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Song Y, Tan Y, Deng M, Shan W, Zheng W, Zhang B, Cui J, Feng L, Shi L, Zhang M, Liu Y, Sun Y, Yi W. Epicardial adipose tissue, metabolic disorders, and cardiovascular diseases: recent advances classified by research methodologies. MedComm (Beijing) 2023; 4:e413. [PMID: 37881786 PMCID: PMC10594046 DOI: 10.1002/mco2.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Epicardial adipose tissue (EAT) is located between the myocardium and visceral pericardium. The unique anatomy and physiology of the EAT determines its great potential in locally influencing adjacent tissues such as the myocardium and coronary arteries. Classified by research methodologies, this study reviews the latest research progress on the role of EAT in cardiovascular diseases (CVDs), particularly in patients with metabolic disorders. Studies based on imaging techniques demonstrated that increased EAT amount in patients with metabolic disorders is associated with higher risk of CVDs and increased mortality. Then, in-depth profiling studies indicate that remodeled EAT may serve as a local mediator of the deleterious effects of cardiometabolic conditions and plays a crucial role in CVDs. Further, in vitro coculture studies provided preliminary evidence that the paracrine effect of remodeled EAT on adjacent cardiomyocytes can promote the occurrence and progression of CVDs. Considering the important role of EAT in CVDs, targeting EAT might be a potential strategy to reduce cardiovascular risks. Several interventions have been proved effective in reducing EAT amount. Our review provides valuable insights of the relationship between EAT, metabolic disorders, and CVDs, as well as an overview of the methodological constructs of EAT-related studies.
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Affiliation(s)
- Yujie Song
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Yanzhen Tan
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Meng Deng
- Department of General MedicineXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wenju Shan
- Department of General MedicineXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wenying Zheng
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Bing Zhang
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Jun Cui
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Lele Feng
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Lei Shi
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Miao Zhang
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Yingying Liu
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Yang Sun
- Department of General MedicineXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wei Yi
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
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Chan J, Thakur U, Tan S, Muthalaly RG, Thakkar H, Goel V, Cheen YC, Dey D, Brown AJ, Wong DTL, Nerlekar N. Inter-software and inter-scan variability in measurement of epicardial adipose tissue: a three-way comparison of a research-specific, a freeware and a coronary application software platform. Eur Radiol 2023; 33:8445-8453. [PMID: 37369831 PMCID: PMC10667389 DOI: 10.1007/s00330-023-09878-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/26/2023] [Accepted: 04/27/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES Epicardial adipose tissue (EAT) is a proposed marker of cardiovascular risk; however, clinical application may be limited by variability in post-processing software platforms. We assessed inter-vendor agreement of EAT volume (EATv) and attenuation on both contrast-enhanced (CE) and non-contrast CT (NCT) using a standard coronary CT reporting software (Vitrea), an EAT research-specific software (QFAT) and a freeware imaging software (OsiriX). METHODS Seventy-six consecutive patients undergoing simultaneous CE and NCT had complete volumetric EAT measurement. Between-software, within-software NCT vs. CE, and inter- and intra-observer agreement were evaluated with analysis by ANOVA (with post hoc adjustment), Bland-Altman with 95% levels of agreement (LoA) and intraclass correlation coefficient (ICC). RESULTS Mean EATv (freeware 53 ± 31 mL vs. research 93 ± 43 mL vs. coronary 157 ± 64 mL) and attenuation (freeware - 72 ± 25 HU vs. research - 75 ± 3 HU vs. coronary - 61 ± 10 HU) were significantly different between all vendors (ANOVA p < 0.001). EATv was consistently higher in NCT vs. CE for all software packages, with most reproducibility found in research software (bias 26 mL, 95% LoA: 2 to 56 mL), compared to freeware (bias 11 mL 95% LoA: - 46 mL to 69 mL) and coronary software (bias 10 mL 95% LoA: - 127 to 147 mL). Research software had more comparable NCT vs. CE attenuation (- 75 vs. - 72 HU) compared to freeware (- 72 vs. - 57 HU) and coronary (- 61 vs. - 39 HU). Excellent inter-observer agreement was seen with research (ICC 0.98) compared to freeware (ICC 0.73) and coronary software (ICC 0.75) with narrow LoA on Bland-Altman analysis. CONCLUSION There are significant inter-vendor differences in EAT assessment. Our study suggests that research-specific software has better agreement and reproducibility compared to freeware or coronary software platforms. KEY POINTS • There are significant differences between EAT volume and attenuation values between software platforms, regardless of scan type. • Non-contrast scans routinely have higher mean EAT volume and attenuation; however, this finding is only consistently seen with research-specific software. • Of the three analyzed packages, research-specific software demonstrates the highest reproducibility, agreement, and reliability for both inter-scan and inter-observer agreement.
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Affiliation(s)
- Jasmine Chan
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Sean Tan
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Harsh Thakkar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Vinay Goel
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Yeong-Chee Cheen
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Damini Dey
- Cedars Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Tong J, Bei GG, Zhang LB, Sun Y, Qi M, Yang BQ. Relationship between quantitative epicardial adipose tissue based on coronary computed tomography angiography and coronary slow flow. BMC Cardiovasc Disord 2023; 23:500. [PMID: 37817079 PMCID: PMC10566056 DOI: 10.1186/s12872-023-03541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The purpose of this study was to explore the relationship between quantitative epicardial adipose tissue (EAT) based on coronary computed tomography angiography (CCTA) and coronary slow flow (CSF). METHODS A total of 85 patients with < 40% coronary stenosis on diagnostic coronary angiography were included in this retrospective study between January 2020 and December 2021. A semi-automatic method was developed for EAT quantification on CCTA images. According to the thrombolysis in myocardial infarction flow grade, the patients were divided into CSF group (n = 39) and normal coronary flow group (n = 46). Multivariate logistic regression was used to explore the relationship between EAT and CSF. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of EAT in CSF. RESULTS EAT volume in the CSF group was significantly higher than that of the normal coronary flow group (128.83± 21.59 mL vs. 101.87± 18.56 mL, P < 0.001). There was no significant difference in epicardial fat attenuation index between the two groups (P > 0.05). Multivariate logistic regression analysis showed that EAT volume was independently related to CSF [odds ratio (OR) = 4.82, 95% confidence interval (CI): 3.06-7.27, P < 0.001]. The area under ROC curve for EAT volume in identifying CSF was 0.86 (95% CI: 0.77-0.95). The optimal cutoff value of 118.46 mL yielded a sensitivity of 0.80 and a specificity of 0.94. CONCLUSIONS Increased EAT volume based on CCTA is strongly associated with CSF. This preliminary finding paves the way for future and larger studies aimed to definitively recognize the diagnostic value of EAT in CSF.
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Affiliation(s)
- Jing Tong
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, Liaoning Province, China
| | - Gui-Guang Bei
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, Liaoning Province, China
| | - Li-Bo Zhang
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, Liaoning Province, China
| | - Yu Sun
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, Liaoning Province, China
| | - Miao Qi
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, Liaoning Province, China
| | - Ben-Qiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, Liaoning Province, China.
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Aldous E, Lin A, Nerlekar N. Letter by Aldous et al Regarding Article, "Epicardial Adipose Tissue Assessed by Computed Tomography and Echocardiography Are Associated With Adverse Cardiovascular Outcomes: A Systematic Review and Meta-analysis". Circ Cardiovasc Imaging 2023; 16:e015844. [PMID: 37800324 DOI: 10.1161/circimaging.123.015844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Emma Aldous
- Victorian Heart Institute and Monash Health Heart, Victorian Heart Hospital, Monash University, Clayton, Australia
| | - Andrew Lin
- Victorian Heart Institute and Monash Health Heart, Victorian Heart Hospital, Monash University, Clayton, Australia
| | - Nitesh Nerlekar
- Victorian Heart Institute and Monash Health Heart, Victorian Heart Hospital, Monash University, Clayton, Australia
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O'Hagan R, Hsu LY, Li H, Hong CG, Parel PM, Berg AR, Manyak GA, Bui V, Patel NH, Florida EM, Teague HL, Playford MP, Zhou W, Dey D, Chen MY, Mehta NN, Sorokin AV. Longitudinal association of epicardial and thoracic adipose tissues with coronary and cardiac characteristics in psoriasis. Heliyon 2023; 9:e20732. [PMID: 37867905 PMCID: PMC10585224 DOI: 10.1016/j.heliyon.2023.e20732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background s: Psoriasis is a disease of systemic inflammation associated with increased cardiometabolic risk. Epicardial adipose tissue (EAT) and thoracic adipose tissue (TAT) are contributing factors for atherosclerosis and cardiac dysfunction. We strove to assess the longitudinal impact of the EAT and TAT on coronary and cardiac characteristics in psoriasis. Methods The study consisted of 301 patients with baseline coronary computed tomography angiography (CTA), of which 139 had four-year follow up scans. EAT and TAT volumes from non-contrast computed tomography scans were quantified by an automated segmentation framework. Coronary plaque characteristics and left ventricular (LV) mass were quantified by CTA. Results When stratified by baseline EAT and TAT volume quartiles, a stepwise significant increase in cardiometabolic parameters was observed. EAT and TAT volumes associated with fibro-fatty burden (FFB) (TAT: ρ = 0.394, P < 0.001; EAT: ρ = 0.459, P < 0.001) in adjusted models. Only EAT had a significant four-year time-dependent association with FFB in fully adjusted models (β = 0.307 P = 0.003), whereas only TAT volume associated with myocardial injury in fully adjusted models (TAT: OR = 1.57 95 % CI = (1.00-2.60); EAT: OR = 1.46 95 % CI = (0.91-2.45). Higher quartiles of EAT and TAT had increased LV mass and developed strong correlation (TAT: ρ = 0.370, P < 0.001; EAT: ρ = 0.512, P < 0.001). Conclusions Our study is the first to explore how both EAT and TAT volumes associate with increased cardiometabolic risk profile in an inflamed psoriasis cohorts and highlight the need for further studies on its use as a potential prognostic tool for high-risk coronary plaques and cardiac dysfunction.
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Affiliation(s)
- Ross O'Hagan
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Li-Yueh Hsu
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Haiou Li
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christin G. Hong
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philip M. Parel
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexander R. Berg
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Grigory A. Manyak
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Vy Bui
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Nidhi H. Patel
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth M. Florida
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather L. Teague
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin P. Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wunan Zhou
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marcus Y. Chen
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nehal N. Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexander V. Sorokin
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Myasoedova VA, Parisi V, Moschetta D, Valerio V, Conte M, Massaiu I, Bozzi M, Celeste F, Leosco D, Iaccarino G, Genovese S, Poggio P. Efficacy of cardiometabolic drugs in reduction of epicardial adipose tissue: a systematic review and meta-analysis. Cardiovasc Diabetol 2023; 22:23. [PMID: 36721184 PMCID: PMC9890718 DOI: 10.1186/s12933-023-01738-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) plays an important role in cardiometabolic risk. EAT is a modifiable risk factor and could be a potential therapeutic target for drugs that already show cardiovascular benefits. The aim of this study is to evaluate the effect of cardiometabolic drugs on EAT reduction. METHODS A detailed search related to the effect on EAT reduction due to cardiometabolic drugs, such as glucagon-like peptide-1 receptor agonist (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT2-i), and statins was conducted according to PRISMA guidelines. Eighteen studies enrolling 1064 patients were included in the qualitative and quantitative analyses. RESULTS All three analyzed drug classes, in particular GLP-1 RA, show a significant effect on EAT reduction (GLP-1 RA standardize mean difference (SMD) = - 1.005; p < 0.001; SGLT2-i SMD = - 0.552; p < 0.001, and statin SMD = - 0.195; p < 0.001). The sensitivity analysis showed that cardiometabolic drugs strongly benefit EAT thickness reduction, measured by ultrasound (overall SMD of - 0.663; 95%CI - 0.79, - 0.52; p < 0.001). Meta-regression analysis revealed younger age and higher BMI as significant effect modifiers of the association between cardiometabolic drugs and EAT reduction for both composite effect and effect on EAT thickness, (age Z: 3.99; p < 0.001 and Z: 1.97; p = 0.001, respectively; BMI Z: - 4.40; p < 0.001 and Z: - 2.85; p = 0.004, respectively). CONCLUSIONS Cardiometabolic drugs show a significant beneficial effect on EAT reduction. GLP-1 RA was more effective than SGLT2-i, while statins had a rather mild effect. We believe that the most effective treatment with these drugs should target younger patients with high BMI.
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Affiliation(s)
- Veronika A Myasoedova
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy.
| | - Valentina Parisi
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Donato Moschetta
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Vincenza Valerio
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
- Casa Di Cura San Michele, Maddaloni, Italy
| | - Ilaria Massaiu
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Michele Bozzi
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Fabrizio Celeste
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stefano Genovese
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Paolo Poggio
- Unit for the Study of Aortic, Valvular, and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy.
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Papathanasiou KA, Vrachatis DA, Deftereos S. Epicardial Adipose Tissue Hyperinflammation Might be the Broken Thread in Coronary Artery Ectasia Pathogenesis. Angiology 2022; 74:600-601. [DOI: 10.1177/00033197221139690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Inflammation, as assessed by epicardial adipose tissue and serum biomarkers, represents an integral mechanistic link in isolated coronary artery ectasia (iCAE) pathogenesis. This should be further investigated in the context of iCAE management and risk stratification.
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Affiliation(s)
- Konstantinos A. Papathanasiou
- Second Department of Cardiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios A. Vrachatis
- Second Department of Cardiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Deftereos
- Second Department of Cardiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Wang Q, Chi J, Wang C, Yang Y, Tian R, Chen X. Epicardial Adipose Tissue in Patients with Coronary Artery Disease: A Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9080253. [PMID: 36005417 PMCID: PMC9410067 DOI: 10.3390/jcdd9080253] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022] Open
Abstract
Objective: The aim of this study is to assess the association between epicardial adipose tissue (EAT) and coronary artery disease (CAD) via meta−analysis. Methods: Specific searches of online databases from January 2000 to May 2022 were conducted. All observational studies evaluating the association between EAT and CAD in PubMed, Web of Science, and the Cochrane Library databases were screened. A meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta−Analyses guidelines (PRISMA). In total, 21 studies encompassing 4975 subjects met the inclusion criteria, including 2377 diagnosed and assigned as the CAD group, while the other 2598 were assigned as the non−CAD group. Subjects in the CAD group were further divided into the severe stenosis group (stenosis ≥ 50%, n = 846) and the mild/moderate stenosis group (stenosis < 50%, n = 577). Results: Both the volume and thickness of EAT in the CAD group were larger compared to the non−CAD group (p < 0.00001). In a subgroup analysis within the CAD group, the severe stenosis group had a larger volume and thickness with respect to EAT when compared to the mild/moderate group (p < 0.001). Conclusions: The enlargement of EAT presented in CAD patients with an association with CAD severity. Although limited by different CAD types and measuring methods for EAT, as well as a smaller sample size, our results suggest that EAT is a novel predictor and a potential therapeutic target for CAD.
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Affiliation(s)
- Qingpeng Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiangyang Chi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chen Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yun Yang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rui Tian
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xinzhong Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence:
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Goel V, Spear E, Cameron W, Thakur U, Sultana N, Chan J, Tan S, Joshi M, Roberts A, Cheen YC, Youn H, Dey D, Davis E, Nicholls S, Brown A, Nerlekar N. Breast arterial calcification and epicardial adipose tissue volume, but not density are independently associated with cardiovascular risk. Int J Cardiol 2022; 360:78-82. [PMID: 35618106 DOI: 10.1016/j.ijcard.2022.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mammographically detected breast arterial calcification (BAC) has been proposed as surrogate marker for coronary artery disease (CAD) in women. Epicardial adipose tissue (EAT) and peri-coronary adipose tissue (PCAT) are inflammatory fat depots linked to atherogenesis. BAC has demonstrated association with inflammation, therefore we aimed to determine the association between BAC, EAT and PCAT. METHODS Single-centre, retrospective, cross-sectional study of women with digital mammography and coronary computed tomography angiography (CCTA). EAT and PCAT were quantitively assessed using semi-automated software. Patient demographics and cardiovascular risk factors were obtained from medical records and mammograms reviewed for BAC. Pre-test cardiovascular risk was determined with CAD Consortium Score. Chi-square, t-test and Mann-Whitney U tests were used to assess between group differences. Multivariable linear and logistic regression modelling was conducted to adjust for confounders. RESULTS Among 153 patients (age 61, SD 11) included in this study, BAC was present in 37 (24%) patients. BAC-positive patients had higher EAT volume (EATv) (110.2 mL, SD 41 mL vs 94.4 mL, SD 41 mL, p = 0.02) but this association was not significant after adjusting for cardiovascular risk factors (p = 0.26). BAC did not associate with EAT density or PCAT. BAC and EATv were strongly associated with cardiovascular risk and CAD independent of each other: CV risk (BAC OR 7.55 (3.26-18.49), p < 0.001, EATv OR 1.02 (1.01-1.03), p < 0.001), CAD presence (BAC OR 4.26 (1.39-13), p = 0.01; EATv OR 1.01 (1.0-1.03), p = 0.04). CONCLUSION BAC and EATv are independent predictors of CV risk and CAD, but don't independently associate with each other, the relationship confounded by shared cardiovascular risk factors. BAC doesn't appear to associate with adipose tissue density and its presence may be cumulative result of long-term exposure to CV risk factors.
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Affiliation(s)
- Vinay Goel
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Ella Spear
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - William Cameron
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Nushrat Sultana
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Jasmine Chan
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Sean Tan
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Mitwa Joshi
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Andrew Roberts
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Yeong Chee Cheen
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Hannah Youn
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Damini Dey
- Cedar-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA 90048, USA
| | - Esther Davis
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Stephen Nicholls
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Adam Brown
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Nitesh Nerlekar
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne 3004, Melbourne, Victoria, Australia.
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10
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Conte M, Petraglia L, Poggio P, Valerio V, Cabaro S, Campana P, Comentale G, Attena E, Russo V, Pilato E, Formisano P, Leosco D, Parisi V. Inflammation and Cardiovascular Diseases in the Elderly: The Role of Epicardial Adipose Tissue. Front Med (Lausanne) 2022; 9:844266. [PMID: 35242789 PMCID: PMC8887867 DOI: 10.3389/fmed.2022.844266] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
Human aging is a complex phenomenon characterized by a wide spectrum of biological changes which impact on behavioral and social aspects. Age-related changes are accompanied by a decline in biological function and increased vulnerability leading to frailty, thereby advanced age is identified among the major risk factors of the main chronic human diseases. Aging is characterized by a state of chronic low-grade inflammation, also referred as inflammaging. It recognizes a multifactorial pathogenesis with a prominent role of the innate immune system activation, resulting in tissue degeneration and contributing to adverse outcomes. It is widely recognized that inflammation plays a central role in the development and progression of numerous chronic and cardiovascular diseases. In particular, low-grade inflammation, through an increased risk of atherosclerosis and insulin resistance, promote cardiovascular diseases in the elderly. Low-grade inflammation is also promoted by visceral adiposity, whose accumulation is paralleled by an increased inflammatory status. Aging is associated to increase in epicardial adipose tissue (EAT), the visceral fat depot of the heart. Structural and functional changes in EAT have been shown to be associated with several heart diseases, including coronary artery disease, aortic stenosis, atrial fibrillation, and heart failure. EAT increase is associated with a greater production and secretion of pro-inflammatory mediators and neuro-hormones, so that thickened EAT can pathologically influence, in a paracrine and vasocrine manner, the structure and function of the heart and is associated to a worse cardiovascular outcome. In this review, we will discuss the evidence underlying the interplay between inflammaging, EAT accumulation and cardiovascular diseases. We will examine and discuss the importance of EAT quantification, its characteristics and changes with age and its clinical implication.
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Affiliation(s)
- Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Casa di Cura San Michele, Maddaloni, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Serena Cabaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Campana
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Comentale
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Emilio Attena
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Campania, Italy
| | - Emanuele Pilato
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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11
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Ayton SL, Gulsin GS, McCann GP, Moss AJ. Epicardial adipose tissue in obesity-related cardiac dysfunction. Heart 2022; 108:339-344. [PMID: 33985985 DOI: 10.1136/heartjnl-2020-318242] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/31/2021] [Accepted: 04/22/2021] [Indexed: 11/04/2022] Open
Abstract
Obesity is associated with the development of heart failure and is a major risk factor for heart failure with preserved ejection fraction (HFpEF). Epicardial adipose tissue (EAT) is a unique visceral fat in close proximity to the heart and is of particular interest to the study of cardiac disease. Small poorly differentiated adipocytes with altered lipid:water content are associated with a proinflammatory secretome and may contribute to the pathophysiology observed in HFpEF. Multimodality imaging approaches can be used to quantify EAT volume and characterise EAT composition. Current research studies remain unclear as to the magnitude of effect that EAT plays on myocardial dysfunction and further work using multimodality imaging techniques is ongoing. Pharmacological interventions, including glucagon-like peptide 1 receptor agonists and sodium-dependent glucose linked transporter 2 inhibitors have shown promise in attenuating the deleterious metabolic and inflammatory changes seen in EAT. Clinical studies are ongoing to explore whether these therapies exert their beneficial effects by modifying this unique adipose deposit.
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Affiliation(s)
- Sarah L Ayton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Alastair J Moss
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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12
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Ellis CN, Neville SJ, Sayyouh M, Elder JT, Nair RP, Gudjonsson JE, Ma T, Kazerooni EA, Rubenfire M, Agarwal PP. Epicardial adipose tissue volume is greater in men with severe psoriasis, implying an increased cardiovascular disease risk: A cross-sectional study. J Am Acad Dermatol 2021; 86:535-543. [PMID: 34678237 DOI: 10.1016/j.jaad.2021.09.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with psoriasis have elevated risk of coronary artery disease. OBJECTIVE Do patients with severe psoriasis have larger epicardial adipose tissue volumes (EAT-V) that are associated with cardiovascular risk? METHODS For this cross-sectional study, we recruited dermatology patients with severe psoriasis and control patients without psoriasis or rheumatologic disease themselves or in a first-degree relative. Participants aged 34 to 55 years without known coronary artery disease or diabetes mellitus underwent computed tomography (CT); EAT-V was obtained from noncontrast CT heart images. RESULTS Twenty-five patients with psoriasis (14 men, 11 women) and 16 controls (5 men, 11 women) participated. Groups had no statistical difference in age, body mass index, various cardiovascular risk factors (except high-sensitivity C-reactive protein in men), CT-determined coronary artery calcium scores or plaque, or family history of premature cardiovascular disease. Mean EAT-V was greater in the psoriasis group compared to controls (P = .04). There was no statistically significant difference among women; however, male patients with psoriasis had significantly higher EAT-V than controls (P = .03), even when corrected for elevated high-sensitivity C-reactive protein (P = .05). LIMITATIONS A single-center convenience sample may not be representative. CONCLUSION Males with psoriasis without known coronary disease or diabetes had greater EAT-V than controls. EAT-V may be an early identifier of those at increased risk for cardiovascular events.
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Affiliation(s)
- Charles N Ellis
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stephen J Neville
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mohamed Sayyouh
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James T Elder
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rajan P Nair
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tianwen Ma
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan; Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Melvyn Rubenfire
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Prachi P Agarwal
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan.
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13
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Sousa JA, Mendonça MI, Serrão M, Borges S, Henriques E, Freitas S, Tentem M, Santos M, Freitas P, Ferreira A, Guerra G, Drumond A, Palma Reis R. Epicardial Adipose Tissue: The Genetics Behind an Emerging Cardiovascular Risk Marker. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2021; 15:11795468211029244. [PMID: 34276231 PMCID: PMC8255575 DOI: 10.1177/11795468211029244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/07/2021] [Indexed: 12/16/2022]
Abstract
Evidence points epicardial adipose tissue (EAT) as an emerging cardiovascular risk marker. Whether genetic polymorphisms linked with atherosclerosis are associated with higher EAT is still unknown. We aim to assess the role of genetic burden of atherosclerosis and its association to EAT in a cohort of asymptomatic individuals without coronary disease. A total of 996 participants were prospectively enrolled in a single Portuguese center. EAT volume was measured by Cardiac Computed Tomography and participants were distributed into 2 groups, above and below median EAT. SNPs were genotyped and linked to their respective pathophysiological axes. A multiplicative genetic risk score (mGRS) was constructed, representing the genetic burden of the studied SNPs. To evaluate the association between genetics and EAT, we compared both groups by global mGRS, mGRS by functional axes, and SNPs individually. Individuals above-median EAT were older, had a higher body mass index (BMI) and higher prevalence of hypertension, metabolic syndrome, diabetes, and dyslipidemia. They presented higher GRS, that remained an independent predictor of higher EAT volumes. The group with more EAT consistently presented higher polymorphic burden across numerous pathways. After adjustment, age, BMI, and mGRS of each functional axis emerged as independently related to higher EAT volumes. Amongst the 33 SNPs, MTHFR677 polymorphism emerged as the only significant and independent predictor of higher EAT volumes. Patients with higher polymorphism burden for atherosclerosis present higher EAT volumes. We present the first study in a Portuguese population, evaluating the genetic profile of EAT through GWAS and GRS, casting further insight into this complicated matter.
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Affiliation(s)
- João Adriano Sousa
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Maria Isabel Mendonça
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Marco Serrão
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Sofia Borges
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Eva Henriques
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Sónia Freitas
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Margarida Tentem
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Marina Santos
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Pedro Freitas
- Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, CHLO, Carnaxide, Portugal
| | - António Ferreira
- Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, CHLO, Carnaxide, Portugal
| | - Graça Guerra
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - António Drumond
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Roberto Palma Reis
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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14
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Goeller M, Achenbach S, Duncker H, Dey D, Marwan M. Imaging of the Pericoronary Adipose Tissue (PCAT) Using Cardiac Computed Tomography: Modern Clinical Implications. J Thorac Imaging 2021; 36:149-161. [PMID: 33875629 DOI: 10.1097/rti.0000000000000583] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Modern coronary computed tomography angiography (CTA) is the gold standard to visualize the epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT). The EAT is a metabolic active fat depot enclosed by the visceral pericardium and surrounds the coronary arteries. In disease states with increased EAT volume and dysfunctional adipocytes, EAT secretes an increased amount of adipocytokines and the resulting imbalance of proinflammatory and anti-inflammatory mediators potentially causes atherogenic effects on the coronary vessel wall in a paracrine way ("outside-to-inside" signaling). These EAT-induced atherogenic effects are reported to increase the risk for the development of coronary artery disease, myocardial ischemia, high-risk plaque features, and future major adverse cardiac events. Coronary inflammation plays a key role in the development and progression of coronary artery disease; however, its noninvasive detection remains challenging. In future, this clinical dilemma might be changed by the CTA-derived analysis of the PCAT. On the basis of the concept of an "inside-to-outside" signaling between the inflamed coronary vessel wall and the surrounding PCAT recent evidence demonstrates that PCAT computed tomography attenuation especially around the right coronary artery derived from routine CTA is a promising imaging biomarker and "sensor" to noninvasively detect coronary inflammation. This review summarizes the biological and technical principles of CTA-derived PCAT analysis and highlights its clinical implications to improve modern cardiovascular prevention strategies.
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Affiliation(s)
- Markus Goeller
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Hendrik Duncker
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mohamed Marwan
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Erlangen, Germany
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15
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Guglielmo M, Lin A, Dey D, Baggiano A, Fusini L, Muscogiuri G, Pontone G. Epicardial fat and coronary artery disease: Role of cardiac imaging. Atherosclerosis 2021; 321:30-38. [PMID: 33636676 DOI: 10.1016/j.atherosclerosis.2021.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022]
Abstract
Epicardial adipose tissue (EAT) represents the fat depot located between the myocardium and the visceral pericardial layer. Far from being an inert tissue, EAT has been recognized as secreting a large amount of bioactive molecules called adipokines, which have numerous exocrine and paracrine effects. Recent evidence demonstrates that pericoronary adipose tissue (PCAT) - the EAT directly surrounding the coronary arteries - has a complex bidirectional interaction with the underlying vascular wall. While in normal conditions this mutual cross-talk helps maintain the homeostasis of the vascular wall, dysfunctional PCAT produces deleterious pro-inflammatory adipokines involved in atherogenesis. Importantly, PCAT inflammation has been associated with coronary artery disease (CAD) and major cardiovascular events. This review aims to provide an overview of the imaging techniques used to assess EAT, with a specific focus on cardiac computed tomography (CCT), which has become the key modality in this field. In contrast to echocardiography and cardiac magnetic resonance (CMR), CCT is not only able to visualize and precisely quantify EAT, but also to assess the coronary arteries and the PCAT simultaneously. In recent years, several papers have shown the utility of using CCT-derived PCAT attenuation as a surrogate measure of coronary inflammation. This noninvasive imaging biomarker may potentially be used to monitor patient responses to new antinflammatory drugs for the treatment of CAD.
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Affiliation(s)
- Marco Guglielmo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Andrea Baggiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giuseppe Muscogiuri
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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16
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Mangiafico V, Saberwal B, Lavalle C, Raharja A, Ahmed Z, Papageorgiou N, Ahsan S. The role of CT in detecting AF substrate. Trends Cardiovasc Med 2020; 31:457-466. [PMID: 33068722 DOI: 10.1016/j.tcm.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Despite technological advancements and evolving ablation strategies, atrial fibrillation catheter ablation outcome remains suboptimal for a cohort of patients. Imaging-based biomarkers have the potential to play a pivotal role in the overall assessment and prognostic stratification of AF patients, allowing for tailored treatments and individualized care. Alongside consolidated evaluation parameters, novel imaging biomarkers that can detect and stage the remodelling process and correlate it to electrophysiological phenomena are emerging. This review aims to provide a better understanding of the different types of atrial substrate, and how Computed Tomography can be used as a pre-ablation risk stratification tool by assessing the various novel imaging biomarkers, providing a valuable insight into the mechanisms that sustain AF and potentially allowing for a patient-specific ablation strategy.
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Affiliation(s)
- Valentina Mangiafico
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Bunny Saberwal
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Antony Raharja
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
| | - Zuhair Ahmed
- Queen Mary University of London, London, England.
| | | | - Syed Ahsan
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, England.
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17
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Abstract
According to previous epidemiological studies, we can reduce the thickness of epicardial fat and improve cardiovascular risk factors through exercise, and the changes may depend on the form of exercise. We systemically reviewed published studies that evaluated exercise intervention on epicardial adipose tissue (EAT) levels. We included randomized controlled trials (RCTs) comparing one exercise with another exercise or diet for the treatment to reduce EAT. We used fixed effects models for meta-analyses; effects of exercise on outcomes were described as mean differences (MD) or standardized difference of means (SMD) was used, their 95% confidence intervals (CI). Five RCTs were included (n = 299), 156 in exercise group and 143 in the control. In comparison to the control group, exercise significantly reduced EAT (SMD - 0.57, 95%CI - 0.97 to - 0.18) and waist circumference (MD - 2.95 cm, 95%CI - 4.93 to - 0.97). Exercise did not have an effect on BMI (MD - 0.23 kg/m2, 95%CI - 0.73 to 0.27), weight (MD - 0.06 kg, 95%CI - 1.46 to 1.34), or HDL (SMD 0.26, 95%CI - 0.06 to 0.57).VO2 was significantly increased by exercise (SMD 1.58, 95%CI 1.17 to 1.99). Risk of bias was high for 3 studies, and GRADE quality of evidence was very low to moderate. Exercise reduced epicardial adipose tissue and waist circumference, and did not have effect on weight, BMI, or HDL. Newer trials with better design and methods are necessary to improve the quality of the evidence. PROSPERO registration number (CRD42018096581).
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18
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Nerlekar N, Thakur U, Lin A, Koh JQS, Potter E, Liu D, Muthalaly RG, Rashid HN, Cameron JD, Dey D, Wong DTL. The Natural history of Epicardial Adipose Tissue Volume and Attenuation: A long-term prospective cohort follow-up study. Sci Rep 2020; 10:7109. [PMID: 32346001 PMCID: PMC7188860 DOI: 10.1038/s41598-020-63135-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/04/2020] [Indexed: 12/11/2022] Open
Abstract
Epicardial adipose tissue (EAT) is associated with cardiovascular risk. The longitudinal change in EAT volume (EATv) and density (EATd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (CTCA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (CVRF) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline −76 ± 6 HU vs. −86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. In this select group of patients, EATv consistently increased and EATd consistently decreased at long-term follow-up and these changes were independent of CVRF, age and statin use. Together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that EAT is an independent parameter rather than a surrogate for cardiovascular risk.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Ji Quan Samuel Koh
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Elizabeth Potter
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - David Liu
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul N Rashid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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19
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Yuvaraj J, Lin A, Nerlekar N, Rashid H, Cameron JD, Seneviratne S, Nicholls S, Psaltis PJ, Wong DTL. Is spontaneous coronary artery dissection (SCAD) related to vascular inflammation and epicardial fat? -insights from computed tomography coronary angiography. Cardiovasc Diagn Ther 2020; 10:239-241. [PMID: 32420105 DOI: 10.21037/cdt.2020.01.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul Rashid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Stephen Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Peter J Psaltis
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
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Parisi V, Petraglia L, Formisano R, Caruso A, Grimaldi MG, Bruzzese D, Grieco FV, Conte M, Paolillo S, Scatteia A, Dellegrottaglie S, Iavazzo A, Campana P, Pilato E, Lancellotti P, Russo V, Attena E, Filardi PP, Leosco D. Validation of the echocardiographic assessment of epicardial adipose tissue thickness at the Rindfleisch fold for the prediction of coronary artery disease. Nutr Metab Cardiovasc Dis 2020; 30:99-105. [PMID: 31648886 DOI: 10.1016/j.numecd.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/09/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Echocardiography is a promising technique for the assessment of epicardial adipose tissue (EAT). Increased EAT thickness is associated with different cardiac diseases, including; coronary artery disease (CAD). Since several different echocardiographic approaches have been proposed to measure EAT, the identification of a standardized method is needed. We propose the assessment of EAT maximal thickness at the Rindfleisch fold, the reproducibility of this measurement and its correlation with EAT thickness and volume assessed at cardiac magnetic resonance (CMR). Finally, we will test the predictive role of this measurement on the presence of significant CAD. METHODS AND RESULTS In 1061 patients undergoing echocardiography, EAT thickness was measured at the level of the Rindfleisch fold. In 70 patients, we tested the relationship between echo-EAT thickness and EAT thickness and volume assessed at CMR. In 499 patients with suspected CAD, undergoing coronary artery angiography, we tested the predictive value of EAT on the presence of significant CAD. Echo-EAT thickness measurements had an excellent reliability as indicated by the inter-observer (ICC:0.97; 95% C.I. 0.96 to 0.98) and intra-observer (ICC:0.99; 95% C.I. 0.98 to 0.99) reliability rates. Echo-EAT thickness significantly correlated with CMR-EAT thickness and volume (p < 0.001). An EAT thickness value >10 mm discriminated patients with significant CAD at coronary angiography (p < 0.001). At multivariable analysis, including demographic data and cardiovascular risk factors, EAT thickness was an independent predictor of significant CAD and showed an additive predictive value over common atherosclerotic risk factors. CONCLUSIONS Echocardiographic assessment of EAT thickness at the level of the Rindfleisch fold represents a simple and trustworthy method. An increased EAT thickness shows an additive predictive value on CAD over common atherosclerotic risk factors, thus suggesting its potential clinical use for CAD risk stratification.
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Affiliation(s)
- Valentina Parisi
- Department of Translational Medical Sciences, University Federico II, Naples, Italy; Italian Society of Gerontology and Geriatrics, Italy.
| | - Laura Petraglia
- Department of Translational Medical Sciences, University Federico II, Naples, Italy; Italian Society of Gerontology and Geriatrics, Italy
| | | | | | | | - Dario Bruzzese
- Department of Public Health, University Federico II, Naples, Italy
| | - Fabrizio V Grieco
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Stefania Paolillo
- Italy SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
| | | | | | - Annarita Iavazzo
- Dipartimento di Scienze, Biomediche Avanzate, University Federico II, Naples, Italy
| | - Pasquale Campana
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Emanuele Pilato
- Dipartimento di Emergenze Cardiovascolari, Medicina Clinica e dell'Invecchiamento, University Federico II, Naples, Italy
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Vincenzo Russo
- University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | | | - Pasquale P Filardi
- Dipartimento di Scienze, Biomediche Avanzate, University Federico II, Naples, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, University Federico II, Naples, Italy; Italian Society of Gerontology and Geriatrics, Italy
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Perivascular Adipose Tissue and Coronary Atherosclerosis: from Biology to Imaging Phenotyping. Curr Atheroscler Rep 2019; 21:47. [PMID: 31741080 DOI: 10.1007/s11883-019-0817-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Perivascular adipose tissue (PVAT) has a complex, bidirectional relationship with the vascular wall. In disease states, PVAT secretes pro-inflammatory adipocytokines which may contribute to atherosclerosis. Recent evidence demonstrates that pericoronary adipose tissue (PCAT) may also function as a sensor of coronary inflammation. This review details PVAT biology and its clinical translation to current imaging phenotyping. RECENT FINDINGS PCAT attenuation derived from routine coronary computed tomography (CT) angiography is a novel noninvasive imaging biomarker of coronary inflammation. Pro-inflammatory cytokines released from the arterial wall diffuse directly into the surrounding PCAT and inhibit adipocyte lipid accumulation in a paracrine manner. This can be detected as an increased PCAT CT attenuation, a metric which associates with high-risk plaque features and independently predicts cardiac mortality. There is also evidence that PCAT attenuation relates to coronary plaque progression and is modified by systemic anti-inflammatory therapies. Due to its proximity to the coronary arteries, PCAT has emerged as an important fat depot in cardiovascular research. PCAT CT attenuation has the potential to improve cardiovascular risk stratification, and future clinical studies should examine its role in guiding targeted medical therapy.
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Nerlekar N, Muthalaly RG, Wong N, Thakur U, Wong DTL, Brown AJ, Marwick TH. Association of Volumetric Epicardial Adipose Tissue Quantification and Cardiac Structure and Function. J Am Heart Assoc 2019; 7:e009975. [PMID: 30571602 PMCID: PMC6405553 DOI: 10.1161/jaha.118.009975] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Epicardial adipose tissue ( EAT ) is in immediate apposition to the underlying myocardium and, therefore, has the potential to influence myocardial systolic and diastolic function or myocardial geometry, through paracrine or compressive mechanical effects. We aimed to review the association between volumetric EAT and markers of myocardial function and geometry. Methods and Results PubMed, Medline, and Embase were searched from inception to May 2018. Studies were included only if complete EAT volume or mass was reported and related to a measure of myocardial function and/or geometry. Meta-analysis and meta-regression were used to evaluate the weighted mean difference of EAT in patients with and without diastolic dysfunction. Heterogeneity of data reporting precluded meta-analysis for systolic and geometric associations. In the 22 studies included in the analysis, there was a significant correlation with increasing EAT and presence of diastolic dysfunction and mean e' (average mitral annular tissue Doppler velocity) and E/e' (early inflow / annular velocity ratio) but not E/A (ratio of peak early (E) and late (A) transmitral inflow velocities), independent of adiposity measures. There was a greater EAT in patients with diastolic dysfunction (weighted mean difference, 24.43 mL; 95% confidence interval, 18.5-30.4 mL; P<0.001), and meta-regression confirmed the association of increasing EAT with diastolic dysfunction ( P=0.001). Reported associations of increasing EAT with increasing left ventricular mass and the inverse correlation of EAT with left ventricular ejection fraction were inconsistent, and not independent from other adiposity measures. Conclusions EAT is associated with diastolic function, independent of other influential variables. EAT is an effect modifier for chamber size but not systolic function.
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Affiliation(s)
- Nitesh Nerlekar
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia.,2 Baker Heart and Diabetes Institute Melbourne Australia
| | - Rahul G Muthalaly
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
| | - Nathan Wong
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
| | - Udit Thakur
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
| | - Dennis T L Wong
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia.,3 South Australian Health and Medical Research Institute Adelaide Australia
| | - Adam J Brown
- 1 Monash Cardiovascular Research Centre Department of Medicine (Monash Medical Centre), Monash University and Monash Heart Monash Health Clayton Australia
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Coisne A, Ninni S, Ortmans S, Davin L, Kasprzak K, Longère B, Seunes C, Coppin A, Mouton S, Ridon H, Klein C, Noirot-Cosson B, Staels B, Lancellotti P, Montaigne D, Pontana F. Epicardial fat amount is associated with the magnitude of left ventricular remodeling in aortic stenosis. Int J Cardiovasc Imaging 2018; 35:267-273. [DOI: 10.1007/s10554-018-1477-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/15/2018] [Indexed: 01/04/2023]
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