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Cheng YC, Ma WC, Li YH, Wu J, Liang KW, Lee WJ, Liu HC, Sheu WHH, Lee IT. Plasma aryl hydrocarbon receptor associated with epicardial adipose tissue in men: a cross-sectional study. Diabetol Metab Syndr 2023; 15:188. [PMID: 37749614 PMCID: PMC10519097 DOI: 10.1186/s13098-023-01166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) is a type of ectopic fat with endocrine and paracrine functions. Aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that responds to environmental stimuli. AhR expression is associated with obesity. In this cross-sectional study, we aimed to determine the relationship between circulating AhR concentrations and EAT. METHODS A total of 30 men with obesity and 23 age-matched men as healthy controls were enrolled. Plasma AhR concentrations were determined at fasting. The EAT thickness was measured on the free wall of the right ventricle from the basal short-axis plane by magnetic resonance imaging. RESULTS The participants with obesity had a higher plasma AhR level than the controls (81.0 ± 24.5 vs. 65.1 ± 16.4 pg/mL, P = 0.010). The plasma AhR level was positively correlated with EAT thickness (correlation coefficient = 0.380, P = 0.005). After adjusting for fasting glucose levels, plasma AhR levels were still significantly associated with EAT thickness (95% CI 0.458‒5.357, P = 0.021) but not with body mass index (P = 0.168). CONCLUSION Plasma AhR concentrations were positively correlated with EAT thickness on the free wall of the right ventricle in men. Further investigations are needed to evaluate the causal effects and underlying mechanisms between AhR and EAT.
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Affiliation(s)
- Yu-Cheng Cheng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - Wei-Chun Ma
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, 42055, Taiwan
| | - Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Junyi Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
| | - Kae-Woei Liang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, 402204, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Hsiu-Chen Liu
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | | | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.
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2
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Iacobellis G. Epicardial fat links obesity to cardiovascular diseases. Prog Cardiovasc Dis 2023:S0033-0620(23)00036-1. [PMID: 37105279 DOI: 10.1016/j.pcad.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 04/29/2023]
Abstract
Patients with obesity have been historically associated with higher risk to develop cardiovascular diseases (CVD). However, regional, visceral, organ specific adiposity seems to play a stronger role in the development of those cardiovascular diseases than obesity by itself. Epicardial adipose tissue is the visceral fat depot of the heart with peculiar anatomy, regional differences, genetic profile and functions. Due to its unobstructed contiguity with heart and intense pro inflammatory and pro arrhythmogenic activities, epicardial fat is directly involved in major obesity-related CVD complications, such as coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF). Current and developing imaging techniques can measure epicardial fat thickness, volume, density and inflammatory status for the prediction and stratification of the cardiovascular risk in both symptomatic and asymptomatic obese individuals. Pharmacological modulation of the epicardial fat with glucagon like peptide-1 receptor (GLP1R) analogs, sodium glucose transporter-2 inhibitors, and potentially dual (glucose-dependent insulinotropic polypeptide -GLP1R) agonists, can reduce epicardial fat mass, resume its original cardio-protective functions and therefore reduce the cardiovascular risk. Epicardial fat assessment is poised to change the traditional paradigm that links obesity to the heart.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miami, FL, USA.
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3
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Klingensmith JD, Karlapalem A, Kulasekara MM, Fernandez-Del-Valle M. Spectral analysis of ultrasound radiofrequency backscatter for the identification of epicardial adipose tissue. J Med Imaging (Bellingham) 2022; 9:017001. [PMID: 35005059 DOI: 10.1117/1.jmi.9.1.017001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: The coronary arteries are embedded in a layer of fat known as epicardial adipose tissue (EAT). The EAT influences the development of coronary artery disease (CAD), and increased EAT volume can be indicative of the presence and type of CAD. Identification of EAT using echocardiography is challenging and only sometimes feasible on the free wall of the right ventricle. We investigated the use of spectral analysis of the ultrasound radiofrequency (RF) backscatter for its potential to provide a more complete characterization of the EAT. Approach: Autoregressive (AR) models facilitated analysis of the short-time signals and allowed tuning of the optimal order of the spectral estimation process. The spectra were normalized using a reference phantom and spectral features were computed from both normalized and non-normalized data. The features were used to train random forests for classification of EAT, myocardium, and blood. Results: Using an AR order of 15 with the normalized data, a Monte Carlo cross validation yielded accuracies of 87.9% for EAT, 84.8% for myocardium, and 93.3% for blood in a database of 805 regions-of-interest. Youden's index, the sum of sensitivity, and specificity minus 1 were 0.799, 0.755, and 0.933, respectively. Conclusions: We demonstrated that spectral analysis of the raw RF signals may facilitate identification of the EAT when it may not otherwise be visible in traditional B-mode images.
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Affiliation(s)
- Jon D Klingensmith
- Southern Illinois University Edwardsville, Department of Electrical and Computer Engineering, Edwardsville, Illinois, United States
| | - Akhila Karlapalem
- Southern Illinois University Edwardsville, Department of Electrical and Computer Engineering, Edwardsville, Illinois, United States
| | - Michaela M Kulasekara
- Southern Illinois University Edwardsville, Department of Electrical and Computer Engineering, Edwardsville, Illinois, United States
| | - Maria Fernandez-Del-Valle
- Southern Illinois University Edwardsville, Department of Applied Health, Edwardsville, Illinois, United States
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4
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Vučić D, Bijelić N, Rođak E, Rajc J, Dumenčić B, Belovari T, Mihić D, Selthofer-Relatić K. Right Heart Morphology and Its Association With Excessive and Deficient Cardiac Visceral Adipose Tissue. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2021; 15:11795468211041330. [PMID: 34602829 PMCID: PMC8485260 DOI: 10.1177/11795468211041330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022]
Abstract
Visceral adipose tissue is an independent risk factor for the development of atherosclerotic coronary disease, arterial hypertension, diabetes and metabolic syndrome. Right heart morphology often involves the presence of adipose tissue, which can be quantified by non-invasive imaging methods. The last decade brought a wealth of new insights into the function and morphology of adipose tissue, with great emphasis on its role in the pathogenesis of heart disease. Cardiac adipose tissue is involved in thermogenesis, mechanical protection of the heart and energy storage. However, it can also be an endocrine organ that synthesises numerous pro-inflammatory and anti-inflammatory cytokines, the effect of which is accomplished by paracrine and vasocrine mechanisms. Visceral adipose tissue has several compartments that differ in their embryological origin and vascularisation. Deficiency of cardiac adipose tissue, often due to chronic pathological conditions such as oncological diseases or chronic infectious diseases, predicts increased mortality and morbidity. To date, knowledge about the influence of visceral adipose tissue on cardiac morphology is limited, especially the effect on the morphology of the right heart in a state of excess or deficient visceral adipose tissue.
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Affiliation(s)
- Domagoj Vučić
- Department for Internal Medicine, Division of Cardiology, General Hospital Doctor Josip Benčević, Slavonski Brod, Croatia
| | - Nikola Bijelić
- Department for Histology and Embriology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Edi Rođak
- Department for Histology and Embriology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Jasmina Rajc
- Department for Pathology and Forensic Medicine, University Hospital Center Osijek, Osijek, Croatia.,Department for Pathology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Boris Dumenčić
- Department for Pathology and Forensic Medicine, University Hospital Center Osijek, Osijek, Croatia.,Department for Pathology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Tatjana Belovari
- Department for Histology and Embriology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Damir Mihić
- Department of Intensive Care Medicine, University Center Hospital Osijek, Osijek, Croatia.,Department for Internal Medicine, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Kristina Selthofer-Relatić
- Department for Internal Medicine, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Department for Heart and Vascular Diseases, University Center Hospital Osijek, Osijek, Croatia
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5
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Phan F, Boussouar S, Lucidarme O, Zarai M, Salem JE, Kachenoura N, Bouazizi K, Charpentier E, Niati Y, Bekkaoui H, Amoura Z, Mathian A, Benveniste O, Cacoub P, Allenbach Y, Saadoun D, Lacorte JM, Fourati S, Laroche S, Hartemann A, Bourron O, Andreelli F, Redheuil A. Cardiac adipose tissue volume and IL-6 level at admission are complementary predictors of severity and short-term mortality in COVID-19 diabetic patients. Cardiovasc Diabetol 2021; 20:165. [PMID: 34384426 PMCID: PMC8358546 DOI: 10.1186/s12933-021-01327-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 diabetic adults are at increased risk of severe forms irrespective of obesity. In patients with type-II diabetes, fat distribution is characterized by visceral and ectopic adipose tissues expansion, resulting in systemic inflammation, which may play a role in driving the COVID-19 cytokine storm. Our aim was to determine if cardiac adipose tissue, combined to interleukin-6 levels, could predict adverse short-term outcomes, death and ICU requirement, in COVID-19 diabetic patients during the 21 days after admission. METHODS Eighty one consecutive patients with type-II diabetes admitted for COVID-19 were included. Interleukin-6 measurement and chest computed tomography with total cardiac adipose tissue index (CATi) measurement were performed at admission. The primary outcome was death during the 21 days following admission while intensive care requirement with or without early death (ICU-R) defined the secondary endpoint. Associations of CATi and IL-6 and threshold values to predict the primary and secondary endpoints were determined. RESULTS Of the enrolled patients (median age 66 years [IQR: 59-74]), 73% male, median body mass index (BMI) 27 kg/m2 [IQR: 24-31]) 20 patients had died from COVID-19, 20 required intensive care and 41 were in conventional care at day 21 after admission. Increased CATi and IL-6 levels were both significantly related to increased early mortality (respectively OR = 6.15, p = 0.002; OR = 18.2, p < 0.0001) and ICU-R (respectively OR = 3.27, p = 0.01; OR = 4.86, p = 0.002). These associations remained significant independently of age, sex, BMI as well as troponin-T level and pulmonary lesion extension in CT. We combined CATi and IL-6 levels as a multiplicative interaction score (CATi*IL-6). The cut-point for this score was ≥ 6386 with a sensitivity of 0.90 and a specificity of 0.87 (AUC = 0.88) and an OR of 59.6 for early mortality (p < 0.0001). CONCLUSIONS Cardiac adipose tissue index and IL-6 determination at admission could help physicians to better identify diabetic patients with a potentially severe and lethal short term course irrespective of obesity. Diabetic patients with high CATi at admission, a fortiori associated with high IL-6 levels could be a relevant target population to promptly initiate anti-inflammatory therapies.
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Affiliation(s)
- Franck Phan
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Samia Boussouar
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Olivier Lucidarme
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Mohamed Zarai
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, CIC-1901, INSERM, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Khaoula Bouazizi
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Etienne Charpentier
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Yasmine Niati
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Hasnae Bekkaoui
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Patrice Cacoub
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Yves Allenbach
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - David Saadoun
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Jean-Marc Lacorte
- Department of Endocrine and Oncologic Biochemistry, Inserm, UMR_S 1166, Research Institute of Cardiovascular Disease, Metabolism and Nutrition, Paris, France
| | - Salma Fourati
- Department of Endocrine and Oncologic Biochemistry, Inserm, UMR_S 1166, Research Institute of Cardiovascular Disease, Metabolism and Nutrition, Paris, France
| | - Suzanne Laroche
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France
| | - Agnes Hartemann
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Fabrizio Andreelli
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, INSERM, UMRS U1269, Paris, France
| | - Alban Redheuil
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France. .,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France. .,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.
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Hemodynamic and Functional Impact of Epicardial Adipose Tissue in Heart Failure With Preserved Ejection Fraction. JACC-HEART FAILURE 2020; 8:657-666. [PMID: 32653449 DOI: 10.1016/j.jchf.2020.04.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study determined the impact of excess epicardial adipose tissue (EAT) in patients with the obese phenotype of heart failure with preserved ejection fraction (HFpEF). BACKGROUND Patients with HFpEF and an elevated body mass index differ from nonobese patients, but beyond generalized obesity, fat distribution may be more important. Increases in EAT are associated with excess visceral adiposity, inflammation, and cardiac fibrosis, and EAT has been speculated to play an important role in the pathophysiology of HFpEF, but no study has directly evaluated this question. METHODS Patients with HFpEF and obesity (n = 169) underwent invasive hemodynamic exercise testing with expired gas analysis and echocardiography. Increased EAT was defined by echocardiography (EAT thickness ≥9 mm). RESULTS Compared with obese patients without increased EAT (HFpEFEAT-, n = 92), obese patients with HFpEF with increased EAT (HFpEFEAT+; n = 77) displayed a higher left ventricular eccentricity index, indicating increased pericardial restraint, but similar resting biventricular structure and function. In contrast, hemodynamics were more abnormal in patients with HFpEFEAT+, with higher right atrial, pulmonary artery, and pulmonary capillary wedge pressures at rest and during exercise compared with those of patients with HFpEFEAT-. Peak oxygen consumption (VO2) was reduced in both groups but was 20% lower in patients with HFpEFEAT+ (p < 0.01). CONCLUSIONS Among patients with the obese phenotype of HFpEF, the presence of increased EAT is associated with more profound hemodynamic derangements at rest and exercise, including greater elevation in cardiac filling pressures, more severe pulmonary hypertension, and greater pericardial restraint, culminating in poorer exercise capacity. Further study is needed to understand the biology and treatment of excessive EAT in patients with HFpEF.
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Epicardial adipose tissue thickness is not associated with adverse cardiovascular events in patients undergoing haemodialysis. Sci Rep 2020; 10:6281. [PMID: 32286459 PMCID: PMC7156515 DOI: 10.1038/s41598-020-63341-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/30/2020] [Indexed: 01/20/2023] Open
Abstract
In non-haemodialysis (HD) patients, increased epicardial adipose tissue (EAT) thickness was significantly associated with adverse cardiovascular (CV) events. This study was designed to investigate whether EAT thickness was a useful parameter in the prediction of adverse CV events in HD patients. In addition, we also evaluated the major correlates of EAT thickness in these patients. In 189 routine HD patients, we performed a comprehensive transthoracic echocardiographic examination with assessment of EAT thickness. The definition of CV events included CV death, non-fatal stroke, non-fatal myocardial infarction, peripheral artery disease, and hospitalization for heart failure. The follow-up period for CV events was 2.5 ± 0.7 years. Thirty-one CV events were documented. The multivariable analysis demonstrated that older age, smoking status, the presence of diabetes mellitus and coronary artery disease, and low albumin levels were independently correlated with adverse CV events. However, increased EAT thickness was not associated with adverse CV events (P = 0.631). Additionally, older age, female sex, low haemoglobin, and low early diastolic mitral annular velocity were correlated with high EAT thickness in the univariable analysis. In the multivariable analysis, older age and female sex were still correlated with high EAT thickness. In conclusion, high EAT thickness was associated with older age and female sex in the multivariable analysis in our HD patients. However, EAT thickness was not helpful in predicting adverse CV events in such patients. Further large-scale studies are necessary to verify this finding.
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8
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Meng X, Wang W, Zhang K, Qi Y, An S, Wang S, Zheng J, Kong J, Liu H, Wu J, Zhou Y, Gao C, Tang YD. Epicardial adipose tissue volume is associated with non-alcoholic fatty liver disease and cardiovascular risk factors in the general population. Ther Clin Risk Manag 2018; 14:1499-1506. [PMID: 30197519 PMCID: PMC6112793 DOI: 10.2147/tcrm.s168345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Epicardial adipose tissue (EAT) is considered an important source of bioactive molecules that can influence coronary arteries directly and is related to the concurrent presence of both obstructive coronary stenosis and myocardial ischemia independently. Non-alcoholic fatty liver disease (NAFLD) has become an emergent health problem worldwide. Aim This cross-sectional study aimed to address the relationship between the volume of EAT and NAFLD and other cardiovascular risk factors in the general population. Materials and methods In this study, we selected a total of 2,238 participants aged at least 40 years from the Jidong community in Tangshan, China. The 64-slice CT was used to survey the volume of EAT and liver ultrasonography was used for the diagnosis of NAFLD. The study cohorts were compared according to EAT volume. Results Cardiovascular risk factors, such as coronary artery calcium score, carotid intima-media thickness, NAFLD, and ideal cardiovascular health metrics were also found to be related to EAT. In multivariate logistic regression analysis, NAFLD groups showed significant association with higher EAT volume, after correcting for main cardiovascular disease risk factors (OR [95% CI], 1.407 [1.117, 1.773]). Conclusion Our findings in a general community population provide evidence that EAT is strongly associated with NAFLD and other cardiovascular risk factors.
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Affiliation(s)
- Xiangbin Meng
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, China,
| | - Wenyao Wang
- Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Kuo Zhang
- Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Yu Qi
- Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Shimin An
- Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Siyuan Wang
- Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Jilin Zheng
- Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Joyce Kong
- New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Henghui Liu
- Beijing Recdata Technology Co., Ltd., Beijing, China
| | - Jing Wu
- Beijing Recdata Technology Co., Ltd., Beijing, China
| | - Yong Zhou
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, China,
| | - Yi-Da Tang
- Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
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9
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Epicardial adipose tissue feeding and overfeeding the heart. Nutrition 2018; 59:1-6. [PMID: 30415157 DOI: 10.1016/j.nut.2018.07.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 12/17/2022]
Abstract
Epicardial adipose tissue is a particular visceral fat depot with unique anatomic, biomolecular, and genetic features. Epicardial fat displays both physiological and pathological properties. Epicardial fat expresses genes and secretes cytokines actively involved in the thermogenesis and regulation of lipid and glucose metabolism of the adjacent myocardium. A disequilibrium between epicardial fat feeding and overfeeding the myocardium with free fatty acids leads to intramyocardial fat infiltration causing organ damage and clinical consequences. The upregulation of epicardial fat proinflammatory and lipogenic genes contributes to the fat build up in the proximal coronary arteries. Epicardial fat is a measurable and modifiable risk factor that can serve as a novel and additional tool for cardiovascular risk stratification. Pharmacologically targeting epicardial fat with drugs such as glucagon peptide-like 1 analogs or sodium glucose transport 2 inhibitors reduces the epicardial fat burden and induces beneficial cardiometabolic effects. Assessment and manipulation of epicardial fat transcriptome might open new avenues in the prevention of cardiometabolic diseases.
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Lavie CJ, Arena R, Alpert MA, Milani RV, Ventura HO. Management of cardiovascular diseases in patients with obesity. Nat Rev Cardiol 2017; 15:45-56. [PMID: 28748957 DOI: 10.1038/nrcardio.2017.108] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The management of cardiovascular diseases (CVD) in patients with obesity presents numerous challenges. Obesity has a negative effect on almost all of the major CVD risk factors, and adversely influences cardiovascular structure and function. Patients who are overweight or obese have a higher incidence of almost all CVDs compared with patients who are of normal weight. However, those who are overweight or obese seem to have a better short-term and medium-term prognosis after major CVD events and interventional procedures or cardiac surgeries than leaner patients, a phenomenon termed the 'obesity paradox'. In considering the mechanisms underlying this paradox, we review evidence of the deleterious consequences of obesity in patients with coronary heart disease, and the limited data on the benefits of weight loss in patients with CVD. Additional studies are needed on the efficacy of purposeful weight loss on cardiovascular outcomes to determine the ideal body composition for patients with CVD.
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA
| | - Ross Arena
- Department of Physical Therapy, Department of Kinesiology and Nutrition, Integrative Physiology Laboratories, College of Applied Sciences, University of Illinois at Chicago, 1919 W Taylor Street, Chicago, Illinois 60612, USA
| | - Martin A Alpert
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, One Hospital Drive, Columbia, Missouri 65212, USA
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA
| | - Hector O Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA
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Gaborit B, Sengenes C, Ancel P, Jacquier A, Dutour A. Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat? Compr Physiol 2017. [PMID: 28640452 DOI: 10.1002/cphy.c160034] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epicardial adipose tissue (EAT) is a small but very biologically active ectopic fat depot that surrounds the heart. Given its rapid metabolism, thermogenic capacity, unique transcriptome, secretory profile, and simply measurability, epicardial fat has drawn increasing attention among researchers attempting to elucidate its putative role in health and cardiovascular diseases. The cellular crosstalk between epicardial adipocytes and cells of the vascular wall or myocytes is high and suggests a local role for this tissue. The balance between protective and proinflammatory/profibrotic cytokines, chemokines, and adipokines released by EAT seem to be a key element in atherogenesis and could represent a future therapeutic target. EAT amount has been found to predict clinical coronary outcomes. EAT can also modulate cardiac structure and function. Its amount has been associated with atrial fibrillation, coronary artery disease, and sleep apnea syndrome. Conversely, a beiging fat profile of EAT has been identified. In this review, we describe the current state of knowledge regarding the anatomy, physiology and pathophysiological role of EAT, and the factors more globally leading to ectopic fat development. We will also highlight the most recent findings on the origin of this ectopic tissue, and its association with cardiac diseases. © 2017 American Physiological Society. Compr Physiol 7:1051-1082, 2017.
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Affiliation(s)
- Bénédicte Gaborit
- NORT, Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France.,Endocrinology Metabolic Diseases, and Nutrition Department, Pole ENDO, APHM, Aix-Marseille Univ, Marseille, France
| | - Coralie Sengenes
- STROMALab, Université de Toulouse, EFS, ENVT, Inserm U1031, ERL CNRS 5311, CHU Rangueil, Toulouse, France
| | - Patricia Ancel
- NORT, Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France
| | - Alexis Jacquier
- CNRS UMR 7339, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), Marseille, France.,Radiology department, CHU La Timone, Marseille, France
| | - Anne Dutour
- NORT, Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France.,Endocrinology Metabolic Diseases, and Nutrition Department, Pole ENDO, APHM, Aix-Marseille Univ, Marseille, France
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Obokata M, Reddy YNV, Pislaru SV, Melenovsky V, Borlaug BA. Evidence Supporting the Existence of a Distinct Obese Phenotype of Heart Failure With Preserved Ejection Fraction. Circulation 2017; 136:6-19. [PMID: 28381470 DOI: 10.1161/circulationaha.116.026807] [Citation(s) in RCA: 687] [Impact Index Per Article: 98.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Phenotyping patients into pathophysiologically homogeneous groups may enable better targeting of treatment. Obesity is common in HFpEF and has many cardiovascular effects, suggesting that it may be a viable candidate for phenotyping. We compared cardiovascular structure, function, and reserve capacity in subjects with obese HFpEF, those with nonobese HFpEF, and control subjects. METHODS Subjects with obese HFpEF (body mass index ≥35 kg/m2; n=99), nonobese HFpEF (body mass index <30 kg/m2; n=96), and nonobese control subjects free of HF (n=71) underwent detailed clinical assessment, echocardiography, and invasive hemodynamic exercise testing. RESULTS Compared with both subjects with nonobese HFpEF and control subjects, subjects with obese HFpEF displayed increased plasma volume (3907 mL [3563-4333 mL] versus 2772 mL [2555-3133 mL], and 2680 mL [2380-3006 mL]; P<0.0001), more concentric left ventricular remodeling, greater right ventricular dilatation (base, 34±7 versus 31±6 and 30±6 mm, P=0.0005; length, 66±7 versus 61±7 and 61±7 mm, P<0.0001), more right ventricular dysfunction, increased epicardial fat thickness (10±2 versus 7±2 and 6±2 mm; P<0.0001), and greater total epicardial heart volume (945 mL [831-1105 mL] versus 797 mL [643-979 mL] and 632 mL [517-768 mL]; P<0.0001), despite lower N-terminal pro-B-type natriuretic peptide levels. Pulmonary capillary wedge pressure was correlated with body mass and plasma volume in obese HFpEF (r=0.22 and 0.27, both P<0.05) but not in nonobese HFpEF (P≥0.3). The increase in heart volumes in obese HFpEF was associated with greater pericardial restraint and heightened ventricular interdependence, reflected by increased ratio of right- to left-sided heart filling pressures (0.64±0.17 versus 0.56±0.19 and 0.53±0.20; P=0.0004), higher pulmonary venous pressure relative to left ventricular transmural pressure, and greater left ventricular eccentricity index (1.10±0.19 versus 0.99±0.06 and 0.97±0.12; P<0.0001). Interdependence was enhanced as pulmonary artery pressure load increased (P for interaction <0.05). Compared with those with nonobese HFpEF and control subjects, obese patients with HFpEF displayed worse exercise capacity (peak oxygen consumption, 7.7±2.3 versus 10.0±3.4 and12.9±4.0 mL/min·kg; P<0.0001), higher biventricular filling pressures with exercise, and depressed pulmonary artery vasodilator reserve. CONCLUSIONS Obesity-related HFpEF is a genuine form of cardiac failure and a clinically relevant phenotype that may require specific treatments.
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Affiliation(s)
- Masaru Obokata
- From Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.O., Y.N.V.R., S.V.P., V.M., B.A.B.); and Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (V.M.)
| | - Yogesh N V Reddy
- From Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.O., Y.N.V.R., S.V.P., V.M., B.A.B.); and Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (V.M.)
| | - Sorin V Pislaru
- From Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.O., Y.N.V.R., S.V.P., V.M., B.A.B.); and Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (V.M.)
| | - Vojtech Melenovsky
- From Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.O., Y.N.V.R., S.V.P., V.M., B.A.B.); and Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (V.M.)
| | - Barry A Borlaug
- From Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.O., Y.N.V.R., S.V.P., V.M., B.A.B.); and Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic (V.M.).
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Abstract
Epicardial adipose tissue is a unique and multifaceted fat depot with local and systemic effects. This tissue is distinguished from other visceral fat depots by a number of anatomical and metabolic features, such as increased fatty acid metabolism and a unique transcriptome enriched in genes that are associated with inflammation and endothelial function. Epicardial fat and the heart share an unobstructed microcirculation, which suggests these tissues might interact. Under normal physiological conditions, epicardial fat has metabolic, thermogenic (similar to brown fat) and mechanical (cardioprotective) characteristics. Development of pathological conditions might drive the phenotype of epicardial fat such that it becomes harmful to the myocardium and the coronary arteries. The equilibrium between protective and detrimental effects of this tissue is fragile. Expression of the epicardial-fat-specific transcriptome is downregulated in the presence of severe and advanced coronary artery disease. Improved local vascularization, weight loss and targeted medications can restore the protective physiological functions of epicardial fat. Measurements of epicardial fat have several important applications in the clinical setting: accurate measurement of its thickness or volume is correlated with visceral adiposity, coronary artery disease, the metabolic syndrome, fatty liver disease and cardiac changes. On account of this simple clinical assessment, epicardial fat is a reliable marker of cardiovascular risk and an appealing surrogate for assessing the efficacy of drugs that modulate adipose tissues.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, 1400 NW 10th Avenue, Dominion Tower suite 805-807, Miami, FL 33136, USA
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Gökdeniz T, Erkol A, Kalaycıoğlu E, Çağrı Aykan A, Gül İ, Boyacı F, Turan B, Ozkan M. Relation of epicardial fat thickness to subclinical right ventricular dysfunction assessed by strain and strain rate imaging in subjects with metabolic syndrome: a two-dimensional speckle tracking echocardiography study. Echocardiography 2014; 32:248-56. [PMID: 24815416 DOI: 10.1111/echo.12635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function is known to be impaired in the presence of metabolic syndrome (MetS). Epicardial adipose tissue is a metabolically active organ that generates various bioactive molecules, which might affect cardiac function and morphology. Thus, we hypothesized that RV dysfunction in patients with MetS may be related to increased epicardial fat thickness (EFT) in these patients. In patients with MetS, we aimed to assess the relation of EFT with RV function using two-dimensional speckle tracking echocardiography (2DSTE)-derived strain and strain rate imaging. METHODS The study involved 76 subjects with MetS and 61 subjects without MetS. Biventricular structure and function together with EFT were evaluated by conventional echocardiography. RV free and septal walls strain (RVFW-S & RVSW-S), systolic and early diastolic strain rates (RVSRs & RVSRe) were evaluated by 2DSTE. RESULTS Epicardial fat thickness was significantly higher in subjects with MetS (6.45 ± 1.48 mm vs. 5.49 ± 1.05 mm, P < 0.001). RVFW-S (-22.95 ± 4.97% vs. -24.96 ± 3.63%; P = 0.007), RVSRs (1.53 ± 0.33/sec vs. -1.70 ± 0.33/sec; P = 0.002), and RVSRe (1.40 ± 0.44/sec vs. 1.75 ± 0.49/sec; P < 0.001) were all lower in subjects with MetS, while RVSW-S did not differ. Multiple regression analysis showed that EFT was independently associated with RVFW-S (β = -0.547, P < 0.001), RVSRs (β = -0.332, P = 0.001), and RVSRe (β = -0.187, P = 0.019) in subjects with MetS. CONCLUSIONS Metabolic syndrome is associated with subclinical RV systolic and diastolic dysfunction. In subjects with MetS, increased EFT is independently related to RV systolic and diastolic dysfunction.
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Affiliation(s)
- Tayyar Gökdeniz
- Department of Cardiology, Kafkas University Medical School, Kars, Turkey
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15
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Iacobellis G. Epicardial adipose tissue in endocrine and metabolic diseases. Endocrine 2014; 46:8-15. [PMID: 24272604 DOI: 10.1007/s12020-013-0099-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/22/2013] [Indexed: 02/03/2023]
Abstract
Epicardial adipose tissue has recently emerged as new risk factor and active player in metabolic and cardiovascular diseases. Albeit its physiological and pathological roles are not completely understood, a body of evidence indicates that epicardial adipose tissue is a fat depot with peculiar and unique features. Epicardial fat is able to synthesize, produce, and secrete bioactive molecules which are then transported into the adjacent myocardium through vasocrine and/or paracrine pathways. Based on these evidences, epicardial adipose tissue can be considered an endocrine organ. Epicardial fat is also thought to provide direct heating to the myocardium and protect the heart during unfavorable hemodynamic conditions, such as ischemia or hypoxia. Epicardial fat has been suggested to play an independent role in the development and progression of obesity- and diabetes-related cardiac abnormalities. Clinically, the thickness of epicardial fat can be easily and accurately measured. Epicardial fat thickness can serve as marker of visceral adiposity and visceral fat changes during weight loss interventions and treatments with drugs targeting the fat. The potential of modulating the epicardial fat with targeted pharmacological agents can open new avenues in the pharmacotherapy of endocrine and metabolic diseases. This review article will provide Endocrine's reader with a focus on epicardial adipose tissue in endocrinology. Novel, established, but also speculative findings on epicardial fat will be discussed from the unexplored perspective of both clinical and basic Endocrinologist.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Miller School of Medicine, University of Miami, 1400 NW 10th Ave, Dominion Tower Suite 805-807, Miami, FL, 33136, USA,
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Bazzocchi A, Diano D, Vicennati V, Pizzi C, De Filippo M, Pasquali R, Rossi C, Battista G. Relationships between total and regional adiposity and epicardial fat in obese women: how can dual-energy X-ray absorptiometry be associated with echocardiographic epicardial fat measurements? Clin Obes 2013; 3:132-40. [PMID: 25586628 DOI: 10.1111/cob.12027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/27/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Obesity is an increasingly prevalent metabolic disorder and it is associated with a large number of comorbidities, including cardiovascular diseases. Adipose tissue is an active endocrine organ and its ectopic depots and distribution have different metabolic meanings on risks for health; as a matter of fact, epicardial fat seems to play a specific role in cardiovascular diseases. The use of dual-energy X-ray absorptiometry (DXA) to evaluate and follow-up patients affected by obesity is becoming a very important point in the management of the disease. WHAT THIS STUDY ADDS An investigation of the association between epicardial fat and regional adiposity by DXA in female obese patients. The total amount of central (trunk) fat mass is more strongly correlated than android visceral fat mass to epicardial thickness in obese women. In the interpretation of whole-body DXA data, physician should consider trunk fat mass for good and independent predictivity on epicardial fat depots. Our aim was to analyse in a population of obese women the relationship between the amount of epicardial fat as measured by transthoracic echocardiography (US) and the parameters of regional adiposity by dual-energy X-ray absorptiometry (DXA), with particular reference to a new software for visceral fat assessment and to a new 'heart-suited' regions of interests (ROIs). Sixty patients who satisfied technical inclusion criteria underwent whole-body DXA scan and US on the same day. Total and android fat mass (FM) and FM percentage (FM%) were considered as well as visceral fat (VAT) subcompartment in the android region; moreover, six new ROIs were designed on whole-body DXA images for the investigation of adiposity parameters at heart level. US provided epicardial fat thickness (EPI-thickness) and area (EPI-area), as measured following previously validated methods. Body mass index (BMI), gynoid and lower limbs (FM and FM%) were found not statistically correlated with EPI-thickness. The highest correlation was achieved by trunk FM (and FM%, with r = 0.544 and 0.480 respectively, P < 0.001), followed by ROI-1 FM (ROI-1 was drawn following thoroughly the cardiac profile), and android FM. Multivariate analysis including age, weight, BMI, trunk FM and the new ROIs (added one by one), retained in the final model trunk FM. Correlations of DXA with EPI-area were superimposable. In obese women, VAT or other new-designed ROIs are not better correlated than traditional ROIs (i.e. trunk) with epicardial fat amount.
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Affiliation(s)
- A Bazzocchi
- Department of Specialized, Diagnostic, and Experimetal Medicine, University of Bologna, Bologna, Italy; Diagnostic and Interventional Radiology, 'Rizzoli' Orthopaedic Institute, Bologna, Italy
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Cha MJ, Oh S. The Relationship Between Pericardial Fat and Atrial Fibrillation. J Atr Fibrillation 2013; 5:676. [PMID: 28496808 PMCID: PMC5153103 DOI: 10.4022/jafib.676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 12/10/2012] [Accepted: 12/27/2012] [Indexed: 12/30/2022]
Abstract
Pericardial adiposity is strongly associated with increased cardiovascular risk, especially for coronary artery disease. However, until 2010 researchers have not focused on the mechanistic role of pericardial fat in atrial fibrillation (AF) pathogenesis. Only a limited number of studies have reported on the significant association between pericardial fat and AF prevalence, and the role of pericardial fat on AF chronicity and symptom burden remain an ongoing debate. Several possible mechanisms associating pericardial fat with increased AF prevalence have been suggested, but no prior studies have definitively elucidated the precise role of pericardial adiposity on increased AF risk. Currently, pericardial fat has recently emerged as a new independent AF risk factor. In this brief review, we discuss several potential mechanisms that might associate pericardial fat to AF pathogenesis.
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Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Lima-Martínez MM, Blandenier C, Iacobellis G. [Epicardial adipose tissue: more than a simple fat deposit?]. ACTA ACUST UNITED AC 2012; 60:320-8. [PMID: 23117053 DOI: 10.1016/j.endonu.2012.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 01/13/2023]
Abstract
Obesity increases the risk of development of atherosclerosis. However, this risk significantly depends on adipose tissue distribution in the body and ectopic accumulation of visceral adipose tissue (VAT). Recent evidence suggests that each visceral fat deposit is anatomically and functionally different. Due to proximity to the organ, each visceral fat deposit exerts a local modulation rather than a systemic effect. Because of its unique location and biomolecular properties, a "non-traditional" fat depot - the epicardial adipose tissue - has been considered to play a causative role in atherosclerosis. Epicardial adipose tissue may be measured with imaging techniques and is clinically related to left ventricular mass, coronary artery disease, and metabolic syndrome. Therefore, epicardial fat measurement may play a role in stratification of cardiometabolic risk and may serve as a therapeutic target.
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Affiliation(s)
- Marcos M Lima-Martínez
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela.
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Silaghi A, Silaghi H, Scridon T, Pais R, Achard V. Glucocorticoid receptors in human epicardial adipose tissue: role of coronary status. J Endocrinol Invest 2012; 35:649-54. [PMID: 21971518 DOI: 10.3275/7969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) is in close contact with coronary vessels and therefore could alter coronary homeostasis. Glucocorticoids are pathophysiological mediators of visceral fat deposition and its associated atherogenic complications. AIM We investigated in EAT the expression of the glucocorticoid receptor (GR) and its various (A, B, C) promoters. MATERIALS AND METHODS Paired subcutaneous adipose tissue (SAT) and EAT biopsies were obtained from 15 patients with coronary artery disease (CAD) and 12 patients without CAD (NCAD). GR and 11β-hydroxysteroid dehydrogenase type 1 protein (11β-HSD-1, the enzyme which converts inactive cortisone into active cortisol) were studied by immunohistochemistry and GR and its various promoters were studied by mRNA quantitative RT-PCR. RESULTS GR and 11β-HSD-1 protein were expressed in adipocytes, stromal areas, isolated stromal cells close to adipocytes, and blood vessels. Total GR mRNA levels did not differ in SAT obtained from NCAD or CAD patients and were decreased in EAT, irrespectively of the coronary status, with parallel changes in promoter B- and C-, but not promoter A-associated transcripts. Total GR mRNA and adipocyte surface in EAT obtained from CAD patients were correlated negatively (p<0.035, r=0.39). CONCLUSIONS Our findings demonstrate that in EAT, GR gene promoters could play a role in tissue- specific GR expression levels. EAT may be less sensitive to glucocorticoids than SAT, preventing the EAT mass development in CAD patients and suggesting a protective role on coronary homeostasis.
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Affiliation(s)
- A Silaghi
- County Emergency Hospital, Department of Endocrinology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
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Mariani S, Fiore D, Barbaro G, Basciani S, Saponara M, D'Arcangelo E, Ulisse S, Moretti C, Fabbri A, Gnessi L. Association of epicardial fat thickness with the severity of obstructive sleep apnea in obese patients. Int J Cardiol 2012; 167:2244-9. [PMID: 22726396 DOI: 10.1016/j.ijcard.2012.06.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND The correlation between obesity and severity of obstructive sleep apnea (OSA) is controversial. Although fat excess is a predisposing factor for the development of OSA, it has not been determined whether fat distribution rather than obesity per se is associated with OSA severity. Epicardial fat thickness (EFT) is an independent index of visceral adiposity and cardiometabolic risk. We investigated the relation between fat distribution and cardiometabolic risk factors, including EFT and common carotid intima-media thickness (cIMT), with the severity of OSA in obese patients. METHODS One hundred and fifteen obese patients (56 males, 59 females) with polysomnographic evidence of OSA (≥ 5 apnea/hypopnea events per hour) of various degrees, without significant differences in grade of obesity as defined by body mass index (BMI), were evaluated. The following parameters were measured: BMI, body composition by dual energy X-ray absorptiometry, EFT, right ventricular end-diastolic diameter (RVEDD) and cIMT by ultrasound, and parameters of metabolic syndrome (waist circumference, arterial blood pressure, fasting glucose, HDL-cholesterol and triglycerides). RESULTS EFT, RVEDD, cIMT and trunk/leg fat mass ratio showed a positive correlation with OSA severity in univariate analysis (r=0.536, p<0.001; r=0.480, p<0.001; r=0.345, p<0.001; r=0.330, p<0.001, respectively). However, multiple linear regression analysis showed that EFT was the most significant independent correlate of the severity of OSA (R(2)=0.376, p=0.022). CONCLUSIONS The present study suggests that, in obese patients, EFT may be included among the clinical parameters associating with OSA severity. The association of EFT with OSA, both cardiovascular risk factors, is independent of obesity as defined by classical measures.
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Affiliation(s)
- Stefania Mariani
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, Rome, Italy
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Hickson DA, Liu J, Bidulescu A, Burchfiel CM, Taylor HA, Petrini MF. Pericardial fat is associated with impaired lung function and a restrictive lung pattern in adults: the Jackson Heart Study. Chest 2011; 140:1567-1573. [PMID: 21737489 PMCID: PMC3231961 DOI: 10.1378/chest.11-0258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/01/2011] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Impaired lung function has been linked to obesity and systemic inflammation. Pericardial fat has been shown to be associated with anomalies in cardiac structure, function, and atherosclerosis. We hypothesized that pericardial fat may have a similar role in the impairment of lung function. METHODS Cross-sectional associations of pericardial fat volumes, quantified by multidetector CT scan, with FEV(1) and FVC assessed by spirometry, were investigated in 1,293 participants (54.5 ± 10.8 years; 66.4% women) in the Jackson Heart Study. We also examined whether these associations were independent of visceral adipose tissue (VAT). RESULTS Pericardial fat was associated with impaired lung function after multivariable adjustment, but these associations generally did not remain after adjustment for VAT. An exception was the FEV(1)/FVC ratio. Higher pericardial fat volumes were associated with higher odds of a restrictive lung pattern and lower odds of airway obstruction. Participants in the highest quartile had the highest odds of a restrictive lung pattern (OR, 1.85; 95% CI, 1.22-2.79, compared with quartile 1), even after adjustment for VAT. The odds of obstruction decreased across increasing quartiles of pericardial fat. These relationships were generally graded, suggesting dose-response trends. CONCLUSIONS Pericardial fat is generally associated with lower lung function and independently associated with a restrictive lung pattern in middle-aged and elderly adults. Further research is needed to fully understand the mechanisms through which pericardial fat contributes to pulmonary anomalies.
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Affiliation(s)
- DeMarc A Hickson
- Jackson Heart Study, Jackson State University, Jackson, MS; School of Medicine, University of Mississippi Medical Center, Jackson, MS.
| | - Jiankang Liu
- School of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Aurelian Bidulescu
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA
| | - Cecil M Burchfiel
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Herman A Taylor
- Jackson Heart Study, Jackson State University, Jackson, MS; School of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Marcy F Petrini
- School of Medicine, University of Mississippi Medical Center, Jackson, MS
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Iacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011; 22:450-7. [PMID: 21852149 PMCID: PMC4978122 DOI: 10.1016/j.tem.2011.07.003] [Citation(s) in RCA: 355] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/05/2011] [Accepted: 07/07/2011] [Indexed: 12/13/2022]
Abstract
Epicardial adipose tissue is an unusual visceral fat depot with anatomical and functional contiguity to the myocardium and coronary arteries. Under physiological conditions, epicardial adipose tissue displays biochemical, mechanical and thermogenic cardioprotective properties. Under pathological circumstances, epicardial fat can locally affect the heart and coronary arteries through vasocrine or paracrine secretion of proinflammatory cytokines. What influences this equilibrium remains unclear. Improved local vascularization, weight loss, and targeted pharmaceutical interventions could help to return epicardial fat to its physiological role. This review focuses on the emerging physiological and pathophysiological aspects of the epicardial fat and its numerous and innovative clinical applications. Particular emphasis is placed on the paracrine/endocrine properties of epicardial fat and its role in the development and progression of atherosclerosis.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA.
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23
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Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol 2011; 57:1745-51. [PMID: 21511110 DOI: 10.1016/j.jacc.2010.11.045] [Citation(s) in RCA: 323] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/21/2010] [Accepted: 11/01/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to characterize the relationship between pericardial fat and atrial fibrillation (AF). BACKGROUND Obesity is an important risk factor for AF. Pericardial fat has been hypothesized to exert local pathogenic effects on nearby cardiac structures above and beyond that of systemic adiposity. METHODS One hundred ten patients undergoing first-time AF ablation and 20 reference patients without AF underwent cardiac magnetic resonance imaging for the quantification of periatrial, periventricular, and total pericardial fat volumes using a previously validated technique. Together with body mass index and body surface area, these were examined in relation to the presence of AF, the severity of AF, left atrial volume, and long-term AF recurrence after ablation. RESULTS Pericardial fat volumes were significantly associated with the presence of AF, AF chronicity, and AF symptom burden (all p values <0.05). Pericardial fat depots were also predictive of long-term AF recurrence after ablation (p = 0.035). Finally, pericardial fat depots were also associated with left atrial volume (total pericardial fat: r = 0.46, p < 0.001). Importantly, these associations persisted after multivariate adjustment and additional adjustment for body weight. In contrast, however, systemic measures of adiposity, such as body mass index and body surface area, were not associated with these outcomes in multivariate-adjusted models. CONCLUSIONS Pericardial fat is associated with the presence of AF, the severity of AF, left atrial volumes, and poorer outcomes after AF ablation. These associations are both independent of and stronger than more systemic measures of adiposity. These findings are consistent with the hypothesis of a local pathogenic effect of pericardial fat on the arrhythmogenic substrate supporting AF.
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Comparison of epicardial adipose tissue (EAT) thickness and anthropometric measurements in metabolic syndrome (MS) cases above and under the age of 65. Arch Gerontol Geriatr 2011; 52:e79-84. [DOI: 10.1016/j.archger.2010.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 05/20/2010] [Accepted: 05/22/2010] [Indexed: 11/21/2022]
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25
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Ouwens DM, Sell H, Greulich S, Eckel J. The role of epicardial and perivascular adipose tissue in the pathophysiology of cardiovascular disease. J Cell Mol Med 2011; 14:2223-34. [PMID: 20716126 PMCID: PMC3822561 DOI: 10.1111/j.1582-4934.2010.01141.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Obesity, insulin resistance and the metabolic syndrome, are characterized by expansion and inflammation of adipose tissue, including the depots surrounding the heart and the blood vessels. Epicardial adipose tissue (EAT) is a visceral thoracic fat depot located along the large coronary arteries and on the surface of the ventricles and the apex of the heart, whereas perivascular adipose tissue (PVAT) surrounds the arteries. Both fat depots are not separated by a fascia from the underlying tissue. Therefore, factors secreted from epicardial and PVAT, like free fatty acids and adipokines, can directly affect the function of the heart and blood vessels. In this review, we describe the alterations found in EAT and PVAT in pathological states like obesity, type 2 diabetes, the metabolic syndrome and coronary artery disease. Furthermore, we discuss how changes in adipokine expression and secretion associated with these pathological states could contribute to the pathogenesis of cardiac contractile and vascular dysfunction.
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Affiliation(s)
- D Margriet Ouwens
- The Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Centre, Düsseldorf, Germany.
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Malavazos AE, Di Leo G, Secchi F, Lupo EN, Dogliotti G, Coman C, Morricone L, Corsi MM, Sardanelli F, Iacobellis G. Relation of echocardiographic epicardial fat thickness and myocardial fat. Am J Cardiol 2010; 105:1831-5. [PMID: 20538139 DOI: 10.1016/j.amjcard.2010.01.368] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 01/29/2010] [Accepted: 01/29/2010] [Indexed: 12/13/2022]
Abstract
Epicardial and myocardial fats increase with degree of visceral adiposity and possibly contribute to obesity-associated cardiac changes. Echocardiographic epicardial fat thickness is a new and independent marker of visceral adiposity. The aim of this study was to test whether echocardiographic epicardial fat is related to myocardial fat. Twenty consecutive Caucasian men (body mass index 30.5 +/- 2 kg/m(2), 42 +/- 7 years of age) underwent transthoracic echocardiography for epicardial fat thickness, morphologic and diastolic parameter measurements, hydrogen-1 magnetic resonance spectroscopy for myocardial fat quantification, and magnetic resonance imaging for epicardial fat volume estimation. Hydrogen-1 magnetic resonance spectroscopic myocardial fat content, magnetic resonance imaging of epicardial fat volume, and echocardiographic epicardial fat thickness range varied from 0.5% to 31%, 4.5 to 43 ml, and 3 to 15 mm, respectively. Myocardial fat content showed a statistically significant correlation with echocardiographic epicardial fat thickness (r = 0.79, p <0.01), waist circumference (r = 0.64, p <0.01), low-density lipoprotein cholesterol (r = 0.54, p <0.01), plasma adiponectin levels (r = -0.49, p <0.01), and isovolumic relaxation time (r = 0.59, p <0.01). However, multivariate linear regression analysis showed epicardial fat thickness as the most significant independent correlate of myocardial fat (p <0.001). Although this study is purely correlative and no causative conclusions can be drawn, it can be postulated that increased echocardiographic epicardial fat accumulation could reflect myocardial fat in subjects with a wide range of adiposity.
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