation to epicardial fat volume in patients with type II diabetes mellitus

Low-density lipoprotein- cholesterol and its relation to epicardial fat volume in patients with type II diabetes mellitus

Peripheral and local inflammatory markers associated with epicardial fat volume in patients underwent open heart surgery

Abstract Introduction Epicardial fat (EF) is a source of inflammation, and it is associated with cardiovascular diseases. However, the correlation between EF volume (EFV) and local and peripheral biomarkers as well as adipogenesis behavior were not studied yet. Our objective was to a) Find the peripheral and local markers related to EFV independent of age and BMI. b) Study the relationship between the adipogenesis capacity and the EFV in each patient. Materials and Methods We included 33 patients underwent open heart surgery with preoperative cardiac CT imaging. Blood samples of 24 patients were obtained, neutrophils were isolated using polymorphprep and 16 activity markers were analyzed. Twelve biomarkers in plasma associated with metabolism and inflammation were analyzed. The epicardial adipose tissue biopsies were obtained during the surgery. The fat pads were homogenized and RNA was isolated and retrotranscripted to cDNA. Then 17 markers associated with adipogenesis and inflammation were analyzed by real time PCR. Stromal cells from EF of 21 patients were isolated after collagenase activity and cultured for 14 days and then induced to adipogenesis for the next 14 days. Multimarkers on plasma, peripheral neutrophils, EF and primary cultures were analyzed by multiplex assay and real time PCR, respectively. EFV was measured from CT, percentage of EFV in total heart volume was calculated. The association between FV and biomarkers were evaluated with independent sample t-test, linear regression analysis and correlation analysis. Results The main clinical characteristics of studied patients were (69 ± 9 years old, 30 ± 4 kg/m², 76% HT, 67% DLP, 33% CAD, 27% HF, 30% AF, 30% T2DM). EFV (148±55 cm³) was more correlated with age (r=0.4, p=0.023), but not with BMI. Percentage of EFV in total heart volume (12.9±4.9%) was positively correlated with lymphocytes and monocytes markers, CD3G and CXCR2 levels (r=0.5, p=0.008; r=0.49, p=0.028 respectively), and inversely with FABP4 (r=0.46, p=0.043) in EF. Circulating inflammatory markers, plasma C5a and MPO on neutrophils were associated with a greater amount of EFV (r=0.7, p=0.001 for C5a and r=0.75, p=0.001 for MPO) and percentage of EFV in total heart volume (r=0.63, p=0.003 for C5a and r=0.84, p<0.000 for MPO). Neutrophils markers, NGAL (r=0.49, p=0.048), LF (r=0.52, p=0.034), DEFA3 (r=0.57, p=0.023) were also correlated with percentage of EFV to total heart volume. Lineal regression determined that among local markers CD3G was the best EF predictor (r=0.4, p=0.008); regarding peripheral markers, the C5a expression levels on neutrophils was the best EF predictor (r=0.61, p=0.002). There were no association between adipogenesis ability and EFV among studied patients. Conclusion EFV from patients undergoing open heart surgery were associated with local and peripheral inflammatory markers. It might contribute to cardiovascular disease progression. Long term follow-up is needed to clarify this process.

Epicardial fat volume assessed with cardiac magnetic resonance imaging in patients with Takotsubo cardiomyopathy

PurposeThe aims of our study were to investigate with cardiovascular magnetic resonance (CMR) the role of Epicardial Fat Volume (EFV) and distribution in patients with Takotsubo cardiomyopathy (TTC). Moreover, we explored EFV in patients with TTC and related this to comorbidities, cardiac biomarkers, and cardiac function. MethodsThis retrospective study performed CMR scans in 30 consecutive TTC patients and 20 healthy controls. The absolute amount of EFV was quantified in consecutive short-axis cine stacks through the modified Simpson’s rule. In addition, the left atrio-ventricular groove (LV) and right ventricle (RV) Epicardial Fat Thickness (EFT) were measured as well. Besides epicardial fat, LV myocardial strain parameters and T2 mapping measurements were obtained. ResultsTTC patients and controls were of comparable age, sex, and body mass index. Compared to healthy controls, patients with TTC demonstrated a significantly increased EFV, epicardial fat mass, and EFV indexed for body 7surface area (p = 0.005; p = 0.003; p = 0.008; respectively). In a multiple regression model including age, sex, BMI, atrial fibrillation, and dyslipidemia, TTC remained an independent association with EFV (p = 0.008). Global T2 mapping and Global longitudinal strain in patients with TTC were correlated with EFV (r = 0.63, p = 0.001, and r = 0.44, p = 0.02, respectively). ConclusionPatients with TTC have increased EFV compared to healthy controls, despite a similar body mass index. The amount of epicardial fat was associated with CMR markers of myocardial inflammation and subclinical contractile dysfunction.

Optimized Reconstruction Algorithm-Processed CT Image in the Diagnosis of Correlation between Epicardial Fat Volume and Coronary Heart Disease

This study was to analyze the application value of a reconstruction algorithm in CT images of patients with coronary heart disease and analyze the correlation between epicardial fat volume and coronary heart disease. An optimized reconstruction algorithm was constructed based on compressed sensing theory in this study. Then, the optimized algorithm was applied to the image reconstruction of multislice spiral CT image data after testing its sensitivity, accuracy, and specificity. 60 patients with suspected angina pectoris were divided into lesion group (40 cases) and normal group (20 cases) according to whether there were coronary atherosclerotic plaques in cardiac vessels. The results showed that the sensitivity, specificity, and accuracy of the optimized reconstruction algorithm were 91.78%, 84.27%, and 95.32%, and the running time was (12.18 ± 2.49) s. The CT value of the liver and the CT ratio of the liver and spleen in the lesion group were (53.81 ± 5.91) and (3.88 ± 0.67), respectively. There was no significant difference between the two groups ( P > 0.05 ). The body mass index and epicardial fat volume in the lesion group were (31.93 ± 4.54) kg/m2 and (120.09 ± 22.01) cm3, respectively. The body mass index and fat volume in the lesion group were significantly higher than those in the normal group ( P < 0.05 ). The epicardial fat constitution increased with the increase of the number of coronary arteries involved, and there was a positive correlation between them. Among patients with different coronary atherosclerotic plaques, the epicardial fat volume in patients with mixed plaques was the largest ( P < 0.05 ). In summary, optimizing CT images under compressed a sensing reconstruction algorithm could effectively improve the diagnostic accuracy of doctors. Epicardial fat volume was positively correlated with coronary heart disease. Epicardial fat volume could be used as one of the important indexes to predict coronary heart disease.

Predictors of Epicardial Fat Volume Decrease after Dapagliflozin Treatment in Patients with Type 2 Diabetes.

Background and Objectives: Dapagliflozin treatment proved to reduce the epicardial fat volume (EFV) in patients with type 2 diabetes (T2D). Despite the reduction in EFV being associated with improved diastolic function in patients with T2D, EVF is not routinely evaluated in T2D because it is costly and involves radiation exposure. This study aims to identify biomarkers that predict EFV reduction after dapagliflozin treatment in patients with T2D. Materials and Methods: In a prospective, observational, consecutive-case enrollment scenario, 52 patients with T2D were initiated on dapagliflozin 10 mg q.d. as part of the standard of care. At enrollment and after six months of dapagliflozin treatment, patients were evaluated using cardiac ultrasonography, native computer tomography, transient liver elastography, and metabolic lab tests. In addition, the atherogenic index of plasma (AIP), atherogenic coefficient (AC), triglyceride glucose index (TyG), cardiac risk ratio (CRR), and visceral abdominal index (VAI) were calculated. Results: Higher AIP (r = 0.28; p = 0.04), CRR (r = 0.28; p = 0.04), and TyG (r = 0.32; p = 0.01) are associated with more important reductions in the EFV. A lower conicity index (β = −0.29; p = 0.03), visceral fat volume at the 4th vertebrae (L4VFV) (β = −0.32; p = 0.02), left atrium volume (β = −3.08; p = 0.003), and right ventricle diameter (β = −2.13; p = 0.04) are associated with higher reductions in the EFV after six months of dapagliflozin treatment. A valid performance for predicting clinically relevant decreases in EFV after dapagliflozin treatment was observed for AIP (AUROC = 0.903; Youden = 0.732; p < 0.001), CRR (AUROC = 0.772; Youden = 0.595; p = 0.004), TyG (AUROC = 0.957; Youden = 0.904; p < 0.001), and VAI (AUROC = 0.898; Youden = 0.712; p < 0.001). Conclusion: Higher initial EFV values are associated with more important reductions in EFV in patients with T2D treated for six months with dapagliflozin. TyG values have the best prediction performances for EFV reduction, having the highest sum of sensitivity and specificity at the 0.904 threshold level. AIP, CRR, VAI, conicity index, L4VF, left atrium volume, and right ventricle volume are valid biomarkers for a decrease in EFV after dapagliflozin treatment in diabetes patients.

Effect of 5-lipoxygenase inhibitor, VIA-2291 (Atreleuton), on epicardial fat volume in patients with recent acute coronary syndrome

Background and aimsThe association between inflammation and atherosclerosis has been well described in the literature. There is now mounting evidence in support of adipose tissue as a reservoir for inflammatory markers. Epicardial adipose tissue (EAT) has been shown to associate with coronary atherosclerosis and found to be a predictor of future adverse cardiovascular events. This study, VIA-EAT, assesses the change in epicardial fat volume (EFV) after treatment with an investigational anti-inflammatory agent (VIA-2291) in a cohort of post-acute coronary syndrome (ACS) patients. MethodsThis study is derived from a post-hoc analysis of a previously conducted randomized clinical trial (NCT00358826). Patients were recruited for a prospective, double-blind, multi-center randomized trial of a 5-lipooxygenase inhibitor or placebo in a 3:1 randomization, including doses of placebo, and 25 mg, 50 mg and 100 mg of active treatment. Cardiac computed tomography was performed at baseline and at 24 weeks after treatment with VIA-2291. EAT and pericardial adipose tissue (PAT) were measured using previously published methodology. A Pearson correlation test was used to determine the relationship between change in epicardial fat and change in plaque composition. ResultsWe analyzed 54 pre- and post-treatment scans. There were no major differences between traditional cardiovascular risk factors among the 4 randomized study arms. There was a significant decrease in EAT and PAT in patients in the treatment arms vs. placebo, −3.0 ± 8.2mm3 and −3.9 ± 10.9mm3 vs. 1.7 ± 7.5mm3 and 1.4 ± 10.7mm3 (p = 0.001), respectively. The changes in EAT and PAT were more pronounced in patients taking 100 mg of the drug vs. placebo: 4.2 ± 9.6mm3, -7.6 ± 8.5mm3, p = 0.0001, respectively. In a subgroup analysis, reduction in epicardial fat volume correlated with reduction in total atherosclerotic plaque volume across all VIA treatment groups, r = 0.52 (p = 0.004). ConclusionsAfter adjustment for traditional cardiovascular risk factors including age, gender, body mass index, dyslipidemia and smoking, VIA-2291 decreases EAT and PAT in individuals with recent ACS. Treatment with the drug also appears to alter plaque volume and composition.

Correlation between adiponectin, chemerin, vascular endothelial growth factor and epicardial fat volume in patients with coronary artery disease.

Epicardial fat, a local visceral fat depot surrounded by visceral pericardial sac, surrounds the coronary arteries for most of their course and may contribute to the development of coronary atherosclerosis by local production of inflammatory cytokines. Some studies on non-invasive measurement of epicardial fat mass have shown that epicardial fat mass is associated with the increased incidence of coronary artery disease (CAD), onset and progression of coronary plaque, mainly including major adverse cardiovascular events, myocardial ischemia, and atrial fibrillation. In the present study the correlation of adiponectin, chemerin, and vascular endothelial growth factor (VEGF) with the epicardial fat volume in patients with coronary artery disease was explored, and the risk factors for vascular remodeling of CAD patients were analyzed. A total of 50 CAD patients, treated in Chongzuo People's Hospital from August 2017 to September 2018, were enrolled as the observation group, and further 50 healthy individuals, who underwent physical examinations in the hospital at the same period, were enrolled as the control group. RT-qPCR was adopted to detect the expression levels of adiponectin, chemerin and VEGF in the two groups, a 64-slice dual-source CT to detect epicardial fat volume, and Pearson's correlation to analyze adiponectin, chemerin, VEGF and epicardial fat volume. Logistic regression analysis was performed to analyze the risk factors for vascular remodeling in CAD patients, and a receiver operating characteristic (ROC) curve analysis was used to analyze the value of indexes with multifactorial significance in vascular remodeling. The observation group showed obviously larger epicardial fat volume than the control group (P<0.001), lower adiponectin expression than the control group (P<0.001), and higher chemerin and VEGF expression than the control group (P<0.001). In the observation group, adiponectin expression decreased with the increase of epicardial fat volume (P<0.001), while the expression of chemerin and VEGF increased with the increase of epicardial fat volume (P<0.001). Remodeling occurred in 27 of the 50 patients. ROC curve analysis showed that the areas under the curves of adiponectin, chemerin, VEGF and epicardial fat volume were 0.697, 0.652, 0.696 and 0.689, respectively. Epicardial fat volume, adiponectin, chemerin and VEGF are independent risk factors for vascular remodeling and the expression of adiponectin, chemerin and VEGF can reflect epicardial fat volume.

Epicardial, paracardial and perivascular fat quantity, genes expression and serum cytokines in coronary artery disease and diabetes

Obesity and diabetes mellitus (DM) are common disorders that increase cardiovascular risk and lead to coronary artery disease (CAD). The aim of our study was to assess the link between epicardial fat (EF) volume and paracardial fat (PF) volume, relative expressions of several genes in epicardial, paracardial, and perivascular fat and corresponding serum cytokines in patients with CAD in relation to DM. A total of 66 consecutive patients (33 with DM) with multivessel CAD were included. We obtained cardiac magnetic resonance, serum cytokines levels, and their relative mRNA expressions in EF, PF, and perivascular fat samples of the following: adrenomedullin (ADM), fibroblast growth factor 21 (FGF21), transforming growth factor β (TGFβ), phospholipid transfer protein (PLTP), receptor for advanced glycation endproducts (RAGE), thrombospondin 1 (THSB1), and uncoupling protein 1 (UCP1). There were no differences in the anthropometric parameters or fat depots, except for higher epicardial fat volume in patients with DM (mean [SD], 105.6 [38.5] ml vs 84 [29.2] ml; P = 0.02). Patients with DM exhibited a significantly increased RAGE expression in EF (median [Q1-Q3], 0.17 [0.06-1.48] AU vs 0.08 [0.02-0.24] AU, P = 0.03). Diabetes was also associated with increased expression of ADM in EF and PF and decreased expression of FGF21 compared with patients without DM. Patients with multivessel CAD and DM revealed increased volume and more dysfunctional profile of gene expressions in EF and significantly decreased expression of cardioprotective FGF21.

Soluble LRP1 is an independent biomarker of epicardial fat volume in patients with type 1 diabetes mellitus

Epicardial adipose tissue (EAT) is a metabolically active tissue intimately associated with metabolic syndrome and cardiovascular disease. Quantification of EAT volume is an interesting clinical tool for the evaluation of cardiometabolic disease. Nevertheless, current methodology presents serious disadvantages. The soluble form of the receptor LRP1 (sLRP1) is a non-invasive biomarker of EAT in general population. Here, we analysed the potential of circulating sLRP1 as biomarker of EAT volume in patients with type 1 diabetes mellitus (T1DM). The study included a well-characterized cohort of T1DM patients without clinical cardiovascular disease (N = 73). EAT volume was assessed by a multidetector computed tomography (MDCT). sLRP1 and panel of inflammatory and endocrine mediators were measured using commercially available ELISA. EAT volume showed a direct association with circulating sLRP1 (β = 0.398, P = 0.001) in univariate linear regression analysis. This association was higher than that observed for other potential inflammatory and endocrine biomarkers. Using multivariate linear regression analyses, we demonstrated that the association between EAT volume and circulating sLRP1 was independent of potential confounding factors, including age, sex, body mass index, CRP, HbA1c and LDL-C (P < 0.050 for all multivariate linear regression models). In conclusion, sLRP1 is an independent biomarker of EAT in T1DM patients.

Nocturnal hypoxemic burden is associated with epicardial fat volume in patients with acute myocardial infarction.

Increased epicardial fat volume (EFV) is a common feature of patients with sleep-disordered breathing (SDB), is considered as an established marker of cardiovascular risk, and is associated with adverse cardiovascular events after myocardial infarction (MI). To investigate the association between different measures of SDB severity and EFV after acute MI, we enrolled 105 patients with acute MI in this study. Unattended in-hospital polysomnography was performed to determine the number of apneas and hypopneas per hour during sleep (apnea-hypopnea index, AHI). To determine nocturnal hypoxemic burden, we used pulse oximetry and applied a novel parameter, the hypoxia load representing the integrated area of desaturation divided by total sleep time (HLTST). Of 105 patients, 56 underwent cardiovascular magnetic resonance to define EFV. HLTST was significantly associated with EFV (r2 = 0.316, p = 0.025). Multivariate linear regression analysis accounting for age, sex, body mass index, smoking, and left ventricular mass demonstrated that the HLTST was an independent modulator of EFV (B-coefficient 0.435 (95% CI 0.021-0.591); p = 0.015). In contrast, AHI or established measures of hypoxemia did not correlate with EFV. HLTST, a novel parameter to determine nocturnal hypoxemic burden, and not AHI as an event-based measure of SDB, was associated with EFV in patients with acute MI. Further studies are warranted to confirm the link between nocturnal hypoxemia and EFV and to determine the prognostic value of a more detailed characterization of nocturnal hypoxemic burden in patients with high cardiovascular risk.

Cardiac magnetic resonance based evaluation of aortic stiffness and epicardial fat volume in patients with hypertension, diabetes mellitus, and myocardial infarction.

Background Aortic stiffness and epicardial fat relate to cardiovascular risk. Their relationship with each other and their role with hypertension, diabetes mellitus (DM), and myocardial infarction (MI) can be evaluated by cardiac magnetic resonance (CMR). Purpose To explore an association between aortic stiffness and epicardial as well as paracardial fat volume (EFV and ParaFV, respectively) in hypertensive patients and to relate the results to the presence of DM and MI. Material and Methods A total of 156 hypertensive and 20 non-hypertensive participants were examined at 1.5 Tesla. A 2D-velocity-encoded sequence was acquired to assess aortic pulse wave velocity (PWV in m/s) as a measure of aortic stiffness. A 3D-Dixon sequence was used to determine EFV and ParaFV. Results PWV correlated with EFV (R = 0.474; P < 0.001), but not with ParaFV. Fat volumes (in mL/m2) and PWV were lower in non-hypertensive controls compared to hypertensive patients. EFV and PWV were significantly higher in diabetic hypertensive patients without MI (n = 19; PWV: 10.4 ± 2.9; EFV: 92.5 ± 19.3) compared to hypertension-only patients (n = 84 [no DM or MI]; EFV: 64.8 ± 25.1, PWV: 9.0 ± 2.6; P < 0.05). Logistic regression analysis showed a significant association between the presence of a MI and a higher EFV ( P < 0.05), but not with PWV ( P = 0.060) or ParaFV ( P = 0.375). Conclusion A relationship between aortic stiffness and EFV was found in hypertensive patients. Both were increased in the presence of DM; however, only EFV was increased in the presence of MI. This may relate to the PWV lowering effect of the antihypertensive medication used by hypertensive patients and underscores the benefit of EFV assessment in this regard.

Correlations Between Severity of Coronary Lesions and Epicardial Fat Volume in Patients with Coronary Artery Disease – a Multislice CT-based Study

Abstract Background: Epicardial fat has been recently identified as a major player in the development of the atherosclerotic process. Study aim: The aim of this study was to correlate the epicardial fat volume (EFV), determined by Multisclice CT, and the severity of the coronary lesions, expressed by the Coronary Calcium Score (CCS) and Syntax Score (SxS) in patients with established coronary artery disease (CAD). Material and methods: One-hundred-twenty-six patients underwent Multisclice 64 CT assessment of coronary lesions and epicardial fat quantification. Calculation of CCS was performed on all the three coronary vessels and was followed by determination of SxS according to guidelines. The patients were divided into 2 groups: Group 1 – patients with CCS &gt;400 (n = 26), and Group 2 — patients with CaS &lt;400 (n = 100). Results: The mean age of the study population was 65.32 years for Group 1 and 54 years for Group 2 (p &lt;0.0001). However, patients &gt;65 years of age had a high CCS in a more significant extent than younger patients (50% in Group 1 vs. 17% in Group 2, p = 0.0115). Female gender was recorded in 48% of cases in Group 2 and in 19% of cases in Group 1 (p = 0.008). Several factors were identified in a higher extent in the group with high CCS as compared with the group with low CCS, such as the presence of significant stenosis (&gt;50%) of the left anterior descending artery (LAD) (46% vs. 9%, p &lt;0.0001), the presence of multi-vessel coronary disease (50% vs. 5%, p &lt;0.0001) and a high SxS, above 23 (23% vs. 4%, p = 0.006). The epicardial fat volume was 117.81 ± 40.4 ml (95% CI: 97.98–138.2 ml) in Group 2 and 89.77 ± 37.7 ml (95% CI: 80.4–101.5 ml) in Group 1 (p = 0.0033). Conclusions: Epicardial fat volume could represent a new imaging-derived biomarker, useful for classification of the severity of coronary artery disease, increased values of EFV being associated with other biomarkers of disease severity, such as calcium score.

Increased Regional Epicardial Fat Volume Associated with Reversible Myocardial Ischemia in Patients with Suspected Coronary Artery Disease

Epicardial adipose tissue is a source of pro-inflammatory cytokines and has been linked to the development of coronary artery disease. No study has systematically assessed the relationship between local epicardial fat volume (EFV) and myocardial perfusion defects. We analyzed EFV in patients undergoing SPECT myocardial perfusion imaging combined with computed tomography (CT) for attenuation correction. Low-dose CT without contrast was performed in 396 consecutive patients undergoing SPECT imaging for evaluation of coronary artery disease. Regional thickness, cross-sectional areas, and total EFV were assessed. 295 patients had normal myocardial perfusion scans and 101 had abnormal perfusion scans. Mean EFVs in normal, ischemic, and infarcted hearts were 99.8 ± 82.3 cm3, 156.4 ± 121.9 cm3, and 96.3 ± 102.1 cm3, respectively (P < 0.001). Reversible perfusion defects were associated with increased local EFV compared to normal perfusion in the distribution of the right (69.2 ± 51.5 vs 46.6 ± 32.0 cm3; P = 0.03) and left anterior descending coronary artery (87.1 ± 76.4 vs 46.7 ± 40.6 cm3; P = 0.005). Our results demonstrate increased regional epicardial fat in patients with active myocardial ischemia compared to patients with myocardial scar or normal perfusion on nuclear perfusion scans. Our results suggest a potential role for cardiac CT to improve risk stratification in patients with suspected coronary artery disease.

New evidences about the strict relationship between the epicardial fat and the aerobic exercise

Background/aimsIn this study, we report some experimental results about the strong correlation between the physical activity and the cardiovascular prevention that has been confirmed by many epidemiological studies. In particular, we examined the epicardial fat (EF) behavior in order to investigate its direct role in coronary disease through vasocrine and paracrine cytokines secretions. The purpose of this study was the determine the effects of aerobic exercise on epicardial fat volume in patients with metabolic syndrome. MethodsWe have studied, in primary prevention, 54 non-diabetic patients, 23 female and 31 male, mean age of 60±15years, affected by metabolic syndrome. Patients performed a multi detector computed tomography (MDCT) scan, a non-invasive approach for epicardial fat (EF) quantification ResultsOur findings show that sedentary patients exhibit an EF volume very high compared to subjects with moderate/intensive exercise training. These results, obtained in patients affected by metabolic syndrome, demonstrate sedentary patients to have an epicardial fat volume statistically higher compared to non-sedentary patients. ConclusionThis study confirms that lifestyle, and in particular aerobic exercise, plays a fundamental role in the cardiovascular risk prevention.

Epicardial fat and coronary artery calcification in patients on long-term hemodialysis.

Recent studies have shown a significant correlation between increased epicardial fat volume (EFV) and mortality, coronary artery disease events, and measures of coronary atherosclerotic burden, for example, coronary calcium. Patients with chronic kidney disease on hemodialysis have an increased prevalence of coronary atherosclerosis and coronary calcium. The mechanisms underlying both may differ from patients with normal kidney function. Only limited data are available on the relationship between epicardial fat and coronary calcium in these patients. Ninety-three consecutive patients (62 men and 31 women; mean age, 55 ± 11 years) with chronic kidney failure on regular hemodialysis underwent computed tomography for coronary calcium scoring as well as assessment of cardiovascular risk factors. Calcium scoring was performed using a low-dose, prospectively ECG-triggered high pitch spiral acquisition protocol (dual-source computed tomography, 280-millisecond (ms) rotation, 2 × 128 × 0.6-mm collimation, 120-kV tube voltage, 80-mA·s tube current). Cross-sectional images were reconstructed with 3.0-mm thickness, 1.5-mm increment, and a medium sharp reconstruction kernel (B35f). Agatston score and EVF were analyzed in a semiautomatic fashion using dedicated software. The mean duration of dialysis was 5.7 years. Of all patients, 93% had arterial hypertension, 66% had hyperlipidemia, 30% were diabetic, and 49.5% were current or prior smokers. The mean body mass index (BMI) was 27 ± 4 kg/m. The mean EFV was 162 ± 80 mL, and the mean coronary artery calcification (CAC) was 765 ± 1391 Agatston units (AU). In univariable and multivariable analysis, EFV was significantly correlated to BMI (P < 0.05) and age (P = 0.021), but not to CAC (P = 0.106). In subanalysis for values binned by median, we also found a significant correlation between EFV (binned) and smoking (P = 0.49) as well as a significant correlation between EFV (binned) and CAC for 46 patients younger than 55 years (median age). The epicardial fat volume in patients with chronic kidney disease and on hemodialysis is significantly correlated to BMI, age, and smoking but, with the exception of younger patients, not to the coronary calcium score. Our data suggest that in this special patient cohort, other mechanisms might influence the genesis of coronary calcification.

Relation of coronary collateral circulation with epicardial fat volume in patients with stable coronary artery disease.

ObjectiveTo investigated the relationship between epicardial fat volume (EFV) and coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD).MethodsThe study population consisted of 152 consecutive patients with CAD who underwent coronary angiography and were found to have at least 95% significiant lesion in at least one major coronary artery. EFV was assessed utilizing 64-multislice computed tomography. The patients were classifield into impaired CCC group (Group 1, Rentrop grades 0−1, n = 58), or adequate CCC (Group 2, Rentrop grades 2−3, n = 94).ResultsThe EFV values were significantly higher in paitients with adequate CCC than in those with impaired CCC. In multivariate logistic regression analysis, EFV (OR = 1.059; 95% CI: 1.035−1.085; P = 0.001); and presence of angina were independent predictors of adequate CCC. In receiver-operating characteristic curve analysis, the EFV value > 106.5 mL yielded an area under the curve value of 0.84, with the test sensitivity of 49.3%, and with 98.3% specifity.ConclusionsHigh EFV, and the presence of angina independently predict adequate CCC in patients with stable coronary artery disease. This association offers new diagnostic opportinities to assess collateral flow by conventional ultrasound techniques.

Evaluation of epicardial and intra-myocardial fat in a patient with mitochondrial cardiomyopathy

Mitochondrial cardiomyopathy is one of the main manifestations in patients with primary mitochondrial respiratory chain disease characterized by mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) and carries a similar prognosis. The phenotype frequently includes hypertrophic cardiomyopathy; dilated cardiomyopathy and left ventricular (LV) non-compaction are rarely present [ [1] Bates M.G. Bourke J.P. Giordano C. d'Amati G. Turnbull D.M. Taylor R.W. Cardiac involvement in mitochondrial DNA disease: clinical spectrum, diagnosis, and management. Eur Heart J. 2012; 33: 3023-3033 Crossref PubMed Scopus (147) Google Scholar ]. Cardiac magnetic resonance imaging (MRI) with gadolinium-based contrast agents has been widely used for evaluating the morphology and function of the left ventricle and injured myocardial tissue [ [2] Okayama S. Uemura S. Soeda T. et al. Clinical significance of papillary muscle late enhancement detected via cardiac magnetic resonance imaging in patients with single old myocardial infarction. Int J Cardiol. 2011; 146: 73-79 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar ]. Cine imaging with a standard steady state free precession sequence has been validated for accurate evaluation of epicardial fat [ [3] Nelson A.J. Worthley M.I. Psaltis P.J. et al. Validation of cardiovascular magnetic resonance assessment of pericardial adipose tissue volume. J Cardiovasc Magn Reson. 2009; 5: 15 Crossref Scopus (81) Google Scholar ], which is associated with coronary atherosclerosis and LV systolic dysfunction [ [4] Khawaja T. Greer C. Chokshi A. et al. Epicardial fat volume in patients with left ventricular systolic dysfunction. Am J Cardiol. 2011; 108: 397-401 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar ]. Recent advances in magnetic resonance spectroscopy (MRS) have enabled noninvasive measurement of intra-myocardial triglyceride content [ [5] Nakae I. Mitsunami K. Yoshino T. et al. Clinical features of myocardial triglyceride in different types of cardiomyopathy assessed by proton magnetic resonance spectroscopy: comparison with myocardial creatine. J Card Fail. 2010; 16: 812-822 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ], which is increased and associated with LV diastolic dysfunction in patients with diabetes mellitus [ 6 McGavock J.M. Lingvay I. Zib I. et al. Cardiac steatosis in diabetes mellitus: a 1H-magnetic resonance spectroscopy study. Circulation. 2007; 116: 1170-1175 Crossref PubMed Scopus (464) Google Scholar , 7 Rijzewijk L.J. van der Meer R.W. Smit J.W. et al. Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2 diabetes mellitus. J Am Coll Cardiol. 2008; 52: 1793-1799 Abstract Full Text Full Text PDF PubMed Scopus (423) Google Scholar ].

Cardiac 64-Multislice Computed Tomography Reveals Increased Epicardial Fat Volume in Patients With Acute Coronary Syndrome

Inflammatory cytokines released from epicardial fat around coronary arteries may modulate the coronary arteries and promote coronary atherosclerosis. We assessed the hypothesis that epicardial fat volume (EFV) is increased in patients with acute coronary syndrome (ACS). EFV was measured in 80 Japanese patients hospitalized for ACS using 64-multislice computed tomography. The ACS group included 51 patients with ST-segment elevated myocardial infarction and 29 patients with non-ST-segment elevated myocardial infarction. All patients underwent emergency coronary angioplasty and 64-multislice computed tomographic scanning during hospitalization. The control group included 90 consecutive outpatients with suspected ACS whose coronary computed tomographic results were normal. EFV was larger in patients with ACS than in the control group (117 ± 47 vs 95 ± 33 ml, p <0.001). Multivariate regression analysis showed that EFV was associated with age, body mass index, and visceral fat area in the control group. However, these correlations did not appear in the ACS group. Multivariate logistic regression analysis showed that EFV >100 ml was independently associated with ACS (odds ratio 2.84, 95% confidence interval 1.17 to 6.87, p = 0.021). Receiver operator characteristic analysis determined a cut-off value of 100.3 ml with a sensitivity of 75% and a specificity of 60% for ACS (area under the curve 0.692, 95% confidence interval 0.596 to 0.777, p <0.001). Compared to subcutaneous adipose tissue, epicardial adipose tissue showed inflammatory cell infiltrates on a micrograph. In conclusion, the present study demonstrated significantly increased EFV in patients with ACS. A large amount of epicardial fat may be a risk factor for ACS.

Epicardial Fat Volume in Patients With Left Ventricular Systolic Dysfunction

Epicardial adipose tissue has been linked to cardiovascular metabolism and inflammation and has been shown to predict prevalence and progression of coronary artery disease. Only limited data are available on the role of epicardial fat in patients with heart failure (HF). We analyzed cardiac adiposity and its relation to markers of morbidity and clinical outcome in patients with normal and impaired left ventricular (LV) function. Epicardial fat volume (EFV) and coronary artery calcium were measured in 381 patients (210 women and 171 men, mean age 55 ± 10 years) who underwent low-dose computed tomography. HF was defined by LV ejection fraction (EF) <55%. Three hundred twenty-one patients had an EF >55% (mean 63 ± 6) and 60 patients had an EF <55% (mean 41 ± 12). Subgroup analysis was performed according to degree of LV dysfunction in patients with HF (LVEF 35% to 55% or <35%). Mean EFVs were 114.5 ± 98.5 cm(3) in patients with normal EF and 83.5 ± 67.1 cm(3) in those with decreased EF (p <0.05). Mean EFVs were 96.1 ± 73.9 cm(3) in patients with moderate HF and 52.2 ± 29.7 cm(3) in patients with severe HF (p <0.05). Subgroup analysis revealed a persistently smaller EFV in patients with HF regardless of coronary artery calcium scores, markers of renal function, lipid metabolism, fasting blood glucose, or body mass index. In conclusion, our data demonstrate a stepwise decrease in EFV in patients with impaired cardiac function.