Periaortic Fat Research Articles

Correlation Between Aortic Adipose Tissue and the Indexed Aortic Diameter According to CT Angiography Findings

Background: Aortic aneurysms are dilatations of the aorta that carry a potential risk of rupture. The most common type is the abdominal aortic aneurysm (AAA), while thoracic aortic aneurysms, particularly those in the ascending part, are also significant. Perivascular adipose tissue is an ectopic fat that affects vessels locally by producing bioactive substances. Additionally, central obesity is associated with local aortic diseases. Objectives: The current study aimed to measure periaortic adipose tissue and evaluate its association with the indexed aortic diameter based on multidetector computed tomography (CT) scan findings. Methods: This retrospective and cross-sectional study was conducted in a tertiary center for cardiovascular diseases, continually recruiting 149 patients who had indications for thoracic and abdominal CT angiography. Patients with serious underlying diseases were excluded. The diameters of the aorta and adipose tissue, as well as Body Mass Index, were measured. Data analysis was performed using chi-square, Fisher exact, independent t-test, and Mann–Whitney test with SPSS software, version 16. Comparisons were performed using chi-square or Fisher exact tests for categorical variables, independent t-test for normally distributed data, and Mann–Whitney test for non-normally distributed data. Results: The study population consisted of 149 patients. The prevalence rates of thoracic aortic aneurysm and AAA were 8.7% and 24.8%, respectively. The prevalence of AAA was significantly higher in males (P = 0.025). Patients with AAA and an abdominal aortic diameter exceeding 30 mm were significantly older than the others (P = 0.003). There was a significant correlation between the fat volume around the aorta and the aortic diameter (P < 0.001, r = 0.504). Additionally, significant relationships were found between age and fat volume around both the thoracic and abdominal aorta (P < 0.001 and P < 0.007, r = 0.379 and r = 0.222, respectively), and between body mass index and fat volume around the abdominal aorta (P = 0.044, r = 0.165). Conclusions: The correlation between the volume of periaortic fat tissue and aortic aneurysms was significant in both the thoracic and abdominal aortae. The volume of periaortic fat in AAA was correlated with indexed values, unlike in thoracic aortic aneurysms. In candidates for aortic CT angiography, meticulous measurement of periaortic adipose tissue provides additional valuable data for optimal management.

Pericoronary adipose tissue attenuation in patients with acute aortic dissection based on coronary computed tomography angiography.

Periaortic fat is associated with coronary disease. Thus, it was hypothesized that the inflammation associated with acute aortic dissection (AAD) spreads to pericoronary adipose tissue (PCAT) via thoracic periaortic fat. Pericoronary adipose tissue attenuation (PCATa) serves as a marker for inflammation of perivascular adipose tissue (PVAT). This study sought to examine PCATa in individuals diagnosed with AAD. Consecutive patients with chest pain from May 2020 to September 2022 were prospectively enrolled in this study and underwent coronary computed tomography angiography (CCTA) and/or aorta computed tomography angiography (CTA). Based on the results of the CTA, the patients were divided into the following two groups: (I) the AAD group; and (II) the non-AAD group. PCATa of the right coronary angiography (RCA), left anterior descending (LAD), and left circumflex (LCx) was quantified for each patient using semi-automated software. The PCATa values were compared between the AAD and non-AAD patients according to the atherosclerosis of the coronary arteries. Similarly, the PCATa values of the AAD patients were compared between the preoperative and postoperative steady states. A total of 136 patients (42 female, 94 male; mean age: 63.3±11.9 years) were divided into the two groups according to the presence of aortic dissection on CTA. The RCAPCATa, LADPCATa, and LCxPCATa values were significantly higher in the AAD subjects than the non-AAD subjects, regardless of the presence or absence of atherosclerosis in the coronary arteries [-85.1±9.3 vs. -92.9±10.0 Hounsfield unit (HU); -83.2±7.4 vs. -89.9±9.1 HU; -77.5±8.4 vs. -85.6±7.9 HU, all P<0.001). The preoperative RCAPCATa, LADPCATa, and LCxPCATa values were higher in the AAD patients than the postoperative steady-state patients (-82.9±8.7 vs. -97.6±8.8 HU; -79.8±7.6 vs. -92.8±6.8 HU; -74.6±7.1 vs. -87.7±6.9 HU, all P<0.001). According to the multivariable logistic regression analysis, high RCAPCATa and LADPCATa values were associated with AAD regardless of the degree of stenosis [odds ratio (OR) =0.014; 95% confidence interval (CI): 0.001-0.177; P=0.001 and OR =0.010; 95% CI: 0.001-0.189; P=0.002]. PCATa on computed tomography was increased in patients with AAD regardless of the presence or absence of coronary artery disease (CAD). This suggests that vascular inflammation is present in AAD independent of CAD. Further research should be conducted to investigate the potential of this imaging biomarker to predict AAD and monitor patients' responses to therapies for AAD.

Adipocyte reconstitution of Npy4r gene in Npy4r silenced mice promotes diet-induced obesity.

Neural regulation of adipose tissue is crucial in the homeostasis of energy metabolism. Adipose tissue neuropeptide Y (NPY) and its receptors contribute to the development of diet-induced obesity. NPY1R and NPY2R are major receptors for NPY in peripheral tissues including the adipose tissue. NPY receptor 4 (Npy4r) gene is expressed in adipose tissue. However, it is unknown whether Npy4r is involved in the development of diet-induced obesity. Here, we established an immunofluorescence microscopy technique and generated an adipocyte-reconstituted Npy4r gene knockout mouse. Among six adipose depots, we found that NPY is highly expressed around the vasculature in a dot-like fashion in interscapular brown fat and subcutaneous fat, and NPY receptors are expressed in a depot-specific manner. NPY1R is highly expressed in epidydimal fat, interscapular and peri-aortic brown fat, NPY2R in both interscapular and peri-aortic brown fat, and NPY4R in both brown fat and epidydimal fat. Next, we showed that adipocyte-reconstituted expression of Npy4r promoted diet-induced obesity in mice (P < 0.0001). Overall, this study defines the abundance and distribution of NPY and its receptors 1, 2, and 4 in mouse adipose depots, and demonstrates in an adipocyte-reconstituted gene knockout model that adipocyte Npy4r is sufficient to promote diet-induced obesity.

Distribution of fat stores in young adults with different metabolic phenotypes

Adipose tissue is considered as an endocrine organ that affects the metabolic health of a person. Unified quantitative indicators of fat depots according to computed tomography have not been determined. Determination the critical level of intraabdominal, subcutaneous, epicardial, perivascular fat depots associated with metabolic syndrome in young adults is of scientific and practical interest.The aim of the study was to evaluate the distribution and relationship of fat depots with metabolic profile in young adults with different metabolic phenotypes, and to determine the critical level associated with metabolic syndrome (MS).Materials and methods: the study included 132 people (average age 37,59 ± 6,35 years). 3 groups were formed: 0 group – 16 healthy volunteers (median age 32 [27; 35); 1 group – 46 people with MSAO (40 years [34; 43); 2 group – 70 people with MS 40 years [35; 44. All the subjects were assessed for height, weight, waist circumference (WC), BMI. The following were evaluated: lipid profile, glucose, 2-hour glucose tolerance test, insulin, leptin, adiponectin, HOMA-IR. Performed by BPM. The volumes of subcutaneous, intraabdominal, perivascular, epicardial fats, the ratio of subcutaneous to intraabdominal fat were determined using computed tomography.Results: The maximum values of intraabdominal, epicardial and periportal fat were in individuals with MS – with an unhealthy metabolic phenotype. There was a significant association of the periaortic fat depot with the maximum number of MS indicators: lipid profile (p &lt; 0,01), glucose (p &lt; 0,01), systolic and diastolic blood pressure (p &lt; 0,01), WC (p &lt; 0,01). Intraabdominal and epicardial fat depots were significantly associated with the level of TG, HDL, glucose, with the level of pressure and WC (p &lt; 0,01). Subcutaneous fat had few reliable correlations, and was associated only with TG and WC (p &lt; 0,01). The critical level of periaortic fat associated with metabolic syndrome was &lt; 12,2 cm3 (AuROC 0,72, p &lt; 0,01), epicardial &lt; 88,5 cm3 (AuROC 0,69, p &lt; 0,01), intraabdominal &lt; 129,9 cm2 (AuROC 0,78, p &lt; 0,01), subcutaneous &lt; 330,0 cm2 (AuROC 0,61, p &lt; 0,01), the ratio of subcutaneous to intraabdominal &lt; 1,6 (AuROC 0,70, p &lt; 0,01).Conclusion: Critical values of periportal, epicardial, intraabdominal, subcutaneous and the ratio of subcutaneous to intraabdominal associated with the presence of metabolic syndrome were identified in young adults. The level of periportal fat &lt; 12,2 ml can be considered as a predictor of MS in young adults, but further studies are required.

Role of thoracic periaortic adipose tissue in major adverse cardiovascular events in heart failure

Abstract Objecitve: Adipose tissue is defined as a complex endocrine organ that exerts various regulatory functions and has effects on the cardiovascular system. Previous studies have shown that epicardial adipose tissue is associated with heart failure (HF) and cardiovascular outcome. The effect of thoracic periaortic fat tissue (PFT) on this issue is unknown. We aimed to investigate the relationship between PFT and long-term clinical outcomes in patients with HF. Materials and Methods: This retrospective cohort study included 71 patients with HF and 45 patients without HF. We calculated their PFT volumes by examining multi-detector computed tomography images with special software. Adverse cardiac events occurring within one year were recorded. Results: Adverse cardiac events were seen in 23 of the patients during follow-up. Only one of the events was in the healthy group. In the HF group, there was a statistically significant PFT volume compared to the healthy group (54.5 (41.2-66.5) vs. 42.1 (29.9-52.7), p= 0.014). Logistic regression analysis showed that PFT was an independent predictor of MACE (hazard ratio [HR]: 0.96; 95% CI: 0.94-0.99; p = 0.027). Conclusion: The study has shown for the first time in the literature that PFT volume can be a useful parameter in predicting adverse cardiac events in the follow-up of patients with HF.

S3464 Primary Aortoduodenal Fistula as a Complication of Mycotic Aortitis

Introduction: Mycotic aortitis is an uncommon diagnosis that is almost universally fatal if not diagnosed and treated quickly. Primary aortoenteral fistula is a rare, equally life-threatening complication of mycotic aortitis due to localized inflammation of the aorta and the anatomical proximity of the bowel. The duodenum is the most common segment of bowel involved as it is located directly anterior to the aorta. Just over 250 cases have been documented between 1951 and 2010. With mortality approaching 100%, a high clinical suspicion is required for timely diagnosis and treatment. Case Description/Methods: Here we present the case of a 54-year-old male with a 3 month history of vague abdominal pain. He was recently diagnosed with an unspecified abdominal mass, suspected to be malignancy. A PET scan revealed a hypermetabolic retroperitoneal mass with a biopsy planned at a later date. Before biopsy, the patient had acutely worsening abdominal pain and presented to the emergency department. An abdominal angiogram revealed an irregular saccular infrarenal abdominal aortic aneurysm with a mural thrombus and periaortic fat stranding with mural enhancement consistent with aortitis (Figure A, B, C). These findings were in the same location as the previously noted hypermetabolic retroperitoneal mass. Evaluation also revealed Methicillin sensitive Staphylococcus aureus bacteremia. The patient was diagnosed with mycotic aortitis and initiated on Ertapenem. He subsequently underwent an open procedure for aortic aneurysm repair with extensive debridement, where he was found to have a primary aortoduodenal fistula (PADF) with extensive spillage of duodenal contents. The area was debrided and the fistula repaired with plans to repair the aneurysm at a later time following resolution of severe localized inflammation. Discussion: PDAF is a difficult diagnosis to make due to its low incidence and often vague symptoms. The classic triad of symptoms, in order of most to least common, includes gastrointestinal bleed, abdominal pain, and a pulsatile abdominal mass. However, this triad is only present in 10-11% of cases. Although gastrointestinal bleeding is the most common symptom, it is not present in over 60% of patients. Even with proper treatment, aortitis and primary aortoenteral fistulas both have an exceedingly high mortality rate. Quickly recognizing mycotic aortitis and planning an open surgical intervention led to the diagnosis of PADF in our patient which may have prevented his mortality.Figure 1.: A) Transverse slice from CT abdomen and pelvis revealing 23mm x 38mm abdominal aortic aneurysm. B) Sagittal slice from CT Abdomen and pelvis with IV contrast revealing abdominal aortic aneurysm with thrombus. C) Transverse slice from CT abdomen and pelvis with IV contrast revealing extravasation of blood from the abdominal aorta into the duodenum and surrounding tissues.

Both epicardial and peri-aortic adipose tissue blunt heart rate recovery beyond body fat mass.

BackgroundEpicardial adipose tissue (EAT) as a marker of metabolic disorders has been shown to be closely associated with a variety of unfavorable cardiovascular events and cardiac arrhythmias. Data on regional-specific visceral adiposity outside the heart and its modulation on autonomic dysfunction, particularly heart rate recovery after exercise, remain obscure.MethodsWe studied 156 consecutive subjects (mean age: 49.3 ± 8.0 years) who underwent annual health surveys and completed treadmill tests. Multi-detector computed tomography-based visceral adiposity, including EAT and peri-aortic fat (PAF) tissue, was quantified using dedicated software (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). We further correlated EAT and PAF with blood pressure and heart rate (HR) recovery information from an exercise treadmill test. Metabolic abnormalities were scored by anthropometrics in combination with biochemical data.ResultsIncreased EAT and PAF were both associated with a smaller reduction in systolic blood pressure during the hyperventilation stage before exercise compared to supine status (β-coefficient (coef.): −0.19 and −0.23, respectively, both p < 0.05). Both visceral adipose tissue mediated an inverted relationship with heart rate recovery at 3 (EAT: β-coef.: −0.3; PAF: β-coef.: −0.36) and 6 min (EAT: β-coef.: −0.32; PAF: β-coef.: −0.34) after peak exercise, even after adjusting for baseline clinical variables and body fat composition (all p < 0.05).ConclusionExcessive visceral adiposity, whether proximal or distal to the heart, may modulate the autonomic response by lowering the rate of HR recovery from exercise after accounting for clinical metabolic index. Cardiac autonomic dysfunction may partly explain the increase in cardiovascular morbidity and mortality related to both visceral fats.

The association of pericardial fat and peri-aortic fat with severity of nonalcoholic fatty liver disease

Visceral adipose tissue (VAT) is associated with central obesity, insulin resistance and metabolic syndrome. However, the association of body-site specific adiposity and non-alcoholic fatty liver disease (NAFLD) has not been well characterized. We studies 704 consecutive subjects who underwent annual health survey in Taiwan. All subjects have been divided into three groups including normal (341), mild (227) and moderate and severe (136) NAFLD according to ultrasound finding. Pericardial (PCF) and thoracic peri-aortic adipose tissue (TAT) burden was assessed using a non-contrast 16-slice multi-detector computed tomography (MDCT) dataset with off-line measurement (Aquarius 3DWorkstation, TeraRecon, SanMateo, CA, USA). We explored the relationship between PCF/TAT, NAFLD and cardiometabolic risk profiles. Patients with moderate and mild NAFLD have greater volume of PCF (100.7 ± 26.3vs. 77.1 ± 21.3 vs. 61.7 ± 21.6 ml, P < 0.001) and TAT (11.2 ± 4.1 vs. 7.6 ± 2.6 vs. 5.5 ± 2.6 ml, P < 0.001) when compared to the normal groups. Both PCF and TAT remained independently associated with NAFLD after counting for age, sex, triglyceride, cholesterol and other cardiometabolic risk factors. In addition, both PCF and TAT provided incremental prediction value for NAFLD diagnosis. (AUROC: 0.85 and 0.87, 95%, confidence interval: 0.82–0.89 and 0.84–0.90). Both visceral adipose tissues strongly correlated with the severity of NAFLD. Compared to PCF, TAT is more tightly associated with NAFLD diagnosis in a large Asian population.

Quantification of periaortic adipose tissue in contrast-enhanced CT angiography: technical feasibility and methodological considerations

To examine the feasibility of the quantification of abdominal periaortic fat tissue (PaFT) (tissue within − 45 to − 195 HU) in enhanced CT-angiographies compared to unenhanced CT-scans and identify methodological issues affecting its clinical implementation. Using OsirixMD, PaFT volume and mean HU value were retrospectively measured within a 5 mm periaortic ring in paired unenhanced and enhanced abdominal aortic CT-scans. The correlation between PaFT values was examined in a derivation cohort (n = 101) and linear regression analysis produced correction factors to convert values from enhanced into values from unenhanced CTs. The conversion factors were then applied to enhanced CTs in a different validation cohort (n = 47) and agreement of corrected enhanced values with values from unenhanced scans was evaluated. Correlation between PaFT Volume und Mean HU from enhanced and unenhanced scans was very high (r > 0.99 and r = 0.95, respectively, p < 0.0001 for both). The correction factors for PaFT Volume and Mean HU were 1.1057 and 1.0011. Potential confounding factors (CT-kilovoltage, slice thickness, mean intraluminal contrast density, aortic wall calcification, longitudinal variation of intraluminal contrast density, aortic diameter) showed no significant effect in a multivariate regression analysis (p > 0.05). Bland-Altman analysis of corrected enhanced and unenhanced values showed excellent agreement and Passing–Bablok regression confirmed minimal/no residual bias. PaFT can be quantified in enhanced CT-angiographies very reliably. PaFT Volume scores are very consistently slightly underestimated in enhanced scans by about 10%, while the PaFT Mean HU value remains practically constant and offers distinct methodological advantages. However, a number of methodological issues remain to be addressed.

Ultrasound-Based Assessment of Preperitoneal Fat as a Surrogate Marker of Cardiovascular Risk: Comparative Study Between People Living with HIV and Controls.

Optimal management of cardiovascular disease should start with the identification of subjects at subclinical stages. However, available tools are not always accurate or affordable. We assess the usefulness of ultrasound-guided measurement of abdominal fat layers as a surrogate marker of cardiovascular risk. We performed a cross-sectional, case-control, exploratory, pilot study in 10 people living with HIV (PLWH) and 10 HIV-uninfected subjects (control group) matched for age, sex, and body mass index. All participants were men 45-60 years of age, with no active disease or previous abdominal surgery; the PLWH group had been virologically suppressed for ≥2 years under stable antiretroviral therapy. The thickness of abdominal superficial and deep subcutaneous fat, preperitoneal fat, omental (periaortic) fat, and retroperitoneal (perirenal) fat was compared between both groups. Correlations between fat layers and traditional markers of cardiovascular risk were assessed. The thickness of most layers was always higher among PLWH. The differences were statistically significant for the preperitoneal fat layer (p = .04). The presence of atherosclerotic plaque was correlated with the preperitoneal fat layer in the PLWH group (odds ratio = 1.49, p = .02), and metabolic syndrome was correlated with superficial subcutaneous fat, although this was low (odds ratio = 0.54, p = .02). In the control group, several associations were found between carotid intima media thickness and abdominal fat layers. All abdominal fat layers were thicker in the PLWH group, especially preperitoneal fat, and several associations were found between specific fat layers and traditional cardiovascular risk markers. Our results suggest that the thickness of abdominal fat layers, assessed by ultrasound, could be a marker of cardiovascular risk. However, further studies with larger populations are required to confirm these findings.

Features of infective native aortic aneurysms on computed tomography

BackgroundInfective native aortic aneurysm (INAA) is a rare clinical diagnosis. The purpose of this study was to describe the CT findings of INAAs in detail.MethodsThis was a retrospective single-center study of INAA patients at a major referral hospital between 2005 and 2020. All images were reviewed according to a protocol consisting of aneurysm features, periaortic findings, and associated surrounding structures.ResultsOne hundred and fourteen patients (mean age, 66 years [standard deviation, 11 years]; 91 men) with 132 aneurysms were included. The most common locations were infrarenal (50.8%), aortoiliac (15.2%), and juxtarenal (12.9%). The mean transaxial diameter was 6.2 cm. Most INAAs were saccular (87.9%) and multilobulated (91.7%). Calcified aortic plaque was present in 93.2% and within the aneurysm in 51.5%. INAA instability was classified as contained rupture (27.3%), impending rupture (26.5%), and free rupture (3.8%). Rapid expansion was demonstrated in 13 of 14 (92.9%) aneurysms with sequential CT studies. Periaortic inflammation was demonstrated as periaortic enhancement (94.7%), fat stranding (93.9%), soft-tissue mass (92.4%), and lymphadenopathy (62.1%). Surrounding involvement included psoas muscle (17.8%), spondylitis (11.4%), and perinephric region (2.8%). Twelve patients demonstrated thoracic and abdominal INAA complications: fistulas to the esophagus (20%), bronchus (16%), bowel (1.9%), and inferior vena cava (IVC) (0.9%).ConclusionThe most common CT features of INAA were saccular aneurysm, multilobulation, and calcified plaques. The most frequent periaortic findings were enhancement, fat stranding, and soft-tissue mass. Surrounding involvement, including psoas muscle, IVC, gastrointestinal tract, and bronchi, was infrequent but may develop as critical INAA complications.

Technical Feasibility of Aortic Wall Calcium and Peri-Aortic Fat Tissue Quantification Using CT Angiography Images

Technical Feasibility of Aortic Wall Calcium and Peri-Aortic Fat Tissue Quantification Using CT Angiography Images

Epicardial and periaortic fat characteristics in ischemic stroke: Relationship with stroke etiology and calcification burden

PurposeWe explored epicardial (EAT) and periaortic (PAT) adipose tissue characteristics in patients with acute ischemic stroke (AIS), and the relationship with stroke etiology, calcification burden, and inflammation. MethodWe included a retrospective cohort of consecutive patients admitted with AIS between 2015 and 2020 who underwent a chest computed tomography. We calculated volumes and attenuation of EAT and PAT, and coronary artery (CAC), and thoracic aortic (TAC) calcification. Admission’s neutrophil/lymphocyte ratio (NLR) was recorded. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS), and patients were discriminated between cardioembolic (CE), non-CE, and embolic strokes of uncertain source (ESUS). ResultsA total of 182 patients were included. EAT (non-CE 127.4 ± 47.1 cm3; CE 133.3 ± 56.7 cm3; ESUS 121.6 ± 63.5 cm3, p > 0.05) and PAT (non-CE 37.4 ± 18.6 cm3; CE 40.4 ± 17.2 cm3; ESUS 34.5 ± 14.1 cm3, p > 0.05) volumes were similar between stroke etiologies. Patients with CE stroke had higher PAT attenuation (PAT = non-CE −84.4 ± 7.0 HU; CE −78.1 ± 9.9 HU; ESUS −82.3 ± 9.3 HU, p < 0.001). Using multiple linear regression, albeit weak, we found a significant relationship between NLR and PAT attenuation [Beta 0.24; (95% CI 0.04–0.51), p < 0.05). Despite similar volume, PAT attenuation was higher (p < 0.01) among demised patients. ConclusionIn this study, we identified higher periaortic fat attenuation, despite similar fat volume, in patients with CE stroke.

Association of Region-Specific Cardiac Adiposity With Dysglycemia and New-Onset Diabetes.

BackgroundVisceral adipose tissue is assumed to be an important indicator for insulin resistance and diabetes beyond overweight/obesity. We hypothesized that region‐specific visceral adipose tissue may regulate differential biological effects for new‐onset diabetes regardless of overall obesity.Methods and ResultsWe quantified various visceral adipose tissue measures, including epicardial adipose tissue, paracardial adipose tissue, interatrial fat, periaortic fat, and thoracic aortic adipose tissue in 1039 consecutive asymptomatic participants who underwent multidetector computed tomography. We explored the associations of visceral adipose tissue with baseline dysglycemic indices and new‐onset diabetes. Epicardial adipose tissue, paracardial adipose tissue, interatrial fat, periaortic fat, and thoracic aortic adipose tissue were differentially and independently associated with dysglycemic indices (fasting glucose, postprandial glucose, HbA1c, and homeostasis model assessment of insulin resistance) beyond anthropometric measures. The superimposition of interatrial fat and thoracic aortic adipose tissue on age, sex, body mass index, and baseline homeostasis model assessment of insulin resistance expanded the likelihood of baseline diabetes (from 67.2 to 86.0 and 64.4 to 70.8, P for ∆ ꭕ2: <0.001 and 0.011, respectively). Compared with the first tertile, the highest interatrial fat tertile showed a nearly doubled risk for new‐onset diabetes (hazard ratio, 2.09 [95% CI, 1.38–3.15], P<0.001) after adjusting for Chinese Visceral Adiposity Index.ConclusionsRegion‐specific visceral adiposity may not perform equally in discriminating baseline dysglycemia or diabetes, and showed differential predictive performance in new‐onset diabetes. Our data suggested that interatrial fat may serve as a potential marker for new‐onset diabetes.

The Hyperattenuating Crescent Sign Is Not Necessarily a Sign of Impending Aortic Aneurysm Rupture

The "crescent sign" is a hyperattenuating crescent-shaped region on CT within the mural thrombus or wall of an aortic aneurysm. Although it has previously been associated with aneurysm instability or impending rupture, the literature is largely based on retrospective analyses of urgently repaired aneurysms. We strove to more rigorously assess the association between an isolated "crescent sign" and risk of impending aortic rupture. Patients were identified by querying a single health system PACS database for radiology reports noting a crescent sign. Adult patients with a CT demonstrating a descending thoracic, thoracoabdominal, or abdominal aortic aneurysm and "crescent sign" between 2004 and 2019 were included, with exclusion of those showing definitive signs of aortic rupture on imaging. A total of 82 patients were identified. Aneurysm size was 7.1 ± 2.0 cm. Thirty patients had emergent or urgent repairs during their index admission (37%), 19 had elective repairs at a later date (23%), and 33 patients had no intervention due to either patient choice or prohibitive medical comorbidities (40%). Patients without intervention had a median follow up of 275 days before death or loss to follow up. In patients undergoing elective intervention, 6,968 patient-days elapsed between presentation and repair, with zero episodes of acute rupture (median 105 days). Patients undergoing elective repair had smaller aneurysms compared to those who underwent emergent/urgent repair (6.2 ± 1.3 vs. 7.7 ± 2.1 cm, P=0.008). No surgical candidate with an aneurysm smaller than 8 cm ruptured. There were 31 patients with previous axial imaging within 2 years prior to presentation with a "crescent sign," with mean aneurysm growth rate of 0.85 ± 0.62 cm per 6 months [median 0.65, range 0-2.6]. Those with aneurysms sized below 5.5 cm displayed decreased aneurysm growth compared to patients with aneurysm's sized 5.5-6.5 cm or patients with aneurysms greater than 6.5 cm (0.12 vs. 0.64 vs. 1.16 cm per 6 months, P= 0.002). The finding of an isolated radiographic "crescent sign" without other signs of definitive aortic rupture (i.e., hemothorax, aortic wall disruption, retroperitoneal bleeding) is not necessarily an indicator of impending aortic rupture, but may be found in the setting of rapid aneurysm growth. Many factors, including other associated radiographic findings, aneurysm size and growth rate, and patient symptomatology, should guide aneurysm management in these patients. We found that patients with minimal symptoms, aneurysm sizes below 6.5 cm, and no further imaging findings of aneurysm instability, such as periaortic fat stranding, can be successfully managed with elective intervention after optimization of comorbid factors with no evidence of adverse outcomes.

Association of Periaortic Fat and Abdominal Visceral Fat with Coronary Artery Atherosclerosis in Chinese Middle Aged and Elderly Patients Undergoing Computed Tomography Coronary Angiography.

Background and Aims:Coronary artery disease (CAD) is usually caused by atherosclerosis, which is associated with general obesity and stronger associations with localized ectopic fat depots have been reported. We measured body ectopic fat distribution in Chinese patients to determine the association with coronary artery atherosclerosis (CA).Methods:Patients undergoing coronary computed tomography angiography (CCTA) who agreed to participate in the study (n = 750, 50.4% men, mean age 64.8 years) had cardiovascular disease and risk assessment. Body ectopic fat depots were measured from CT and their association with CA, determined from CCTA, was evaluated by univariate and multivariate logistic regression models.Results:CAD with CA (CAD-CA) was present in 57.2% of participants with CAD of moderate/severe CA (CAD-msCA) present in 23.5% and both were significantly more frequent in men than in women. Overall, men had greater body mass index (BMI) but there was no difference in waist circumference (WC) between genders. However, significantly higher visceral adipose tissue (VAT) and periaortic fat volume (PAFV) were observed in men, whereas women had significantly higher abdominal subcutaneous adipose tissue (SAT). With increasing age, there was a significant decline in BMI, WC and SAT in men, but a significant increase of WC and VAT, PAFV and epicardial fat volume (EFV) in women. A high proportion of non-calcified plaques was observed in CAD-CA, 55.3% in CAD of minimal/mild CA (CAD-mmCA) with 38.7% exclusively non-calcified plaques, and 59.7% in CAD-msCA with multiple type plaques containing non-calcified ones. Multivariate logistic regression showed a significant association of PAFV with CAD-CA and CAD-msCA that was independent of general obesity and clinical risk factors, and independent of abdominal obesity in the highest PAFV quartile patients. VATA was associated with an increased prevalence of CAD-msCA in the patients in the upper 2 VATA quartiles that was independent of clinical risk factors and both general and abdominal obesity.Conclusions:We found age and gender differences of body ectopic fat distribution in Chinese patients with higher VAT and PAFV in men and higher SAT in women. With increased age, there was a decline of WC and SAT in men but not in women and an increase in WC, VAT and PAFV in women but not in men. PAFV was significantly associated with overall CAD-CA and CAD-msCA, while VAT was associated with CAD-msCA.

Abdominal periaortic and renal sinus fat attenuation indices measured on computed tomography are associated with metabolic syndrome.

To investigate the association between abdominal periaortic (APA) and renal sinus (RS) fat attenuation index (FAI) measured on MDCT and metabolic syndrome in non-obese and obese individuals. Visceral, subcutaneous, RS, and APA adipose tissue were measured in preoperative abdominal CT scans of individuals who underwent donor nephrectomy (n = 84) or bariatric surgery (n = 155). FAI was defined as the mean attenuation of measured fat volume. Participants were categorized into four groups: non-obese without metabolic syndrome (n = 64), non-obese with metabolic syndrome (n = 25), obese without metabolic syndrome (n = 21), and obese with metabolic syndrome (n = 129). The volume and FAI of each fat segment were compared among the groups. Receiver operator characteristics curve analysis was used to assess the association between the FAIs and metabolic syndrome. FAIs of all abdominal fat segments were significantly lower in the obese group than in the non-obese group (p < 0.001). RS, APA, and the visceral adipose tissue FAIs were significantly lower in participants with metabolic syndrome than in those without metabolic syndrome in the non-obese group (p < 0.001, p = 0.006, and p < 0.001, respectively). The area under the curve for predicting metabolic syndrome was significantly higher for APA FAI (0.790) than subcutaneous, visceral, and RS FAI in all groups (0.649, 0.647, and 0.655, respectively). Both metabolic syndrome and obesity were associated with lower RS and APA adipose tissue FAI, and APA FAI performed best for predicting metabolic syndrome. • The volume and FAI of RS, APA, and visceral adipose tissue showed opposite trends with regard to metabolic syndrome or obesity. • Both metabolic syndrome and obesity were associated with lower RS FAI and APA FAI. • APA FAIperformed best for predicting metabolic syndrome among FAIs of abdominal fat segments.

RELATION OF PERIAORTIC ADIPOSE TISSUE WITH PARAMETERS OF METABOLIC SYNDROME IN YOUNG PEOPLE WITH ABDOMINAL OBESITY

Objective: The main aim of study was to investigate the association between periaortic fat (PF) and metabolic parameters, subcutaneous (SF), visceral (VF), epicardial (EF) fat in patients with abdominal obesity (AO). Design and method: 127 patients 18–45 y.o. (average age 38,4 ± 6,0) with AO (men (M) – 58,3%) were enrolled in study. Height, weight, BMI, waist circumference, blood tests (fast glucose (FG),glucose tolerance (GT), insulin, HOMA-IR, lipid profile) were measured. MS was defined as AO (cut-off of &gt; 80 cm in women (W) and &gt; 94 cm in M) plus &gt; 1 sign: HDL &lt; 1,30 (w)/1,04(m)mmol/l; triglycerides &gt; 1,7mmol/l; FG &gt; 5,6mmol/l; violation GT; BP &gt; 140/90mmHg. SF, VF, PF, EF (range: -150 to -30 HU) was measured by computed tomography. We calculated ratio subcutaneous to visceral fat (RSV). 24 hour blood pressure monitoring was performed. We formed 2 groups: AO (AO plus 1 or less sing of MS) and MS. Results: Tab. 1. Correlations PF with sex r = 0,223 (p = 0,009), with BMI r = 0,347 (p = 0,000), with WC r = 0,525 (p = 0,000), with uric acid r = 0,425 (p = 0,000), FG r = 0,27 (p = 0,002), insulin level r = 0,40 (p = 0,000), with HOMA r = 0,41 (p = 0,000), TG r = 0,32 (p = 0,000), HDL r = -0,37 (p = 0,000), LDL r = 0,23 (p = 0,005), with VF r = 0,55 (p = 0,000), SF r = 0,31 (p = 0,000), EF r = 0,69 (p = 0,000), RSV r = -0,300 (p = 0,000) were found. Conclusions: PF are directly related to most of metabolically parameters. PF in people with abdominal obesity is involved in metabolic syndrome.

Subclinical Hypothyroidism Represents Visceral Adipose Indices, Especially in Women With Cardiovascular Risk.

Context From previous studies, decreased thermogenesis and metabolic rate in the patients with overt and subclinical hypothyroidism lead to an increase in visceral adipose tissue (VAT) incidence, and which was associated with cardiovascular diseases. In this paper, we want to explore the relationship between various forms of VAT [pericardial (PCF), and thoracic periaortic adipose tissue (TAT)] and obesity indices [body shape index (ABSI), and body roundness index (BRI), Chinese visceral adiposity index (CVAI)] with subclinical hypothyroidism by gender.Objective This study aims to evaluate region-specific cardiovascular (CV) fat tissue (pericardial fat [PCF] and thoracic periaortic fat [TAT) and noninvasive visceral adipose indices (a body shape index [ABSI], body roundness index [BRI]), and Chinese visceral adiposity index [CVAI]) in patients with subclinical hypothyroidism (SCH) as compared to a control population and relative to variations in CV risk.MethodsA total of 125 Taiwanese patients recently diagnosed with SCH (age: 52.9 ± 10.16 years, 41.6% female) and 1519 healthy volunteers (age: 49.54 ± 9.77 years, 29.0% female) were evaluated for this study. All participants underwent PCF and TAT assessment using a multidetector computed tomography scanner, ABSI, BRI, and CVAI evaluation using a mathematical formula. CV risk was classified by Framingham risk score (FRS).ResultsMultivariable logistic regression models showed that the independent association of TAT and BRI with SCH were stronger in women than men. The adjusted model associations (odds ratio [OR]; 95% CI) with SCH for TAT and BRI in women were 2.61 (95% CI, 1.03-6.97) and 2.04 (95% CI, 1.07-3.92). The incidences of TAT and BRI third tertile were also higher in women with SCH (SCH vs euthyroid, TAT third tertile, 9 [17.3%] vs 35 [7.9%], P = .04; BRI third tertile, 22 [42.3%] vs 111 [25.2%], P = .01). In addition to BRI and TAT, there were higher risks of CVAI in SCH with intermediate/high FRS, especially in women (OR; 95% CI, TAT: 4.01; 95% CI, 1.01-6.640; BRI: 6.91; 95% CI, 1.03-10.23; CVAI: 7.81 95% CI, 1.01-12.03).ConclusionOur findings show that patients with SCH have significantly greater TAT, BRI, and CVAI values than control groups, especially in women (with different FRS).

Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype.

The debate regarding the actual cardiovascular burden in metabolically healthy obese or metabolically unhealthy non-obesity individuals is ongoing. Accumulating data have suggested a unique pathophysiological role of pro-inflammatory cytokines in mediating metabolic and cardiovascular disorders by dysregulated visceral adiposity. To compare the burden of visceral adiposity, the inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and the prevalent atherosclerotic burden in metabolically healthy obese (MHO) or metabolically unhealthy (MU) populations, were compared to those of metabolically healthy non-obesity subjects (MHNO). Coronary artery calcification score (CACS) and visceral fat, including pericardial fat (PCF)/thoracic peri-aortic fat (TAT), were quantified in 2846 asymptomatic subjects using a CT dataset. A cross-sectional analysis comparing CACS, inflammatory marker hs-CRP, and visceral fat burden among four obesity phenotypes (MHNO, metabolically unhealthy non-obesity (MUNO), MHO, and metabolically unhealthy obese (MUO)) was performed. Both MUNO and MUO demonstrated significantly higher hs-CRP and greater CACS than MHNO/MHO (adjusted coefficient: 25.46, 95% confidence interval (CI): 5.29–45.63; 43.55, 95% CI: 23.38–63.73 for MUNO and MUO (MHNO as reference); both p < 0.05). Visceral fat (PCF/TAT) was an independent determinant of MU and was similarly higher in the MUNO/MHO groups than in the MHNO group, with the MUO group having the largest amount. PCF/TAT, obesity, and MU remained significantly associated with higher CACS even after adjustment, with larger PCF/TAT modified effects for MU and diabetes in CACS (both pinteraction < 0.05). MU tightly linked to excessive visceral adiposity was a strong and independent risk factor for coronary atherosclerosis even in lean individuals, which could be partially explained by its coalignment with pathological pro-inflammatory signaling.