The relationship between location-specific epicardial adipose tissue volume and coronary atherosclerotic plaque burden in type 2 diabetic patients (original) (raw)
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Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology
Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot that plays an important role in coronary atherosclerosis. In this study, our aim was to investigate the relationship between long-term major adverse cardiovascular events (MACEs) and EAT volume detected by coronary computed tomography angiography (CCTA) in patients with Type 2 diabetes mellitus (T2-DM) without previous coronary events. Methods: A total of 127 patients with diabetes who underwent CCTA between 2012 and 2014 were enrolled retrospectively. The study population was divided into 2 groups according to whether they experienced or did not experience MACE, which was defined as cardiac death, non-fatal myocardial infarction or unstable angina requiring hospitalization, coronary revascularizations (percutaneous coronary intervention or coronary artery bypass grafting surgery), heart failure, peripheral arterial disease, or ischemic stroke. In both groups, EAT volumes were measured by CCTA. Results: During 60±7 months follow-up period, 22 participants experienced MACEs. Data were evaluated with univariate and multivariate analyses and receiver operating characteristic (ROC) analysis. Age, male sex, coronary artery disease, hemoglobin A1c, glucose, creatinine, C-reactive protein, and cholesterol levels were found to be associated with MACE. EAT volume (odds ratio [OR]: 1.027; 95% confidence interval [CI]: 1.010-1.044, p=0.002) and low-density lipoprotein (OR: 1.015; 95% CI: 1.000-1.030, p=0.050) were found to be independent predictors for MACE. ROC analysis indicated that EAT volumes >123.2 mL had a 72.7% sensitivity and a 77.1% specificity for predicting long-term MACE in patients with T2-DM (area under the curve: 0.820; 95% CI: 0.733-0.908). Conclusion: EAT volume is an independent predictor of long-term MACE in patients with T2-DM without previous coronary events. EAT volume may be used additionally in risk stratification for MACE besides the well-known vascular risk factors in patients with T2-DM. Amaç: Epikardiyal yağ dokusu (EYD) koroner aterosklerozda önemli rol oynayan metabolik olarak aktif viseral yağ deposudur. Çalışmamızda amacımız koroner olay geçirmemiş tip 2 diyabetik (T2-DM) hastalarda uzun dönem majör istenmeyen kardiyovasküler olay (MİKO) ile koroner bilgisayarlı tomografi anjiyografi (KBTA) ile ölçülen EYD hacim ilişkisini değerlendirmektir. Yöntemler: 2012-2014 yılları arasında KBTA yapılmış toplam 127 diyabetik hasta retrospektif olarak çalışmaya dahil edildi. Hastalar MİKO varlığına göre iki gruba ayrıldı. MİKO kardiyak ölüm, hastane yatışı gerektiren ölümcül olmayan miyokart enfarktüsü ya da kararsız angina, koroner revaskülarizasyon (perkütan koroner girişim, koroner arter baypas greftleme cerrahisi), kalp yetersizliği, periferik arter hastalığı, iskemik inme olarak tanımlandı. İki grubun EYD hacmi KBTA ile ölçüldü. Bulgular: 60±7 aylık takip süresinde 22 MİKO tespit edildi. Tek ve çok değişkenli analizler ve alıcı işlem karakteristiği (ROC) analizi ile veriler değerlendirildi. Yaş, erkek cinsiyet, koroner arter hastalığı, hemoglobin A1c, glukoz, kreatinin, C-reaktif protein (CRP) ve kolesterol kan düzeyleri MİKO ile ilişkili bulundu. EYD hacmi (OR: 1.027; %95 GA: 1.010-1.044, p: 0.002) ve düşük dansiteli (yoğunluklu) lipoprotein (OR: 1.015; 95% CI: 1.000-1.030, p: 0.050) MİKO için bağımsız öngördürücü olarak bulundu. ROC analiz sonucuna göre 123.2 mL üzerinde EYD hacmi, %72.7 duyarlılık ve %77.1 özgüllük ile T2-DM hastalarında uzun dönem MİKO'yu öngördürür (Eğri altındaki alan: 0.820; %95 CI: 0.733-0.908). Sonuç: EYD hacmi, öncesinde koroner olay geçirmemiş T2-DM hastalarda uzun dönem MİKO'yu bağımsız olarak öngördürebilmektedir. EYD hacmi T2-DM hastalarda iyi bilinen vasküler risk faktörleri yanı sıra risk sınıflamasında ek olarak kullanılabilir.
Diabetes Research and Clinical Practice, 2014
Aims-The association between epicardial adipose tissue (EAT) volume and coronary artery disease (CAD) severity was evaluated, independent of traditional risk factors and coronary artery calcium (CAC) scores, in patients with diabetes type 2 (DM-2) using cardiac computed tomography angiography (CTA). Methods-A multivariate analysis was utilized to assess for an independent association after calculating EAT volume, CAD severity, and calcium scores in 92 patients with DM-II from the CTRAD study. We graded CAD severity as none (normal coronaries), mild-moderate (<70% stenosis), and severe (70% or greater stenosis). Results-A total of 39 (42.3 %) asymptomatic patients with diabetes did not have CAD; 30.4% had mild/moderate CAD; and 27.1% had severe CAD. Mean EAT volume was highest in patients with severe CAD (143.14 cm 3) as compared to mild/moderate CAD (112.7 cm 3), and no CAD (107.5 cm 3) (p= 0.003). After adjustment of clinical risk factors, notably, CAC score, multivariate regression analysis showed EAT volume was an independent predictor of CAD severity in this sample (odds ratio 11.2, 95% confidence interval 1.7-73.8, p =0.01). Conclusions-Increasing EAT volume in asymptomatic patients with DM-II is associated with presence of severe CAD, independent of BMI and CAC, as well as traditional risk factors.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2014
Objective: This study is important for the determination of branches and segments of the first atherosclerotic coronary artery. The objective was to examine the role of epicardial adipose tissue (EAT) volume in estimating the presence and localization of plaque of coronary arteries. Methods: Our study is a retrospective study, consisting of 50 male (mean age: 45.5±12 yrs) and 58 female (mean age: 52.5±11.6 yrs). A total of 108 consecutive patients underwent coronary computerized tomography (CT) angiography. Each coronary artery segment was assessed for the presence of atherosclerotic plaque. According to the plaque-involved vessel, patients were grouped as without plaque; plaque-involved left anterior descending artery (LAD), right coronary artery (RCA), or circumflex artery (Cx); and mixed (two or more vessels). Results: The differences in mean values between the two groups were compared using the independent samples t test. Mann-Whitney U test was used for the comparison of continuous variables among groups. While EAT volume was found to be higher in the group with plaque, the difference between the two groups was statistically significant (88.6±9.2 cm 3 , 67.4±7.2 cm 3 , respectively, p=0.001). EAT volume was 67.3±7.1 cm 3 in the without plaque group, 97.7±22.8 cm 3 in LAD, 79.7±10.1 cm 3 in RCA, 70.7±8.9 cm 3 in Cx, and 101.9±18.6 cm 3 in mixed vessels. In the intragroup comparison, the EAT volume of plaque-involved LAD and mixed vessels was significantly higher than in the other groups. The EAT volume of plaque-involved RCA was significantly higher (p=0.015) than in plaque-involved Cx. Conclusion: Increased EAT volume is directly proportional to the presence of coronary artery plaques, especially in LAD and with more than one artery. (Anadolu Kardiyol Derg 2015; 15(0): 000-000)
Clinical Endocrinology, 2009
Epicardial adipose tissue (EAT) is a part of visceral fat deposited around the heart between the pericardium and myocardium along the distribution of coronary arteries. EAT thickness is reported to be associated with coronary atherosclerosis; however, no study has measured EAT volume in patients with type 2 diabetes or investigate its association with coronary artery disease. A hospital-based case control study. A total of 49 patients with type 2 diabetes mellitus (T2DM) and 78 nondiabetic controls were studied. Cardiac multislice computed tomography was used to measure EAT volume, Gensini score, coronary artery calcium score and, coronary lesions. The relationships between EAT volume, markers of coronary atherosclerosis and anthropometric and biochemical parameters of metabolic syndrome (MetS) were investigated. EAT volume was significantly higher in patients with T2DM than in nondiabetic subjects (166.1 +/- 60.6 cm(3) vs. 123.4 +/- 41.8 cm(3), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Logistic regression analysis revealed independent and significant associations between EAT and diabetic status. EAT volume was significantly associated with components of MetS (BMI, waist circumference, fasting serum glucose, total cholesterol, HDL-cholesterol, and triglycerides levels), Gensini score, coronary lesions, coronary disease and coronary calcium scores. Univariate, multivariate and trend analyses confirmed that EAT volume was associated with MetS component clustering and the coronary atherosclerosis index. The analytical results indicate that EAT volume is increased in T2DM patients and is associated with unfavourable components of MetS and coronary atherosclerosis. The close anatomical relationship between EAT and the coronary arteries, combined with other evidence indicating that EAT is a biologically active adipokine-secreting tissue, suggest that EAT participates in the pathogenesis of diabetic coronary atherosclerosis.
Journal of the American College of Cardiology, 2013
Background. Epicardial fat reflects abdominal visceral adiposity and visceral fat plays an important role in the development of an unfavorable metabolic and atherosclerosis risk profile. Intracoronary thrombus burden is an important factor affecting the success of the procedure particularly in patients undergoing percutaneous coronary intervention (PCI). Therefore, determining the factors predicting thrombus burden has great importance in predicting adverse cardiovascular events as well as determining the most appropriate treatment strategy to prevent failure in PCI. Aim. The aim of the current study was to evaluate the relationship between Epicardial adipose thickness (EAT) and thrombus burden in the patients with ST-elevation myocardial infarction (STEMI) who undergo primary PCI (pPCI). Methods. The study was prospective and included patients (n=156) who were referred to Kosuyolu Research and Education hospital with STEMI between 2016 and 2017. Thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus <0.5xreference vessel diameter), 3 (definite thrombus 0.5-2xreference vessel diameter), 4 (definite thrombus >2xreference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0-3) and high thrombus burden (grades 4 and 5). EAT, identified as an echo-free space between the myocardium and visceral pericardium, was measured perpendicularly, on the free wall of the right ventricle at both parasternal long-and short-axis views at end-diastole in three cardiac cycles. Results. Fifty-one subjects were in the low thrombus burden group and 105 in the high thrombus burden group. There were no differences in the two groups for LVEF, smoking status, family history of coronary artery disease (CAD), diabetes mellitus (DM), hypertension (HT), and hypercholesterolemia and for total cholesterol, triglyceride, GFR, LDL-C and HDL-C. In multivariate logistic regression analysis the EAT (odds ratio: 2.53, 95% CI: 1.76-3.67; p < .001) was found as an independent predictor of high thrombus burden. Conclusions. The present study showed that EAT was an independent predictor of coronary thrombus burden in STEMI.
Epicardial Fat Volume as a Predictor of the Severity of Cad by MSCT
Zagazig University Medical Journal, 2018
Background: Distribution of body fat is known to be more independent and potent predictor of morbidity and mortality than total body adipocity. Each visceral fat storage is anatomically and functionally different and according to its closeness to an organ, it exerts a specific local function for each one. Epicardial adipose tissue (EAT) as a fat depot is further implicated on coronary artery disease (CAD) because of proximity to the adventitia of major epicardial coronary arteries. Epicardial fat volume (EFV) can be evaluated by MSCT even without contrast injection which helps in prediction of the presence and the severity of CAD. Objectives: To evaluate the relationship between epicardial fat volume and the severity of coronary artery disease among patients presented by chest pain with low to intermediate pretest probability for CAD using Multi-Slice CT coronary angiography. Subjects and methods: The study included 100 patients, 94 males and 6 females with mean age 56.03 ± 10.24 years who were referred to the MSCT coronary angiography unit in Zagazig University Hospital and Kobri Elkobba Military Hospital during the period from January 2017 to August 2017. All patients were subjected to through history taking including age, sex, family history of CAD, DM, HTN, smoking, complete clinical examination including BMI and overweight was defined as ≥ 25 kg/m 2 , standard ECG, analysis of lipid profile, measurement of serum creatinine and random blood glucose level as well as Multi-slice CT angiography. Results: There was significant relationship between EFV and Proximal LAD and D1 lesions (p = 0.020) as regarding segment involvement score (SIS) and segment stenosis score (SSS) by MSCT. Epicardial fat volume (EFV) was 125.34 ± 35.37 cm 3 (range from 47.4 to 221.3 cm 3 and the median value of EFV in our patients was 123.35 cm 3) and Coronary artery calcium score (CACS) was 157.69 ± 352.95 (range from 0 to 2212 and the median value was 29.55) with significant relationship between EFV and Ca score (p = 0.009), highly significant relationship between EFV and SIS score and SSS score (p < 0.001). There was significant relationship between EFV and sex (p = 0.002), highly significant relationship between EFV and hypertension and diabetes mellitus (p < 0.001), no significant relationship between EFV and smoking (p = 0.754) and family history of ischemic heart disease (p = 0.082), significant relationship between EFV and age (p = 0.011), highly significant relationship between EFV and serum cholesterol, LDL, serum triglycerides, LDL/HDL ratio, BMI and inversely proportional to HDL (p < 0.001). Conclusion: we concluded in our study that EFV was associated with coronary atherosclerosis and EFV increased steeply in patients with significant coronary artery stenosis and in those with severe coronary artery calcification as revealed by MSCT angiography. Quantitation of EFV may be useful in addition to coronary artery calcium score as a predictor to identify patients at risk for CAD.
The American Journal of Cardiology, 2014
Patients with coronary artery disease and/or type 2 diabetes mellitus (DM) generally exhibit more epicardial adipose tissue (EAT) than healthy controls. Recently, it has been proposed that EAT affects vascular function and structure by secreting proinflammatory and vasoactive substances, thereby potentially contributing to the development of cardiovascular disease. In the present study, the interrelation of EAT, coronary vasomotor function, and coronary artery calcium was investigated in patients with and without DM, who were evaluated for coronary artery disease. Myocardial blood flow (MBF) was assessed at rest and during adenosine-induced hyperemia using [ 15 O]-water positron emission tomography combined with computed tomography to quantify coronary artery calcium and EAT in 199 patients (46 with DM). In this cohort (mean age 58 -10 years), the patients with DM had a greater body mass index, heart rate, and systolic blood pressure at rest (all p <0.05). Coronary artery calcium and the EAT volumes were comparable between those with and without DM. Both patient groups showed comparable MBF at rest and coronary vascular resistance. A lower hyperemic MBF and coronary flow reserve (CFR) and greater hyperemic coronary vascular resistance (all p <0.05) was observed in the patients with DM. A pooled analysis showed a positive association of EAT volume with hyperemic coronary vascular resistance but not with the MBF at rest, hyperemic MBF, or coronary vascular resistance at rest. In the group analysis, the EAT volume was inversely associated with hyperemic MBF r [ L0.16, p [ 0.05) and CFR (r [ L0.17, p [ 0.04) and positively with hyperemic coronary vascular resistance (r [ 0.26, p [ 0.002) only in patients without DM. Multivariate regression analysis, adjusted for age, gender, and body mass index, showed an independent association between the EAT volume and hyperemic MBF (b [ L0.16, p [ 0.02), CFR (b [ L0.16, p [ 0.04), and hyperemic coronary vascular resistance (b [ 0.25, p <0.001) in the non-DM group. In conclusion, these results suggest a role for EAT in myocardial microvascular dysfunction; however, once DM has developed, other factors might be more dominant in contributing to impaired myocardial microvascular dysfunction. Ó 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;113:90e97)
Nutrition Metabolism and Cardiovascular Diseases, 2009
Background and aim: Epicardial adipose tissue (EAT), which is thought to be a component of visceral adiposity, is associated with the metabolic syndrome. We aimed to test the hypothesis that echocardiographic EAT thickness can be a marker for the presence and severity of coronary artery disease (CAD). Method and results: In all, 150 patients (100 patients with CAD and 50 patients with normal coronary arteries by diagnostic coronary angiography; 65 women, 85 men; mean age 55.7 AE 7.4 years) were enrolled. EAT thickness was measured using 2-D echocardiographic parasternal long-and short-axis views. EAT thickness measurements were compared with angiographic findings.
Journal of Endocrinology and Metabolism, 2020
Background: Epicardial adipose tissue (EAT) is a distinct visceral adipose tissue that is present in between the visceral pericardium and myocardium, in which the coronary arteries are lodged. This tissue releases several inflammatory and atherogenic mediators which lead to the initiation and/or progression of coronary atherosclerosis and its thickness is related to the presence and severity of atherosclerotic coronary artery disease (CAD). In this study, we aimed to evaluate the EAT thickness in type 2 diabetes mellitus (T2DM) patients by non-contrast computed tomography (NCCT) of the chest and to correlate its value with HbA1c levels, duration of T2DM and carotid intima-media thickness (CIMT). Methods: This was a cross-sectional study comprising of 40 patients with T2DM who underwent NCCT of chest and ultrasonographic estimation of CIMT. Ten individuals with equivalent age and sex were included as controls, in whom NCCT of chest was done for other purposes. All the individuals und...