1
|
Filtz A, Lorenzatti D, Scotti A, Piña P, Fernandez-Hazim C, Huang D, Ippolito P, Skendelas JP, Kuno T, Rodriguez CJ, Schenone AL, Latib A, Lavie CJ, Shaw LJ, Blankstein R, Shapiro MD, Garcia MJ, Berman DS, Dey D, Virani SS, Slipczuk L. Relationship between epicardial adipose tissue and coronary atherosclerosis by CCTA in young adults (18-45). Am J Prev Cardiol 2024; 19:100711. [PMID: 39157644 PMCID: PMC11327837 DOI: 10.1016/j.ajpc.2024.100711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/09/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Objective Epicardial adipose tissue (EAT) is implicated in the pathogenesis and progression of coronary artery disease (CAD). Limited data exists on the interplay between EAT and atherosclerosis in young individuals. Our study aims to explore the relationship between EAT and CAD in a young cohort. Methods All young (18-45 years) patients without prior CAD, referred for coronary computed tomography angiography (CCTA) from 2016 to 2022 were included. EAT volume and coronary artery calcium (CAC) were calculated from dedicated non-contrast scans. Coronary plaque presence, extent, and volume were quantified from CCTA. Multivariable logistic regression models for the presence of CAD, defined as any coronary atherosclerosis, were performed. Results Overall, 712 patients (39±4.8 years, 54 % female) with 45 % Hispanic, and 21 % non-Hispanic Black were included. Patients with CAD had higher EAT volume than those without (80.80 mL ± 36.00 vs 55.16 mL ± 27.92; P < 0.001). In those with CAC=0, higher EAT was associated with the presence of CAD compared to lower EAT volume (P < 0.001). An EAT volume >76 mL was associated with higher CAC (P < 0.001), segment involvement score (P < 0.001), and quantitative total, non-calcified, and low-attenuation plaque volumes (P < 0.002). At multivariable analysis, EAT volume (per 10 mL, OR: 1.21; 95 %CI: 1.12-1.30; P < 0.0001) was independently associated with the presence of CAD. Conclusion In a diverse cohort of young adults without history of CAD and undergoing a clinically indicated CCTA, EAT volume was independently associated with the presence of CAD. Our findings highlight EAT potential as a novel marker for CAD risk-assessment and a potential therapeutic target in young patients.
Collapse
Affiliation(s)
- Annalisa Filtz
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
- IRCCS Ospedale Ca’ Granda Maggiore Policlinico, Università degli Studi di Milano. Milan, Italy
| | - Daniel Lorenzatti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Andrea Scotti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Pamela Piña
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
- Department of Cardiology, CEDIMAT. Santo Domingo, Dominican Republic
| | - Carol Fernandez-Hazim
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Dou Huang
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Paul Ippolito
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - John P Skendelas
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Toshiki Kuno
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carlos J Rodriguez
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Azeem Latib
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Leslee J. Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital. Boston, MA, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center. Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center. Los Angeles, CA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University. Karachi, Pakistan. Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine. Houston, TX, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| |
Collapse
|
2
|
Pugliese L, Ricci F, Sica G, Scaglione M, Masala S. Non-Contrast and Contrast-Enhanced Cardiac Computed Tomography Imaging in the Diagnostic and Prognostic Evaluation of Coronary Artery Disease. Diagnostics (Basel) 2023; 13:2074. [PMID: 37370969 DOI: 10.3390/diagnostics13122074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
In recent decades, cardiac computed tomography (CT) has emerged as a powerful non-invasive tool for risk stratification, as well as the detection and characterization of coronary artery disease (CAD), which remains the main cause of morbidity and mortality in the world. Advances in technology have favored the increasing use of cardiac CT by allowing better performance with lower radiation doses. Coronary artery calcium, as assessed by non-contrast CT, is considered to be the best marker of subclinical atherosclerosis, and its use is recommended for the refinement of risk assessment in low-to-intermediate risk individuals. In addition, coronary CT angiography (CCTA) has become a gate-keeper to invasive coronary angiography (ICA) and revascularization in patients with acute chest pain by allowing the assessment not only of the extent of lumen stenosis, but also of its hemodynamic significance if combined with the measurement of fractional flow reserve or perfusion imaging. Moreover, CCTA provides a unique incremental value over functional testing and ICA by imaging the vessel wall, thus allowing the assessment of plaque burden, composition, and instability features, in addition to perivascular adipose tissue attenuation, which is a marker of vascular inflammation. There exists the potential to identify the non-obstructive lesions at high risk of progression to plaque rupture by combining all of these measures.
Collapse
Affiliation(s)
- Luca Pugliese
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Francesca Ricci
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, 80131 Napoli, Italy
| | - Mariano Scaglione
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Salvatore Masala
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
3
|
Liu J, Yu Q, Li Z, Zhou Y, Liu Z, You L, Tao L, Dong Q, Zuo Z, Gao L, Zhang D. Epicardial adipose tissue density is a better predictor of cardiometabolic risk in HFpEF patients: a prospective cohort study. Cardiovasc Diabetol 2023; 22:45. [PMID: 36870978 PMCID: PMC9985864 DOI: 10.1186/s12933-023-01778-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) accumulation is associated with multiple cardiometabolic risk factors and prognosis of heart failure with preserved ejection fraction (HFpEF). The correlation between EAT density and cardiometabolic risk and the effect of EAT density on clinical outcome in HFpEF remain unclear. We evaluated the relationship between EAT density and cardiometabolic risk factors, also the prognostic value of EAT density in patients with HFpEF. METHODS We included 154 HFpEF patients who underwent noncontrast cardiac computed tomography (CT) and all patients received follow-up. EAT density and volume were quantified semi-automatically. The associations of EAT density and volume with cardiometabolic risk factors, metabolic syndrome and the prognostic impact of EAT density were analyzed. RESULTS Lower EAT density was associated with adverse changes in cardiometabolic risk factors. Each 1 HU increase in fat density, BMI was 0.14 kg/m2 lower (95% CI 0.08-0.21), waist circumference was 0.34 cm lower (95% CI 0.12-0.55), non-HDL-cholesterol was 0.02 mmol/L lower (95% CI 0-0.04), triglyceride was 0.03 mmol/L lower (95% CI 0.01-0.04), fasting plasma glucose was 0.05 mmol/L lower (95% CI 0.02-0.08), TyG index was 0.03 lower (95% CI 0.02-0.04), Log2(TG/HDL-C) was 0.03 lower (95% CI 0.02-0.05), METS-IR was 0.36 lower (95% CI 0.23-0.49), MetS Z-score was 0.04 lower (95% CI 0.02-0.06), and Log2(CACS + 1) was 0.09 lower (95% CI 0.02-0.15). After adjusting for BMI and EAT volume, the associations of non-HDL-cholesterol, triglyceride, fasting plasma glucose, insulin resistance indexes, MetS Z-score, and CACS with fat density remained significant. The area under the curve (AUC) for the presence and severity of metabolic syndrome was greater in EAT density than volume (AUC: 0.731 vs 0.694, 0.735 vs 0.662, respectively). Over a median follow-up of 16 months, the cumulative incidence of heart failure readmission and composite endpoint increased with lower level of EAT density (both p < 0.05). CONCLUSIONS EAT density was an independent impact factor of cardiometabolic risk in HFpEF. EAT density might have better predictive value than EAT volume for metabolic syndrome and it might have prognostic value in patients with HFpEF.
Collapse
Affiliation(s)
- Jie Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Yu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziyang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yujiao Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiqiang Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linna You
- Department of Cardiovascular Medicine, Changshou District People's Hospital of Chongqing, Chongqing, China
| | - Li Tao
- Department of Medical Imaging, The First Affiliated Hospital of Chongqing Medical University (Jinshan Campus), Chongqing, China
| | - Qian Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziyu Zuo
- Department of Medical Imaging, The First Affiliated Hospital of Chongqing Medical University (Jinshan Campus), Chongqing, China
| | - Lei Gao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Dongying Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
4
|
Wang X, Xin R, Shan D, Dou G, Zhang W, Jing J, He B, Chen Y, Yang J. Incremental Value of Noncontrast Chest Computed Tomography-derived Parameters in Predicting Subclinical Carotid Atherosclerosis: From the PERSUADE Study. J Thorac Imaging 2023; 38:113-119. [PMID: 35576552 PMCID: PMC9936967 DOI: 10.1097/rti.0000000000000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the incremental value of noncontrast chest computed tomography (CT)-derived parameters, such as coronary artery calcium score (CACS) and epicardial adipose tissue volume (EATv), in predicting subclinical carotid atherosclerosis above traditional risk factors in community-based asymptomatic populations of northern China. MATERIALS AND METHODS A total of 2195 community-based asymptomatic individuals were enrolled from Jidong Oilfield in accordance with the PERSUADE study. CACS and EATv were measured on noncontrast chest CT. Demographics and ideal cardiovascular health score (ICHS) were collected through questionnaires. We recalculated the ideal cardiovascular health risk score (ICHRS) (ICHRS=14-ICHS) and standardized the parameters as log-CACS and body mass index adjusted EATv (i-EATv). Subclinical carotid atherosclerosis was assessed by Doppler sonography and defined as any prevalence of average carotid intima-media thickness ≥1.00 mm, appearance of carotid plaque, and carotid arterial stenosis in the areas of extracranial carotid arteries on both sides. RESULTS A total of 451 (20.55%) individuals presented subclinical carotid atherosclerosis. CACS and EATv were significantly greater in the subclinical group, while ICHS was lower. In multivariate logistic regression, ICHRS (odds ratio [OR]=1.143, 95% confidence interval [CI]: 1.080-1.210, P <0.001), log-CACS (OR=1.701, 95% CI: 1.480-1.955, P <0.001), and i-EATv (OR=1.254, 95% CI: 1.173-1.341, P <0.001) were found to be independent risk predictors for subclinical carotid atherosclerosis. In receiver-operating characteristic curve analysis, when combined with male sex and age level, the area under the curve of the ICHRS basic model increased from 0.627 (95% CI: 0.599-0.654) to 0.757 (95% CI: 0.732-0.781) ( P <0.0001). Further adding log-CACS and i-EATv, the area under the curve demonstrated a statistically significant improvement (0.788 [95% CI: 0.765-0.812] vs. 0.757 [95% CI: 0.732-0.781], P <0.0001). CONCLUSION Noncontrast chest CT-derived parameters, including CACS and EATv, could provide significant incremental improvement for predicting subclinical carotid atherosclerosis beyond the conventional risk assessment model based on ICHRS.
Collapse
Affiliation(s)
- Xi Wang
- Medical School of Chinese PLA
- Department of Cardiology, the Sixth Medical Centre
| | - Ran Xin
- Department of Cardiology, the Sixth Medical Centre
- School of Medicine, Nankai University, Tianjin, P.R. China
| | - Dongkai Shan
- Department of Cardiology, the Sixth Medical Centre
| | - Guanhua Dou
- Department of Cardiology, the Second Medical Centre
| | - Wei Zhang
- Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing
| | - Jing Jing
- Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing
| | - Bai He
- Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing
| | - Yundai Chen
- Department of Cardiology, the Sixth Medical Centre
| | - Junjie Yang
- Department of Cardiology, the Sixth Medical Centre
| |
Collapse
|
5
|
Chiocchi M, Cavallo AU, Pugliese L, Cesareni M, Pasquali D, Accardo G, De Stasio V, Spiritigliozzi L, Benelli L, D’Errico F, Cerimele C, Floris R, Garaci F, Di Donna C. Cardiac Computed Tomography Evaluation of Association of Left Ventricle Disfunction and Epicardial Adipose Tissue Density in Patients with Low to Intermediate Cardiovascular Risk. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020232. [PMID: 36837434 PMCID: PMC9960536 DOI: 10.3390/medicina59020232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Abstract
Background and objectives: Epicardial adipose tissue density (EAD) has been associated with coronary arteries calcium score, a higher load of coronary artery disease (CAD) and plaque vulnerability. This effect can be related to endocrine and paracrine effect of molecules produced by epicardial adipose tissue (EAT), that may influence myocardial contractility. Using coronary computed tomography angiography (CCT) the evaluation of EAD is possible in basal scans. The aim of the study is to investigate possible associations between EAD and cardiac function. Material and Methods: 93 consecutive patients undergoing CCT without and with contrast medium for known or suspected coronary CAD were evaluated. EAD was measured on basal scans, at the level of the coronary ostia, the lateral free wall of the left ventricle, at the level of the cardiac apex, and at the origin of the posterior interventricular artery. Cardiac function was evaluated in post-contrast CT scans in order to calculate ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Results: A statistically significant positive correlation between EAD and ejection fraction (r = 0.29, p-value < 0.01) was found. Additionally, a statistically significant negative correlation between EAD and ESV (r = -0.25, p-value < 0.01) was present. Conclusion: EAD could be considered a new risk factor associated with reduced cardiac function. The evaluation of this parameter with cardiac CT in patients with low to intermediate cardiovascular risk is possible.
Collapse
Affiliation(s)
- Marcello Chiocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-3473154183
| | - Armando Ugo Cavallo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Radiology, Istituto Dermopatico dell’Immacolata, 00167 Rome, Italy
| | - Luca Pugliese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Matteo Cesareni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Daniela Pasquali
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Giacomo Accardo
- ASL Salerno Ds 63 Poliambulatorio Costa d’Amalfi, 84013 Salerno, Italy
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca D’Errico
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- IRCSS San Raffaele, 03043 Cassino, Italy
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| |
Collapse
|
6
|
Martins KPMP, Barreto SM, Bos D, Pedrosa J, Azevedo DRM, Araújo LF, Foppa M, Duncan BB, Ribeiro ALP, Brant LCC. Epicardial Fat Volume Is Associated with Endothelial Dysfunction, but not with Coronary Calcification: From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Arq Bras Cardiol 2022; 119:912-920. [PMID: 36228276 PMCID: PMC9814820 DOI: 10.36660/abc.20210750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/15/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The increase in epicardial fat volume (EFV) is related to coronary artery disease (CAD), independent of visceral or subcutaneous fat. The mechanism underlying this association is unclear. Coronary artery calcium (CAC) score and endothelial dysfunction are related to coronary events, but whether EFV is related to these markers needs further clarification. OBJECTIVES To evaluate the association between automatically measured EFV, cardiovascular risk factors, CAC, and endothelial function. METHODS In 470 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with measures of EFV, CAC score and endothelial function, we performed multivariable models to evaluate the relation between cardiovascular risk factors and EFV (response variable), and between EFV (explanatory variable) and endothelial function variables or CAC score. Two-sided p <0.05 was considered statistically significant. RESULTS Mean age was 55 ± 8 years, 52.3% of patients were men. Mean EFV was 111mL (IQ 86-144), and the prevalence of CAC score=0 was 55%. In the multivariable analyses, increased EFV was related to female sex, older age, waist circumference, and triglycerides (p<0.001 for all). Higher EFV was associated with worse endothelial function: as compared with the first quartile, the odds ratio for basal pulse amplitude were (q2=1.22, 95%CI 1.07-1.40; q3=1.50, 95%CI 1.30-1.74; q4=1.50, 95%CI 1.28-1.79) and for peripheral arterial tonometry ratio were (q2=0.87, 95%CI 0.81-0.95; q3=0.86, 95%CI 0.79-0.94; q4=0.80, 95%CI 0.73-0.89), but not with CAC score>0. CONCLUSION Higher EFV was associated with impaired endothelial function, but not with CAC. The results suggest that EFV is related to the development of CAD through a pathway different from the CAC pathway, possibly through aggravation of endothelial dysfunction and microvascular disease.
Collapse
Affiliation(s)
- Karina P. M. P. Martins
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Hospital das Clínicas , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil ,Faculdade de MedicinaFaculdade de MedicinaPrograma de Pós-GraduaçãoBelo HorizonteMGBrasil Faculdade de Medicina , Programa de Pós-Graduação , Belo Horizonte , MG – Brasil
| | - Sandhi M. Barreto
- Faculdade de MedicinaFaculdade de MedicinaPrograma de Pós-GraduaçãoBelo HorizonteMGBrasil Faculdade de Medicina , Programa de Pós-Graduação , Belo Horizonte , MG – Brasil ,Departamento de Medicina Social e PreventivaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Social e Preventiva da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Daniel Bos
- Departamento de EpidemiologiaErasmus MCHolanda Departamento de Epidemiologia , Erasmus MC – Holanda ,Departamento de Radiologia e Medicina NuclearErasmus MCHolanda Departamento de Radiologia e Medicina Nuclear , Erasmus MC – Holanda ,Departamento de Epidemiologia ClínicaHarvard TH Chan School of Public HealthBostonEUA Departamento de Epidemiologia Clínica - Harvard TH Chan School of Public Health , Boston – EUA
| | - Jesiana Pedrosa
- Departamento de Anatomia e ImagemUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Anatomia e Imagem da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Douglas R. M. Azevedo
- Departamento de EstatísticaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Estatística , Interno, Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Larissa Fortunato Araújo
- Secretaria de Saúde ComunitáriaUniversidade Federal do CearáFortalezaCEBrasil Secretaria de Saúde Comunitária , Universidade Federal do Ceará , Fortaleza , CE – Brasil
| | - Murilo Foppa
- Hospital das Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Bruce B. Duncan
- Hospital das Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil ,Programa de Pós-GraduaçãoUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Programa de Pós-Graduação, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Antonio Luiz P. Ribeiro
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Hospital das Clínicas , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil ,Faculdade de MedicinaFaculdade de MedicinaPrograma de Pós-GraduaçãoBelo HorizonteMGBrasil Faculdade de Medicina , Programa de Pós-Graduação , Belo Horizonte , MG – Brasil ,Departamento de Medicina InternaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Interna, Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Luisa C. C. Brant
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Hospital das Clínicas , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil ,Faculdade de MedicinaFaculdade de MedicinaPrograma de Pós-GraduaçãoBelo HorizonteMGBrasil Faculdade de Medicina , Programa de Pós-Graduação , Belo Horizonte , MG – Brasil ,Departamento de Medicina InternaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Interna, Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| |
Collapse
|
7
|
Epicardial fat volume is related to the degree of cardiac allograft vasculopathy. Eur Radiol 2022; 33:330-338. [DOI: 10.1007/s00330-022-09029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/18/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Abstract
Abstract
Objectives
Increasing evidence suggests a role for epicardial fat in the development of coronary artery disease in the general population. Heart transplantation patients are at increased risk of developing a specific form of coronary artery disease, cardiac allograft vasculopathy (CAV), which has far-reaching consequences in terms of morbidity and mortality. Until now, the role of epicardial fat volume (EFV) in the development of CAV remains unknown. Hence, we investigated the relationship between EFV and CAV as well as the influence of donor/recipient sex on EFV.
Methods
Adult heart transplant patients who underwent coronary computed tomography angiography (CCTA) for CAV screening who were four or more years post-HT were included. Using the CT examinations, we quantified the EFV and the degree of CAV. Ordinal and linear regression models were used to assess the association of EFV with CAV.
Results
In total, 149 (median age 44.5 years, 36% women) patients were included. The median time between HT and the CT scan was 11.0 (7.3–16.1) years. CAV grade 0, 1, 2 and 3 were seen in 85 (57%), 32 (22%), 14 (9%), and 18 (12%) patients, respectively. The median EFV was 208.4 (128.9–276.0) mL. Larger EFV were related to higher degrees of CAV (median of 164.7 to 290.6 mL for CAV grade 0 and 3, respectively, OR 5.23 (2.47–11.06), p < 0.001). Male recipients had significantly more EFV than female recipients irrespective of the donor sex (232.7 mL vs. 147.2 mL respectively, p < 0.001). Determinants for EFV were recipient sex, number of rejections, donor age, time between HT and CT scan, recipient BMI, and diabetes mellitus.
Conclusions
EFV was associated with higher degrees of CAV. The recipient sex influenced the EFV more than the donor sex.
Key Points
• Patients after heart transplantation have a high amount of epicardial fat while larger amounts of epicardial fat are related to higher grades of cardiac allograft vasculopathy.
• Determinants of higher epicardial fat volume included recipient sex, number of rejections, donor age, time between HT and CT scan, recipient BMI, and diabetes mellitus.
• Longitudinal studies are needed to further disentangle the role of epicardial fat in the development and progression of cardiac allograft vasculopathy.
Graphical abstract
Collapse
|
8
|
Gupta A, Bera K, Kikano E, Pierce JD, Gan J, Rajdev M, Ciancibello LM, Gupta A, Rajagopalan S, Gilkeson RC. Coronary Artery Calcium Scoring: Current Status and Future Directions. Radiographics 2022; 42:947-967. [PMID: 35657766 DOI: 10.1148/rg.210122] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary artery calcium (CAC) scores obtained from CT scans have been shown to be prognostic in assessment of the risk for development of cardiovascular diseases, facilitating the prediction of outcome in asymptomatic individuals. Currently, several methods to calculate the CAC score exist, and each has its own set of advantages and disadvantages. Agatston CAC scoring is the most extensively used method. CAC scoring is currently recommended for use in asymptomatic individuals to predict the risk of developing cardiovascular diseases and the disease-specific mortality. In specific subsets of patients, the CAC score has also been recommended for reclassifying cardiovascular risk and aiding in decision making when planning primary prevention interventions such as statin therapy. The progression of CAC scores on follow-up images has been shown to be linked to risk of myocardial infarction and cardiovascular mortality. While the CAC score is a validated tool used clinically, several challenges, including various pitfalls associated with the acquisition, calculation, and interpretation of the score, prevent more widespread adoption of this metric. Recent research has been focused extensively on strategies to improve existing scoring methods, including measuring calcium attenuation, detecting microcalcifications, and focusing on extracoronary calcifications, and on strategies to improve image acquisition. A better understanding of CAC scoring approaches will help radiologists and other physicians better use and interpret these scores in their workflows. An invited commentary by S. Gupta is available online. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Amit Gupta
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Kaustav Bera
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Elias Kikano
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Jonathan D Pierce
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Jonathan Gan
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Maharshi Rajdev
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Leslie M Ciancibello
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Aekta Gupta
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Sanjay Rajagopalan
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| | - Robert C Gilkeson
- From the Department of Radiology (Amit Gupta, K.B., E.K., J.D.P., J.G., M.R., L.M.C., R.C.G.) and Harrington Heart & Vascular Institute (S.R.), University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106; and Department of Medicine, Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, OH (Aekta Gupta)
| |
Collapse
|
9
|
Kovac N, Grymyr LMD, Gerdts E, Nadirpour S, Nedrebø BG, Hjertaas JJ, Matre K, Cramariuc D. Markers of Subclinical Atherosclerosis in Severe Obesity and One Year after Bariatric Surgery. J Clin Med 2022; 11:2237. [PMID: 35456330 PMCID: PMC9029498 DOI: 10.3390/jcm11082237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Aortic valve sclerosis (AVS), mitral valve sclerosis (MVS), remodeling of major arteries, and increased pericardial fat are associated with subclinical atherosclerosis. We assessed these markers of atherosclerosis in severely obese patients before and 1 year after bariatric surgery. Methods: Eighty-seven severely obese patients (43 ± 10 years, preoperative body mass index [BMI] 41.8 ± 5 kg/m2) underwent echocardiography before and 1 year after Roux-en-Y bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic aortic wall thickness (AWT), pericardial fat thickness at the right ventricular free wall, and AVS/MVS based on combined aortic leaflet thickness and hyperechoic valve lesions. Results: Postoperatively, patients experienced a reduction of 12.9 ± 3.9 kg/m2 in BMI, 0.5 ± 1.9 mm in AWT, 2.6 ± 2.3 mm in pericardial fat, and 45%/53% in AVS/MVS (p < 0.05). In multivariate regression analyses with adjustment for clinical and hemodynamic variables, less pericardial fat reduction was associated with male sex and higher 1-year blood pressure and BMI, and less AWT-reduction with higher age and 1-year BMI (p < 0.05). Persistent AVS and MVS were related to higher 1-year BMI and more advanced valve sclerosis preoperatively (p < 0.05). Conclusions: Markers of subclinical atherosclerosis decreases significantly 1 year after bariatric surgery, particularly in younger patients that achieve a BMI < 28 kg/m2.
Collapse
Affiliation(s)
- Nina Kovac
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (N.K.); (L.M.D.G.); (E.G.); (B.G.N.); (K.M.)
| | - Lisa M. D. Grymyr
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (N.K.); (L.M.D.G.); (E.G.); (B.G.N.); (K.M.)
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (N.K.); (L.M.D.G.); (E.G.); (B.G.N.); (K.M.)
| | - Saied Nadirpour
- Department of Medicine, Haugesund Hospital, 5528 Haugesund, Norway; (S.N.); (J.J.H.)
| | - Bjørn G. Nedrebø
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (N.K.); (L.M.D.G.); (E.G.); (B.G.N.); (K.M.)
- Department of Medicine, Haugesund Hospital, 5528 Haugesund, Norway; (S.N.); (J.J.H.)
| | - Johannes J. Hjertaas
- Department of Medicine, Haugesund Hospital, 5528 Haugesund, Norway; (S.N.); (J.J.H.)
| | - Knut Matre
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (N.K.); (L.M.D.G.); (E.G.); (B.G.N.); (K.M.)
| | - Dana Cramariuc
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (N.K.); (L.M.D.G.); (E.G.); (B.G.N.); (K.M.)
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway
| |
Collapse
|
10
|
Bao W, Chen C, Yang M, Qin L, Xu Z, Yan F, Yang W. A preliminary coronary computed tomography angiography-based study of perivascular fat attenuation index: relation with epicardial adipose tissue and its distribution over the entire coronary vasculature. Eur Radiol 2022; 32:6028-6036. [PMID: 35389051 DOI: 10.1007/s00330-022-08781-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the perivascular fat attenuation index (FAI) in association with epicardial adipose tissue (EAT) parameters and its distribution over the entire coronary vasculature in patients with known or suspected coronary artery disease (CAD). METHODS Patients with known or suspected CAD who underwent coronary computed tomography angiography from January 1, 2019, to June 1, 2019, were retrospectively included. The perivascular FAI was quantified on four main epicardial coronary arteries and seven coronary segments. Moreover, EAT density and volume were measured. RESULTS We included 192 consecutive patients (55 without coronary plaque [mean age 46.4 ± 13.2 years, 69.1% male] and 137 with coronary plaque [mean age 57.9 ± 13.0 years, 84.7% male]). EAT density was lower than perivascular FAI in both groups, but they exhibited substantial correlation (- 83.33 ± 4.54 vs. - 78.22 ± 6.52 HU, p < 0.001; r = 0.667 in plaque- patients and - 83.11 ± 4.48 vs. - 77.81 ± 5.63 HU, p < 0.001; r = 0.778 in plaque+ patients). The left main coronary artery had the highest perivascular FAI, followed by the left circumflex artery. The perivascular FAI in proximal segments was significantly higher compared to that in distal segments (all p < 0.05). Furthermore, the presence of plaque did not alter perivascular FAI on the patient or segmental level. CONCLUSION The perivascular FAI was significantly higher than EAT density and correlated substantially with EAT density. The perivascular FAI distribution over the entire coronary tree varied and prompted for vessel-specific or segment-specific thresholds to determine abnormal perivascular FAI in practice. KEY POINTS • The perivascular FAI correlated well with EAT density and had higher values than EAT density. • The distributions of perivascular FAI differ between coronary vessels or segments; considering segment and vessel confounding factors while conducting a perivascular FAI study is necessary. • No significant difference of perivascular FAI was observed between patients without and with coronary plaque, nor between coronary segments without plaque and those with plaque.
Collapse
Affiliation(s)
- Wenrui Bao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Chihua Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Min Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zhihan Xu
- Siemens Healthineers CT Collaboration, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
| |
Collapse
|
11
|
Rachwalik M, Obremska M, Zyśko D, Matusiewicz M, Protasiewicz M, Jasiński M. Resistin levels in perivascular adipose tissue and mid-term mortality in patients undergoing coronary artery bypass grafting. Physiol Res 2021; 70:543-550. [PMID: 34062078 DOI: 10.33549/physiolres.934661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Higher serum resistin levels were reported to be associated with increased mortality risk. We aimed to assess the predictive value of resistin levels in perivascular adipose tissue (PVAT) around the left main coronary artery (LMCA) for mid-term survival of patients with advanced coronary artery disease (CAD).This was a prospective study including patients referred for elective coronary artery grafting in 2016 and 2017, performed using a standard approach. A sample of PVAT was harvested and resistin levels were measured using an enzyme-linked immunosorbent assay. Patients were followed from the day of the procedure until March 2021. In each patient, the SYNTAX score and EuroSCORE II were calculated. The study included 108 patients aged 68.1 ±7.9 years, including 83 men (76.9%). The duration of follow-up was 731 (range, 275-1020) for nonsurvivors and 1418 median (range, 1174-1559) for survivors (p <0.001). Patients who died had a higher SYNTAX score, higher EuroSCORE II, and lower resistin levels in PVAT than survivors (p <0.001, p = 0.004, and p = 0.041, respectively). A stepwise regression analysis revealed that survival was related to resistin concentrations above the median value (hazard ratio [HR], 4.67; 95% CI, 1.02-21.4; p = 0.048) and EuroSCORE II (used as continuous variable; HR, 1.55; 95% CI, 1.16-2.07; p = 0.003). The mid-term mortality in patients with advanced CAD is associated with low resistin concentrations in PVAT surrounding the LMCA.
Collapse
Affiliation(s)
- M Rachwalik
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland.
| | | | | | | | | | | |
Collapse
|
12
|
Kenchaiah S, Ding J, Carr JJ, Allison MA, Budoff MJ, Tracy RP, Burke GL, McClelland RL, Arai AE, Bluemke DA. Pericardial Fat and the Risk of Heart Failure. J Am Coll Cardiol 2021; 77:2638-2652. [PMID: 34045020 PMCID: PMC8218602 DOI: 10.1016/j.jacc.2021.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity is a well-established risk factor for heart failure (HF). However, implications of pericardial fat on incident HF is unclear. OBJECTIVES This study sought to examine the association between pericardial fat volume (PFV) and newly diagnosed HF. METHODS This study ascertained PFV using cardiac computed tomography in 6,785 participants (3,584 women and 3,201 men) without pre-existing cardiovascular disease from the MESA (Multi-Ethnic Study of Atherosclerosis). Cox proportional hazards regression was used to evaluate PFV as continuous and dichotomous variable, maximizing the J-statistic: (Sensitivity + Specificity - 1). RESULTS In 90,686 person-years (median: 15.7 years; interquartile range: 11.7 to 16.5 years), 385 participants (5.7%; 164 women and 221 men) developed newly diagnosed HF. PFV was lower in women than in men (69 ± 33 cm3 vs. 92 ± 47 cm3; p < 0.001). In multivariable analyses, every 1-SD (42 cm3) increase in PFV was associated with a higher risk of HF in women (hazard ratio [HR]: 1.44; 95% confidence interval [CI]: 1.21 to 1.71; p < 0.001) than in men (HR: 1.13; 95% CI: 1.01 to 1.27; p = 0.03) (interaction p = 0.01). High PFV (≥70 cm3 in women; ≥120 cm3 in men) conferred a 2-fold greater risk of HF in women (HR: 2.06; 95% CI: 1.48 to 2.87; p < 0.001) and a 53% higher risk in men (HR: 1.53; 95% CI: 1.13 to 2.07; p = 0.006). In sex-stratified analyses, greater risk of HF remained robust with additional adjustment for anthropometric indicators of obesity (p ≤ 0.008), abdominal subcutaneous or visceral fat (p ≤ 0.03) or biomarkers of inflammation and hemodynamic stress (p < 0.001) and was similar among Whites, Blacks, Hispanics, and Chinese (interaction p = 0.24). Elevated PFV predominantly augmented the risk of HF with preserved ejection fraction (p < 0.001) rather than reduced ejection fraction (p = 0.31). CONCLUSIONS In this large, community-based, ethnically diverse, prospective cohort study, pericardial fat was associated with an increased risk of HF, particularly HF with preserved ejection fraction, in women and men.
Collapse
Affiliation(s)
- Satish Kenchaiah
- Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, Maryland, USA.
| | - Jingzhong Ding
- Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - J Jeffrey Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, La Jolla, California, USA
| | - Matthew J Budoff
- Division of Cardiology, Lundquist Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, Maryland, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
13
|
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: 21] [Impact Index Per Article: 7.0] [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.
Collapse
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
| |
Collapse
|
14
|
Brahimaj A, Ahmadizar F, Vernooij MW, Ikram MK, Ikram MA, van Walsum T, Dehghan A, Franco OH, Bos D, Kavousi M. Epicardial fat volume and the risk of cardiometabolic diseases among women and men from the general population. Eur J Prev Cardiol 2021; 28:e14-e16. [PMID: 33598682 DOI: 10.1093/eurjpc/zwaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/14/2020] [Accepted: 10/30/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Adela Brahimaj
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of General Practice, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Meike Willemijn Vernooij
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Kamran Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department Of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Biostatistics and Epidemiology, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Oscar Horacio Franco
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.,Department of Clinical Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC-University Medical Center, office Na-2714 PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| |
Collapse
|
15
|
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.
Collapse
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.
| |
Collapse
|
16
|
Metabolic syndrome, fatty liver, and artificial intelligence-based epicardial adipose tissue measures predict long-term risk of cardiac events: a prospective study. Cardiovasc Diabetol 2021; 20:27. [PMID: 33514365 PMCID: PMC7847161 DOI: 10.1186/s12933-021-01220-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/17/2021] [Indexed: 02/08/2023] Open
Abstract
Background We sought to evaluate the association of metabolic syndrome (MetS) and computed tomography (CT)-derived cardiometabolic biomarkers (non-alcoholic fatty liver disease [NAFLD] and epicardial adipose tissue [EAT] measures) with long-term risk of major adverse cardiovascular events (MACE) in asymptomatic individuals. Methods This was a post-hoc analysis of the prospective EISNER (Early-Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study of participants who underwent baseline coronary artery calcium (CAC) scoring CT and 14-year follow-up for MACE (myocardial infarction, late revascularization, or cardiac death). EAT volume (cm3) and attenuation (Hounsfield units [HU]) were quantified from CT using fully automated deep learning software (< 30 s per case). NAFLD was defined as liver-to-spleen attenuation ratio < 1.0 and/or average liver attenuation < 40 HU. Results In the final population of 2068 participants (59% males, 56 ± 9 years), those with MetS (n = 280;13.5%) had a greater prevalence of NAFLD (26.0% vs. 9.9%), higher EAT volume (114.1 cm3 vs. 73.7 cm3), and lower EAT attenuation (−76.9 HU vs. −73.4 HU; all p < 0.001) compared to those without MetS. At 14 ± 3 years, MACE occurred in 223 (10.8%) participants. In multivariable Cox regression, MetS was associated with increased risk of MACE (HR 1.58 [95% CI 1.10–2.27], p = 0.01) independently of CAC score; however, not after adjustment for EAT measures (p = 0.27). In a separate Cox analysis, NAFLD predicted MACE (HR 1.78 [95% CI 1.21–2.61], p = 0.003) independently of MetS, CAC score, and EAT measures. Addition of EAT volume to current risk assessment tools resulted in significant net reclassification improvement for MACE (22% over ASCVD risk score; 17% over ASCVD risk score plus CAC score). Conclusions MetS, NAFLD, and artificial intelligence-based EAT measures predict long-term MACE risk in asymptomatic individuals. Imaging biomarkers of cardiometabolic disease have the potential for integration into routine reporting of CAC scoring CT to enhance cardiovascular risk stratification. Trial registration NCT00927693.
Collapse
|
17
|
Zhao N, Wang X, Wang Y, Yao J, Shi C, Du J, Bai R. The Effect of Liraglutide on Epicardial Adipose Tissue in Type 2 Diabetes. J Diabetes Res 2021; 2021:5578216. [PMID: 34825006 PMCID: PMC8610652 DOI: 10.1155/2021/5578216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To study the effect of liraglutide on the thickness of epicardial adipose tissue (EAT) in type 2 diabetes mellitus (T2DM) patients with abdominal obesity. METHODS Abdominal obesity T2DM patients with poor glycemic control were collected and treated with liraglutide. The changes of blood glucose, blood lipid, waist circumference, body mass index (BMI), and EAT thickness were compared after 3 months of treatment with liraglutide. Cardiac magnetic resonance imaging (MRI) was used to measure EAT thickness. RESULTS After 3 months of treatment with liraglutide, glycosylated hemoglobin (HbA1c) decreased from 9.81 ± 1.46% to 6.94 ± 1.29% (95%CI = 2.14-3.59, p < 0.001). The weight decreased from 91.67 ± 16.29 kg to 87.29 ± 16.43 kg (95%CI = 2.97-5.79, p < 0.001). Waist circumference before treatment was 103.69 ± 9.14 cm, and after treatment was 96.42 ± 8.42 cm (95%CI = 5.04-9.50, p < 0.001). Total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) were significantly lower than those before treatment. TC decreased from 5.34 ± 1.05 mmol/L to 4.86 ± 0.97 mmol/L (95%CI = 0.15-0.82, p < 0.001). TG was 1.89 (1.48-3.17) and then to 1.92 ± 0.69 (p = 0.03). LDL-C decreased from 3.39 ± 0.84 mmol/L to 3.01 ± 0.74 mmol/L (95%CI = 0.17-0.59, p = 0.001). HDL-C increased by 1.7% after treatment, with no significant difference (p = 0.062). More importantly, the thickness of EAT decreased from 5.0 (5.0-7.0) mm to 3.95 ± 1.43 mm (p < 0.001) after liraglutide administered for 3 months. CONCLUSION Liraglutide significantly reduces EAT thickness in T2DM with abdominal obesity, which provides theoretical support for the cardiovascular benefits of liraglutide.
Collapse
Affiliation(s)
- Na Zhao
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xiaoying Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yongbo Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Junjie Yao
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Chunhong Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Jianling Du
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Ran Bai
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| |
Collapse
|
18
|
Mancio J, Barros AS, Conceicão G, Santa C, Pessoa-Amorim G, Bartosch C, Fragao-Marques M, Ferreira W, Carvalho M, Ferreira N, Vouga L, Miranda IM, Vitorino R, Fontes-Carvalho R, Manadas B, Falcão-Pires I, Ribeiro VG, Leite-Moreira A, Bettencourt N. Influence of EPICardial adipose tissue in HEART diseases (EPICHEART) study: Protocol for a translational study in coronary atherosclerosis. Rev Port Cardiol 2020; 39:625-633. [PMID: 33168363 DOI: 10.1016/j.repc.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Accumulation of epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) and increased risk of coronary events in asymptomatic subjects and low-risk patients, suggesting that EAT promotes atherosclerosis in its early stage. Recent studies have shown that the presence of CAD affects the properties of adjacent EAT, leading to dynamic changes in the molecular players involved in the interplay between EAT and the coronary arteries over the history of the disease. The role of EAT in late-stage CAD has not been investigated. OBJECTIVES In a comparative analysis with mediastinal and subcutaneous adipose tissue, we aim to investigate whether the volume of EAT assessed by computed tomography and its proteome assessed by SWATH-MS mass spectrometry are associated with late stages of CAD in an elderly cohort of severe aortic stenosis patients. METHODS The EPICHEART study (NCT03280433) is a prospective study enrolling patients with severe degenerative aortic stenosis referred for elective aortic valve replacement, whose protocol includes preoperative clinical, nutritional, echocardiographic, cardiac computed tomography and invasive coronary angiographic assessments. During cardiac surgery, samples of EAT and mediastinal and subcutaneous thoracic adipose tissue are collected for proteomics analysis by SWATH-MS. In addition, pericardial fluid and peripheral and coronary sinus blood samples are collected to identify circulating and local adipose tissue-derived biomarkers of CAD. CONCLUSION We designed a translational study to explore the association of EAT quantity and quality with advanced CAD. We expect to identify new biochemical factors and biomarkers in the crosstalk between EAT and the coronary arteries that are involved in the pathogenesis of late coronary atherosclerosis, especially coronary calcification, which might be translated into new therapeutic targets and imaging tools by biomedical engineering.
Collapse
Affiliation(s)
- Jennifer Mancio
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal.
| | - António S Barros
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Glória Conceicão
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Cátia Santa
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Guilherme Pessoa-Amorim
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Mariana Fragao-Marques
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Wilson Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Mónica Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Nuno Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Luís Vouga
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Isabel M Miranda
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Rui Vitorino
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Bruno Manadas
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Inês Falcão-Pires
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar de Sao João, Portugal
| | - Nuno Bettencourt
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| |
Collapse
|
19
|
Influence of EPICardial adipose tissue in HEART diseases (EPICHEART) study: Protocol for a translational study in coronary atherosclerosis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Yıldız D, Seferoğlu M, Güneş A, Büyükkoyuncu N, Sığırlı D. Epicardial Adipose Thickness and Neutrophil Lymphocyte Ratio in Acute Occlusive Cerebrovascular Diseases. J Stroke Cerebrovasc Dis 2020; 29:105203. [PMID: 33066933 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES We investigate the relationship between the severity of vascular disease and epicardial adipose tissue thickness(EAT-t) and the neutrophil/lymphocyte (NEU/LY) ratio in acute stroke patients. METHODS Seventy-six patients and 38 healthy controls were included in the study. Strokes were divided into three groups: lacunar infarction, middle cerebral artery infarction (MCA), and other arterial infarcts. Patients were assessed using the GCS (Glasgow coma scale) and NIHSS (National Institutes of Health Stroke Scale) scales. In addition to laboratory measurements, EAT-t was evaluated in all patients by using echocardiography. RESULTS The EAT-t value and NEU/LY ratio were higher in the patient group than in the control group. The MCA group was found to have a significantly higher NEU/LY ratio than the lacuna group (p = 0.017) as well as the other patient (p = 0.025) group. There was a positive correlation of NIHSS score with EAT-t (r = 0.291; p = 0.013), and NEU/LY ratio (r = 0.289; p = 0.014). CONCLUSION The EAT-t and NEU/LY ratio were high in patients with acute ischemic stroke patients. The higher ratio of NEU/LY compared to other infarcts in the MCA group. These findings support the relationship between acute ischemic stroke severity and inflammation .
Collapse
Affiliation(s)
- Demet Yıldız
- Department of Neurology, Bursa Yuksek Ihtisas Training and Reserach Hospital, Bursa; Turkey.
| | - Meral Seferoğlu
- Department of Neurology, Bursa Yuksek Ihtisas Training and Reserach Hospital, Bursa; Turkey.
| | - Aygül Güneş
- Department of Neurology, Bursa Yuksek Ihtisas Training and Reserach Hospital, Bursa; Turkey.
| | - Nilüfer Büyükkoyuncu
- Department of Neurology, Bursa Yuksek Ihtisas Training and Reserach Hospital, Bursa; Turkey.
| | - Deniz Sığırlı
- Department of Biostatistics, Uludag University Faculty of Medicine, Bursa; Turkey.
| |
Collapse
|
21
|
Milanese G, Silva M, Ledda RE, Goldoni M, Nayak S, Bruno L, Rossi E, Maffei E, Cademartiri F, Sverzellati N. Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: Results from the ALTER-BIO registry. Int J Cardiol 2020; 314:20-24. [DOI: 10.1016/j.ijcard.2020.04.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 01/05/2023]
|
22
|
Pugliese L, Spiritigliozzi L, Di Tosto F, Ricci F, Cavallo AU, Di Donna C, De Stasio V, Presicce M, Benelli L, D'Errico F, Pasqualetto M, Floris R, Chiocchi M. Association of plaque calcification pattern and attenuation with instability features and coronary stenosis and calcification grade. Atherosclerosis 2020; 311:150-157. [PMID: 32771265 DOI: 10.1016/j.atherosclerosis.2020.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/10/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Coronary computed tomography (CT) allows calculating coronary artery calcium score (CACS). However, other CT features might be more strongly related to plaque vulnerability and risk of future coronary events. This study investigated the association of plaque calcification pattern and attenuation with plaque instability features, coronary artery disease (CAD) grade and CACS. METHODS One-hundred patients with coronary stenosis associated with calcified plaques were considered for this analysis. CACS, CAD grade, calcification pattern and attenuation, features of plaque instability, and epicardial adipose tissue (EAT) thickness and attenuation were assessed with non-contrast and contrast-enhanced CT angiography. RESULTS Of 373 calcified plaques, 131 were responsible for the highest degree of coronary stenosis (1.31 ± 0.53 per patient). Participants were stratified according to the features of the highest-grade lesion(s) into patients with large (35%), spotty (52%) or mixed (13%) calcification pattern and tertiles of plaque calcification attenuation (using the mean value for multiple lesions). Patients with large calcification pattern or higher plaque calcification attenuation had higher stenosis and CACS grade (and EAT attenuation), but lower plaque instability score, whereas those with spotty calcification pattern or lower plaque calcification attenuation had lower stenosis and CACS grade (and EAT attenuation), but higher plaque instability score. Among the instability features, low attenuation and napkin-ring sign, but not positive remodeling, were associated with a spotty pattern and a lower calcification attenuation. CONCLUSIONS Both the pattern and attenuation of calcification should be considered, in addition to CACS, for risk stratification of heavily calcified high-risk patients with non-critical coronary stenosis.
Collapse
Affiliation(s)
- Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Federica Di Tosto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Armando U Cavallo
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Matteo Presicce
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Francesca D'Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Monia Pasqualetto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| |
Collapse
|
23
|
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.
Collapse
|
24
|
Reinhardt M, Cushman TR, Thearle MS, Krakoff J. Epicardial adipose tissue is a predictor of decreased kidney function and coronary artery calcification in youth- and early adult onset type 2 diabetes mellitus. J Endocrinol Invest 2019; 42:979-986. [PMID: 30674009 DOI: 10.1007/s40618-019-1011-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To examine the association of epicardial and pericardial fat volume (EFV, PFV) with cardiovascular risk factors and kidney function in Native Americans of southwestern heritage with youth and early adult onset type 2 diabetes mellitus (T2DM) versus healthy controls. METHODS Using computed tomography, we quantified EFV and PFV in 149 Native Americans (92 women, 57 men), 95 of which had T2DM (38 diagnosed prior to age 20 years). Duration of T2DM, mean carotid arterial mass (AM), coronary artery calcification (CAC), IL-6, and estimated glomerular filtration rate eGFRcr(CKD-EPI) were measured. RESULTS EFV and PFV were associated with BMI (r = 0.37, p < 0.0001; r = 0.26, p = 0.001) and did not differ between onset age-groups and controls (p > 0.05). EFV was associated with AM only in controls (r = 0.51, p < 0.0001). After adjustment for BMI, T2DM duration, HbA1C, age, and sex, EFV was a predictor of CAC and IL-6 concentrations in early adult onset T2DM (β = 0.05 ± 0.02 cm3, p = 0.03; β = 0.05 ± 0.01 pg/ml/cm3, p = 0.002). EFV and PFV were independent predictors of reduced eGFRcr(CKD-EPI) in the youth onset T2DM group (β = -0.3 ± 0.08 ml/min/cm3, p = 0.001; β = -0.25 ± 0.05 ml/min/cm3, p < 0.0001). CONCLUSIONS Epicardial fat volume may be a risk factor for heart disease in individuals with early adult onset T2DM and a predictor of decreased kidney function in individuals with youth onset T2DM.
Collapse
Affiliation(s)
- M Reinhardt
- Obesity and Diabetes Clinical Research Section, Department of Health and Human Services, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 N. 16th Street, Phoenix, AZ, 85016, USA.
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
| | - T R Cushman
- Obesity and Diabetes Clinical Research Section, Department of Health and Human Services, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 N. 16th Street, Phoenix, AZ, 85016, USA
| | - M S Thearle
- Obesity and Diabetes Clinical Research Section, Department of Health and Human Services, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 N. 16th Street, Phoenix, AZ, 85016, USA
| | - J Krakoff
- Obesity and Diabetes Clinical Research Section, Department of Health and Human Services, Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 N. 16th Street, Phoenix, AZ, 85016, USA
| |
Collapse
|
25
|
Gullaksen S, Funck KL, Laugesen E, Hansen TK, Dey D, Poulsen PL. Volumes of coronary plaque disease in relation to body mass index, waist circumference, truncal fat mass and epicardial adipose tissue in patients with type 2 diabetes mellitus and controls. Diab Vasc Dis Res 2019; 16:328-336. [PMID: 30714400 DOI: 10.1177/1479164119825761] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Coronary atherosclerosis in patients with type 2 diabetes mellitus may be promoted by regional fat distribution. We investigated the association between anthropometric measures of obesity, truncal fat mass, epicardial adipose tissue and coronary atherosclerosis in asymptomatic patients and matched controls. METHODS We examined 44 patients and 59 controls [mean (standard deviation) age 64.4 ± 9.9 vs 61.8 ± 9.7, male 50% vs 47%, diabetes duration mean (standard deviation) 7.7 ± 1.5] with coronary computed tomography angiography. Coronary plaques were quantified as total, calcified, non-calcified and low-density non-calcified plaque volumes (mm3). Regional fat distribution was assessed by dual-energy X-ray absorptiometry, body mass index (kg/m2), waist circumference (cm) and epicardial fat volume (mm3). Endothelial function and systemic inflammation were evaluated by peripheral arterial tonometry (log transformed Reactive Hyperemia Index) and C-reactive protein (mg/L). RESULTS Body mass index and waist circumference (p < 0.02) were associated with coronary plaque volumes. Body mass index was associated with low-density non-calcified plaque volume after adjustment for age, sex and diabetes status (p < 0.01). Truncal fat mass (p > 0.51), waist circumference (p > 0.06) and epicardial adipose tissue (p > 0.17) were not associated with coronary plaque volumes in adjusted analyses. CONCLUSION Body mass index is associated with coronary plaque volumes in diabetic as well as non-diabetic individuals.
Collapse
Affiliation(s)
- Søren Gullaksen
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian Løkke Funck
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Laugesen
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Damini Dey
- 3 Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Per Løgstrup Poulsen
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- 2 Steno Diabetes Center, Aarhus, Denmark
| |
Collapse
|
26
|
Haider A, Possner M, Messerli M, Bengs S, Osto E, Maredziak M, Portmann A, Fiechter M, Giannopoulos AA, Treyer V, Gaisl T, von Felten E, Patriki D, Benz DC, Fuchs TA, Gräni C, Pazhenkottil AP, Buechel RR, Kaufmann PA, Gebhard C. Quantification of intrathoracic fat adds prognostic value in women undergoing myocardial perfusion imaging. Int J Cardiol 2019; 292:258-264. [PMID: 31178224 DOI: 10.1016/j.ijcard.2019.04.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 01/12/2023]
Abstract
AIM Amongst patients with coronary artery disease (CAD), women experience relatively worse outcomes as compared to men. Evidence to date has failed to explore unique female imaging targets as major determinants of cardiovascular risk. We sought to assess the prognostic value of epicardial (EFV) and intrathoracic fat volume (IFV) quantification in women and men with suspected and known CAD. METHODS AND RESULTS Intrathoracic fat volume and EFV were calculated from non-contrast CT and analyzed in a propensity-matched cohort of 190 patients (95 women, mean age 62.5 ± 11.3 years) undergoing myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) for evaluation of CAD. IFV and EFV were significantly lower in women as compared to men (198.2 ± 78.4 vs 293.2 ± 114.7 cm3 and 105.6 ± 48.9 vs 135.8 ± 60.9 cm3, p < 0.001) and showed a strong association with coronary artery calcium score (CACS) and obstructive CAD in women (p < 0.05), but not in men. Fat volumes were not related to abnormal MPI in either population (p = NS). During a median follow-up of 2.8 years, high IFV was associated with reduced event free survival (log rank = 0.019 vs low IFV) in women, but not in men. Accordingly, a multivariate Cox regression model adjusted for cardiovascular risk factors, CACS, CCTA, and MPI findings selected IFV as a significant predictor of major adverse cardiovascular events (MACE) in women (HR 1.32, 95%CI 1.18-1.55, p = 0.001). CONCLUSION Quantification of IFV provides incremental prognostic value for MACE in women, beyond that provided by traditional risk factors and imaging findings.
Collapse
Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Elena Osto
- Center for Molecular Cardiology, University of Zurich, Switzerland; Laboratory of Translational Nutrition Biology, ETH, Zurich, Switzerland; University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Monika Maredziak
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Michael Fiechter
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland.
| |
Collapse
|
27
|
Milanese G, Silva M, Bruno L, Goldoni M, Benedetti G, Rossi E, Ferrari C, Grutta LL, Maffei E, Toia P, Forte E, Bonadonna RC, Sverzellati N, Cademartiri F. Quantification of epicardial fat with cardiac CT angiography and association with cardiovascular risk factors in symptomatic patients: from the ALTER-BIO (Alternative Cardiovascular Bio-Imaging markers) registry. ACTA ACUST UNITED AC 2019; 25:35-41. [PMID: 30644366 DOI: 10.5152/dir.2018.18037] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE We aimed to assess the association between features of epicardial adipose tissue and demographic, morphometric and clinical data, in a large population of symptomatic patients with clinical indication to cardiac computed tomography (CT) angiography. METHODS Epicardial fat volume (EFV) and adipose CT density of 1379 patients undergoing cardiac CT angiography (918 men, 66.6%; age range, 18-93 years; median age, 64 years) were semi-automatically quantified. Clinical variables were compared between diabetic and nondiabetic patients to assess potential differences in EFV and adipose CT density. Multiple regression models were calculated to find the clinical variables with a significant association with EFV and adipose CT density. RESULTS The median EFV in diabetic patients (112.87 mL) was higher compared with nondiabetic patients (82.62 mL; P < 0.001). The explanatory model of the multivariable analysis showed the strongest associations between EFV and BMI (β=0.442) and age (β=0.365). Significant yet minor association was found with sex (β=0.203), arterial hypertension (β=0.072), active smoking (β=0.068), diabetes (β=0.068), hypercholesterolemia (β=0.046) and cardiac height (β=0.118). The mean density of epicardial adipose tissue was associated with BMI (β=0.384), age (β=0.105), smoking (β=0.088), and diabetes (β=0.085). CONCLUSION In a large population of symptomatic patients, EFV is higher in diabetic patients compared with nondiabetic patients. Clinical variables are associated with quantitative features of epicardial fat.
Collapse
Affiliation(s)
- Gianluca Milanese
- Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mario Silva
- Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Livia Bruno
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Matteo Goldoni
- Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giorgio Benedetti
- Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Enrica Rossi
- Division of Radiology, University of Parma, Parma, Italy; Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Caterina Ferrari
- Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Erica Maffei
- Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Patrizia Toia
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Ernesto Forte
- Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy
| | - Riccardo C Bonadonna
- Division of Endocrinology and Metabolic Diseases, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nicola Sverzellati
- Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | |
Collapse
|
28
|
Saritas T, Reinartz SD, Nadal J, Schmoee J, Schmid M, Marwan M, Achenbach S, Störk S, Wanner C, Eckardt KU, Floege J, Peter Schneider M, Schlieper G. Epicardial fat, cardiovascular risk factors and calcifications in patients with chronic kidney disease. Clin Kidney J 2019; 13:571-579. [PMID: 32905245 PMCID: PMC7467583 DOI: 10.1093/ckj/sfz030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/19/2019] [Indexed: 12/20/2022] Open
Abstract
Background Epicardial adipose tissue (EAT) exerts cardiopathogenic effects, but the independent association between EAT and cardiovascular (CV) calcification in patients with chronic kidney disease (CKD) remains controversial. We therefore assessed the association between EAT, CV risk factors and CV calcifications. Methods 257 patients with CKD Stage 3 and/or overt proteinuria underwent quantification of EAT, coronary artery calcification and aortic valve calcification by computed tomography. Framingham and American College of Cardiology and American Heart Association (ACC-AHA) 10-year CV event risk scores were calculated for each patient. Results Using multivariable regression analysis, higher EAT was significantly associated with the majority of investigated risk factors {higher age: odds ratio [OR] 1.05/year [95% confidence interval (CI) 1.02-1.08]; male sex: OR 4.03 [95% CI 2.22-7.31]; higher BMI: OR 1.28/kg/m2 [95% CI 1.20-1.37]; former smoking: OR 1.84 [95% CI 1.07-3.17]; lower high-density lipoprotein cholesterol: OR 0.98/mg/dL [95% CI 0.96-1.00] and lower estimated glomerular filtration rate: OR 0.98/mL/min/1.73 m2 [95% CI 0.97-0.99]; all P < 0.05} and was not associated with diabetes mellitus, hypertensive nephropathy, total cholesterol and albuminuria. EAT was positively associated with higher ACC-AHA and Framingham risk scores. EAT correlated with coronary artery calcification and aortic valve calcification [Spearman ρ = 0.388 (95% CI 0.287-0.532) and r rb = 0.409 (95% CI 0.310-0.556), respectively], but these correlations were dependent on CV risk factors. Conclusions The increase of EAT can be explained by individual CV risk factors and kidney function and correlates with 10-year risk for CV event scores, suggesting that EAT is a modifiable risk factor in patients with CKD. Although EAT correlates with CV calcifications, these relations depend on CV risk factors.
Collapse
Affiliation(s)
- Turgay Saritas
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
- Correspondence and offprint requests to: Turgay Saritas; E-mail:
| | - Sebastian Daniel Reinartz
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jennifer Nadal
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Jonas Schmoee
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Störk
- Division of Cardiology (Comprehensive Heart Failure Center), Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Peter Schneider
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Klinikum Nürnberg, Paracelsus Private Medical University, Nürnberg, Germany
| | - Georg Schlieper
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
29
|
Antoniades C, Kotanidis CP, Berman DS. State-of-the-art review article. Atherosclerosis affecting fat: What can we learn by imaging perivascular adipose tissue? J Cardiovasc Comput Tomogr 2019; 13:288-296. [PMID: 30952610 PMCID: PMC6928589 DOI: 10.1016/j.jcct.2019.03.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 01/05/2023]
Abstract
Perivascular adipose tissue (PVAT) surrounding the human coronary arteries, secretes a wide range of adipocytokines affecting the biology of the adjacent vascular wall in a paracrine way. However, we have recently found that PVAT also behaves as a sensor of signals coming from the vascular wall, to which it reacts by changing its morphology and secretory profile. Indeed, vascular inflammation, a key feature of vascular disease pathogenesis, leads to the release of inflammatory signals that disseminate into local fat, inducing local lipolysis and inhibiting adipogenesis. This ability of PVAT to sense inflammatory signals from the vascular wall, can be used as a "thermometer" of the vascular wall, allowing for non-invasive detection of coronary inflammation. Vascular inflammation induces a shift of PVAT's composition from lipid to aqueous phase, resulting into increased computed tomography (CT) attenuation around the inflamed artery, forming a gradient with increasing attenuation closer to the inflamed coronary artery wall. These spatial changes in PVAT's attenuation are easily detected around culprit lesions during acute coronary syndromes. A new biomarker designed to captured these spatial changes in PVAT's attenuation around the human coronary arteries, the Fat Attenuation Index (FAI), has additional predictive value in stable patients for cardiac mortality and non-fatal heart attacks, above the prediction provided by the current state of the art that includes risk factors, calcium score and presence of high risk plaque features. The use of perivascular FAI in clinical practice may change the way we interpret cardiovascular CT angiography, as it is applicable to any coronary CT angiogram, and it offers dynamic information about the inflammatory burden of the coronary arteries, providing potential guidance for preventive measures and invasive treatments.
Collapse
Affiliation(s)
- Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Christos P Kotanidis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
30
|
Yaman M, Arslan U, Bayramoglu A, Bektas O, Gunaydin ZY, Kaya A. The presence of fragmented QRS is associated with increased epicardial adipose tissue and subclinical myocardial dysfunction in healthy individuals. Rev Port Cardiol 2019; 37:469-475. [PMID: 29776809 DOI: 10.1016/j.repc.2017.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 08/01/2017] [Accepted: 09/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM The aim of this study was to measure epicardial adipose tissue (EAT) and to assess left ventricular (LV) systolic and diastolic function in a healthy population grouped according to the presence of fragmented QRS (fQRS). METHODS In this prospective case-control study, the study population consisted of 308 healthy individuals who were divided into two groups according to the existence of fQRS: 180 fQRS(+) individuals (with fQRS), and 128 age- and gender-matched fQRS(-) individuals (without fQRS). These individuals were assessed for EAT thickness and subclinical myocardial dysfunction using transthoracic echocardiography including strain imaging. RESULTS The baseline clinical characteristics were similar between groups. EAT thickness was significantly increased in fQRS(+) individuals (0.59 vs. 0.44 mm, p<0.001). LV global longitudinal strain, reflecting systolic function (19.62±3.05 vs. 20.95±2.36, p<0.001) and E/A ratio, reflecting diastolic function (0.95±0.30 vs. 1.10±0.37, p<0.001), were decreased, revealing subclinical myocardial dysfunction, in fQRS(+) individuals. CONCLUSIONS The presence of fQRS on the admission ECG is associated with increased EAT and pronounced subclinical LV systolic and diastolic dysfunction in a healthy population. Further studies with larger patient groups are needed to clarify the exact pathophysiological mechanisms underlying these findings in healthy populations.
Collapse
Affiliation(s)
- Mehmet Yaman
- University of Health Sciences, Samsun Training and Research Hospital, Samsun, Turkey; Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey.
| | - Ugur Arslan
- University of Health Sciences, Samsun Training and Research Hospital, Samsun, Turkey
| | - Adil Bayramoglu
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
| | - Osman Bektas
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
| | - Zeki Yuksel Gunaydin
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
| | - Ahmet Kaya
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
| |
Collapse
|
31
|
Liu Z, Wang S, Wang Y, Zhou N, Shu J, Stamm C, Jiang M, Luo F. Association of epicardial adipose tissue attenuation with coronary atherosclerosis in patients with a high risk of coronary artery disease. Atherosclerosis 2019; 284:230-236. [PMID: 30777338 DOI: 10.1016/j.atherosclerosis.2019.01.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/25/2019] [Accepted: 01/30/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Density may indicate some tissue characteristics and help reveal the role of epicardial adipose tissue (EAT) in coronary artery disease (CAD). Therefore, we assessed the association of EAT density with the coronary artery plaque burden in patients presenting with chest pain. METHODS This retrospective cohort study comprised 614 patients (mean age 61 ± 9 years, 61% males) with a high cardiovascular disease risk, who underwent cardiac computed tomography angiography. Density was reflected as attenuation. RESULTS EAT attenuation was significantly associated with EAT volume with a negative Pearson's correlation coefficient and gradually increased across coronary artery calcium (CAC) scores of 0, 1-100, 101-400 and > 400. EAT attenuation was tightly associated with CAD risk factors, including age, sex, BMI, total cholesterol, neutrophil to lymphocyte ratios and CAC score. The association between EAT attenuation and CAC score was strengthened after adjusting for multivariable indices (OR 1.21, 95% CI 1.05-1.40, p = 0.01) and further adjusting for EAT volume (OR 1.26 95% CI 1.06-1.51, p<0.01). However, EAT attenuation was associated only with CAD presence (OR 1.32, 95% CI 1.02-1.69, p<0.05), CAC presence (OR 1.28, 95% CI 1.02-1.60, p<0.05), segment involvement score (OR 1.19, 95% CI 1.01-1.40, p<0.05) and segment stenosis score (OR 1.19, 95% CI 1.01-1.40, p<0.05) in the EAT volume- and multivariable-adjusted model. Additionally, EAT attenuation was not associated with significant coronary artery lesions and triple-vessel plaques. CONCLUSIONS Higher EAT attenuation is associated with a higher risk of CAD.
Collapse
Affiliation(s)
- Zihou Liu
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Shunjun Wang
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Yongqiang Wang
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Ningbo Zhou
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Jie Shu
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Christof Stamm
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Meng Jiang
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Fanyan Luo
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
| |
Collapse
|
32
|
The relationship between epicardial adipose tissue and coronary artery stenosis by sex and menopausal status in patients with suspected angina. Biol Sex Differ 2018; 9:52. [PMID: 30547834 PMCID: PMC6295015 DOI: 10.1186/s13293-018-0212-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/04/2018] [Indexed: 01/11/2023] Open
Abstract
Background Evidence suggests that epicardial adipose tissue (EAT) is closely related to coronary artery stenosis (CAS). However, sexual dimorphism may be present in adipose tissue, and its influence on CAS between men and women is controversial. We assessed the relationship between EAT and CAS by sex and menopausal status in patients with suspected angina. Methods Six hundred twenty-eight consecutive patients (men/women n = 257/371; mean age = 59.9 ± 10.2 years) who had chest pain for angina and underwent coronary angiography were included. CAS was defined as > 50% luminal narrowing of at least one epicardial coronary artery. EAT thickness was measured by transthoracic echocardiography. Results Of the 628 patients, 52.1% (n = 134) of men and 35.3% (n = 131) of women had CAS. The mean EAT thickness was not different between men and women and was larger in patients with CAS (8.04 ± 2.39 vs 6.58 ± 1.88 mm, P < 0.001). EAT thickness was independently associated with CAS in both sexes (P < 0.001). The odds ratio (OR) of EAT for the presence of CAS was higher in men (OR = 1.43, 95% confidence interval [CI] 1.21–1.69) than in women (OR = 1.24, 95% CI 1.10–1.40). EAT thickness was larger in postmenopausal women than in premenopausal women (7.59 ± 2.25 vs 5.80 ± 1.57 mm, P < 0.001) and was independently related with CAS (OR = 1.24, 95% CI 1.09–1.41). This was not the case in premenopausal women. Conclusion In patients with suspected angina, an increase in EAT thickness was independently related to the presence of CAS in both men and women, with it being stronger in men. According to menopausal status in women, EAT thickness is significantly associated with CAS only in postmenopausal women.
Collapse
|
33
|
Epicardial fat: a novel marker of subclinical atherosclerosis in clinical practice? Anatol J Cardiol 2018; 17:64-65. [PMID: 28144006 DOI: 10.14744/anatoljcardiol.2017.22129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
34
|
Yaman M, Arslan U, Bayramoglu A, Bektas O, Gunaydin ZY, Kaya A. The presence of fragmented QRS is associated with increased epicardial adipose tissue and subclinical myocardial dysfunction in healthy individuals. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
35
|
Mancio J, Oikonomou EK, Antoniades C. Perivascular adipose tissue and coronary atherosclerosis. Heart 2018; 104:1654-1662. [PMID: 29853488 DOI: 10.1136/heartjnl-2017-312324] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/25/2022] Open
Abstract
Adipose tissue (AT) is no longer viewed as a passive, energy-storing depot, and a growing body of evidence supports the concept that both quantitative and qualitative aspects of AT are critical in determining an individual's cardiometabolic risk profile. Among all AT sites, perivascular AT (PVAT) has emerged as a depot with a distinctive biological significance in cardiovascular disease given its close anatomical proximity to the vasculature. Recent studies have suggested the presence of complex, bidirectional paracrine and vasocrine signalling pathways between the vascular wall and its PVAT, with far-reaching implications in cardiovascular diagnostics and therapeutics. In this review, we first discuss the biological role of PVAT in both cardiovascular health and disease, highlighting its dual pro-atherogenic and anti-atherogenic roles, as well as potential therapeutic targets in cardiovascular disease. We then review current evidence and promising new modalities on the non-invasive imaging of epicardial AT and PVAT. Specifically, we present how our expanding knowledge on the bidirectional interplay between the vascular wall and its PVAT can be translated into novel clinical diagnostics tools to assess coronary inflammation. To this end, we present the example of a new CT-based method that tracks spatial changes in PVAT phenotype to extract information about the inflammatory status of the adjacent vasculature, highlighting the numerous diagnostic and therapeutic opportunities that arise from our increased understanding of PVAT biology.
Collapse
Affiliation(s)
- Jennifer Mancio
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Evangelos K Oikonomou
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Charalambos Antoniades
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
36
|
Epicardial adipose tissue is related to arterial stiffness and inflammation in patients with cardiovascular disease and type 2 diabetes. BMC Cardiovasc Disord 2018; 18:31. [PMID: 29433433 PMCID: PMC5809843 DOI: 10.1186/s12872-018-0770-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Epicardial adipose tissue (EAT) is an emerging cardio-metabolic risk factor and has been shown to correlate with adverse cardiovascular (CV) outcome; however the underlying pathophysiology of this link is not well understood. The aim of this study was to evaluate the relationship between EAT and a comprehensive panel of cardiovascular risk biomarkers and pulse wave velocity (PWV) and indexed left ventricular mass (LVMI) in a cohort of patients with cardiovascular disease (CVD) and diabetes compared to controls. Methods One hundred forty-five participants (mean age 63.9 ± 8.1 years; 61% male) were evaluated. All patients underwent cardiovascular magnetic resonance (CMR) examination and PWV. EAT measurements from CMR were performed on the 4-chamber view. Blood samples were taken and a range of CV biomarkers was evaluated. Results EAT measurements were significantly higher in the groups with CVD, with or without T2DM compared to patients without CVD or T2DM (group 1 EAT 15.9 ± 5.5 cm2 vs. group 4 EAT 11.8 ± 4.1 cm2, p = 0.001; group 3 EAT 15.1 ± 4.3 cm2 vs. group 4 EAT 11.8 ± 4.1 cm2, p = 0.024). EAT was independently associated with IL-6 (beta 0.2, p = 0.019). When added to clinical variables, both EAT (beta 0.16, p = 0.035) and IL-6 (beta 0.26, p = 0.003) were independently associated with PWV. EAT was significantly associated with LVMI in a univariable analysis but not when added to significant clinical variables. Conclusions In patients with cardio-metabolic disease, EAT was independently associated with PWV. EAT may be associated with CVD risk due to an increase in systemic vascular inflammation. Whether targeting EAT may reduce inflammation and/or cardiovascular risk should be evaluated in prospective studies. Electronic supplementary material The online version of this article (10.1186/s12872-018-0770-z) contains supplementary material, which is available to authorized users.
Collapse
|
37
|
Bos D, Leening MJG. Leveraging the coronary calcium scan beyond the coronary calcium score. Eur Radiol 2018; 28:3082-3087. [PMID: 29383526 PMCID: PMC5986828 DOI: 10.1007/s00330-017-5264-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/28/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
Non-contrast cardiac computed tomography in order to obtain the coronary artery calcium score has become an established diagnostic procedure in the clinical setting, and is commonly employed in clinical and population-based research. This state-of-the-art review paper highlights the potential gain in information that can be obtained from the non-contrast coronary calcium scans without any necessary modifications to the scan protocol. This includes markers of cardio-metabolic health, such as the amount of epicardial fat and liver fat, but also markers of general health including bone density and lung density. Finally, this paper addresses the importance of incidental findings and of radiation exposure accompanying imaging with non-contrast cardiac computed tomography. Despite the fact that coronary calcium scan protocols have been optimized for the visualization of coronary calcification in terms image quality and radiation exposure, it is important for radiologists, cardiologists and medical specialists in the field of preventive medicine to acknowledge that numerous additional markers of cardio-metabolic health and general health can be readily identified on a coronary calcium scan. KEY POINTS • The coronary artery calcium score substantially increased the use of cardiac CT. • Cardio-metabolic and general health markers may be derived without changes to the scan protocol. • Those include epicardial fat, aortic valve calcifications, liver fat, bone density, and lung density. • Clinicians must be aware of this potential additional yield from non-contrast cardiac CT.
Collapse
Affiliation(s)
- Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
38
|
Gender differences in the association of epicardial adipose tissue and coronary artery calcification: EPICHEART study: EAT and coronary calcification by gender. Int J Cardiol 2017; 249:419-425. [PMID: 28986055 DOI: 10.1016/j.ijcard.2017.09.178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association of epicardial adipose tissue (EAT) and coronary artery calcification (CAC) seems to differ by gender. However, few studies have controlled for body size, and the ideal method for body size indexing has not been explored. OBJECTIVES To analyse the effect of gender related-body size and-body fat differences on the association of EAT with CAC. METHODS This was a prospective cohort of 371 severe aortic stenosis patients (77±8.5year-old, 51% females) referred to cardiac surgery. Agatston calcium score, EAT volume and visceral abdominal fat (VAF) were obtained by computed tomography. Body composition was determined using bioelectrical impedance analysis. Body weight and height were measured to derive body mass index (BMI), body surface area (BSA), and body surface index (BSI). EAT volume was normalized for BSA, weight and height. RESULTS Median CAC score was higher in men (887; IQR: 2010) than in women (279: IQR: 145) (p<0.01). Similarly, men had higher volume of EAT than women (137±65.6 vs. 106±65.6mL, p<0.01), even when BSA- or height-indexed, but not if weight-indexed. EAT volume was associated with CAC adjusting for adiposity (BMI or BSI and VAF, or fat mass), but not with further adjustment for gender. In a stratified analysis, absolute- and indexed-volumes of EAT were independently associated with CAC in men while no association was found in women (gender-interaction p<0.05). CONCLUSIONS In these high-risk patients, we demonstrated that EAT was associated with CAC score irrespective of body size, body fat and cardiovascular risk factors in men but not in women.
Collapse
|
39
|
Ikram MA, Brusselle GGO, Murad SD, van Duijn CM, Franco OH, Goedegebure A, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BH, Tiemeier H, Uitterlinden AG, Vernooij MW, Hofman A. The Rotterdam Study: 2018 update on objectives, design and main results. Eur J Epidemiol 2017; 32:807-850. [PMID: 29064009 PMCID: PMC5662692 DOI: 10.1007/s10654-017-0321-4] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
Collapse
Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sarwa Darwish Murad
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Gastro-Enterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
40
|
The association of epicardial fat volume with coronary characteristics and clinical outcome. Int J Cardiovasc Imaging 2017; 34:301-309. [PMID: 28808885 DOI: 10.1007/s10554-017-1227-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/07/2017] [Indexed: 01/26/2023]
Abstract
Recent studies have demonstrated the relationship between epicardial fat volume (EFV) and coronary atherosclerosis, but their association is modest at best. Our purpose is to elucidate the association of epicardial fat with coronary characteristics and clinical outcome. We performed coronary computed tomographic angiography in 651 patients and divided them into three groups according to tertiles of EFV; low-tertile (n = 215), 36-123 ml; middle-tertile (n = 218), 124-165 ml; high-tertile (n = 218), 166-489 ml. The prevalence of coronary calcium score (CCS) >0 (71.6, 73.4, and 83.9% in low-, middle-, and high-tertile group, respectively) and CCS >100 (39.1, 39.9, and 59.2% in each group) was significantly higher in patients with high-tertile EFV compared to the other two groups (p = 0.0047 and p < 0.0001, respectively). The prevalence of CCS >400 was 17.2, 25.7, and 33.1% in each group, which increased stepwise as EFV increased. The significant stenosis (36.2 vs. 27.0%, p = 0.0383), total coronary occlusion (5.5 vs. 0.9%, p = 0.0156), and high-risk plaque (11.0 vs. 5.6%, p = 0.0368) were more prevalent in patients with high-tertile EFV compared to those with low-tertile EFV. The combined rate of cardiac death and myocardial infarction was 0.9, 2.3, and 6.4% in each patient group, respectively, which was significantly higher in patients with high-tertile EFV compared to those with low-tertile EFV (p = 0.0004). The prevalence of coronary artery calcium, significant stenosis, and high-risk plaque increased sharply in patients with high EFV, which was associated with higher rate of cardiac death and myocardial infarction. Thus, high EFV was associated with advanced coronary atherosclerosis and poor prognosis.
Collapse
|
41
|
Christensen RH, von Scholten BJ, Hansen CS, Heywood SE, Rosenmeier JB, Andersen UB, Hovind P, Reinhard H, Parving HH, Pedersen BK, Jørgensen ME, Jacobsen PK, Rossing P. Epicardial, pericardial and total cardiac fat and cardiovascular disease in type 2 diabetic patients with elevated urinary albumin excretion rate. Eur J Prev Cardiol 2017. [PMID: 28650207 DOI: 10.1177/2047487317717820] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background We evaluated the association of cardiac adipose tissue including epicardial adipose tissue and pericardial adipose tissue with incident cardiovascular disease and mortality, coronary artery calcium, carotid intima media thickness and inflammatory markers. Design A prospective study of 200 patients with type 2 diabetes and elevated urinary albumin excretion rate (UAER). Methods Cardiac adipose tissue was measured from baseline echocardiography. The composite endpoint comprised incident cardiovascular disease and all-cause mortality. Coronary artery calcium, carotid intima media thickness and inflammatory markers were measured at baseline. Cardiac adipose tissue was investigated as continuous and binary variable. Analyses were performed unadjusted (model 1), and adjusted for age, sex (model 2), body mass index, low-density lipoprotein cholesterol, smoking, glycated haemoglobin, and systolic blood pressure (model 3). Results Patients were followed-up after 6.1 years for non-fatal cardiovascular disease ( n = 29) or mortality ( n = 23). Cardiac adipose tissue ( p = 0.049) and epicardial adipose tissue ( p = 0.029) were associated with cardiovascular disease and mortality in model 1. When split by the median, patients with high cardiac adipose tissue had a higher risk of cardiovascular disease and mortality than patients with low cardiac adipose tissue in unadjusted (hazard ratio 1.9, confidence interval: 1.1; 3.4, p = 0.027) and adjusted (hazard ratio 2.0, confidence interval: 1.1; 3.7, p = 0.017) models. Cardiac adipose tissue ( p = 0.033) was associated with baseline coronary artery calcium (model 1) and interleukin-8 (models 1-3, all p < 0.039). Conclusions In type 2 diabetes patients without coronary artery disease, high cardiac adipose tissue levels were associated with increased risk of incident cardiovascular disease or all-cause mortality even after accounting for traditional cardiovascular disease risk factors. High cardiac adipose tissue amounts were associated with subclinical atherosclerosis (coronary artery calcium) and with the pro-atherogenic inflammatory marker interleukin-8.
Collapse
Affiliation(s)
- Regitse H Christensen
- 1 Steno Diabetes Center, Denmark.,2 Center of Inflammation and Metabolism/Center for Physical Activity Research (CIM/CFAS), University of Copenhagen, Denmark
| | | | | | - Sarah E Heywood
- 2 Center of Inflammation and Metabolism/Center for Physical Activity Research (CIM/CFAS), University of Copenhagen, Denmark
| | | | - Ulrik B Andersen
- 4 Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet-Glostrup, Denmark
| | - Peter Hovind
- 4 Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet-Glostrup, Denmark
| | | | - Hans-Henrik Parving
- 5 Department of Medical Endocrinology, Rigshospitalet, Denmark.,6 Department of Clinical Medicine, Copenhagen University, Denmark
| | - Bente K Pedersen
- 2 Center of Inflammation and Metabolism/Center for Physical Activity Research (CIM/CFAS), University of Copenhagen, Denmark
| | - Marit E Jørgensen
- 1 Steno Diabetes Center, Denmark.,7 National Institute of Public Health, Southern Denmark University, Denmark
| | | | - Peter Rossing
- 1 Steno Diabetes Center, Denmark.,6 Department of Clinical Medicine, Copenhagen University, Denmark.,9 HEALTH, University of Aarhus, Denmark
| |
Collapse
|
42
|
Relation of Epicardial Adipose Tissue Radiodensity to Coronary Artery Calcium on Cardiac Computed Tomography in Patients at High Risk for Cardiovascular Disease. Am J Cardiol 2017; 119:1359-1365. [PMID: 28279438 DOI: 10.1016/j.amjcard.2017.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 12/14/2022]
Abstract
Adipose tissue radiodensity detected by computed tomography (CT) is hypothesized to be associated with differences in adipose tissue composition which may contribute to the development of coronary atherosclerosis independent of epicardial adipose tissue volume. The aim of the present study is to quantify the relation between epicardial adipose tissue radiodensity and presence, distribution, and density of coronary artery calcium (CAC) in patients at high risk for cardiovascular disease. A total of 140 patients of the Secondary Manifestations of ARTerial disease (SMART) study underwent cardiac-CT angiography. Ordinal logistic and linear regression was used to quantify the relation between epicardial adipose tissue radiodensity (in Hounsfield Units, HU) and CAC. One SD lower attenuation (5 HU) was associated with a 1.90 (95% confidence interval [CI] 1.14 to 3.19) higher odds for men and a 1.07 (95% CI 0.41 to 2.75) higher odds for women of being in a higher CAC class (0, 1 to 100, 101 to 400, and >400), independent of age, coronary artery bypass graft history, epicardial adipose tissue volume, and body mass index. One SD lower attenuation was not associated with more diffuse distribution of CAC, but increased the odds of being in a higher tertile of CAC density per plaque (odds ratio 1.77, 95% CI 1.18 to 2.66). In conclusion, low epicardial adipose tissue CT attenuation is associated with higher CAC scores in men at high risk for cardiovascular disease, independent of epicardial depot volume and body mass index. Present results suggest a potential role for epicardial adipose tissue radiodensity as a measure of adipose tissue composition and may inform on the contribution of epicardial adipose tissue composition to coronary atherosclerosis.
Collapse
|
43
|
Stabley JN, Towler DA. Arterial Calcification in Diabetes Mellitus: Preclinical Models and Translational Implications. Arterioscler Thromb Vasc Biol 2017; 37:205-217. [PMID: 28062508 PMCID: PMC5480317 DOI: 10.1161/atvbaha.116.306258] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus increasingly afflicts our aging and dysmetabolic population. Type 2 diabetes mellitus and the antecedent metabolic syndrome represent the vast majority of the disease burden-increasingly prevalent in children and older adults. However, type 1 diabetes mellitus is also advancing in preadolescent children. As such, a crushing wave of cardiometabolic disease burden now faces our society. Arteriosclerotic calcification is increased in metabolic syndrome, type 2 diabetes mellitus, and type 1 diabetes mellitus-impairing conduit vessel compliance and function, thereby increasing the risk for dementia, stroke, heart attack, limb ischemia, renal insufficiency, and lower extremity amputation. Preclinical models of these dysmetabolic settings have provided insights into the pathobiology of arterial calcification. Osteochondrogenic morphogens in the BMP-Wnt signaling relay and transcriptional regulatory programs driven by Msx and Runx gene families are entrained to innate immune responses-responses activated by the dysmetabolic state-to direct arterial matrix deposition and mineralization. Recent studies implicate the endothelial-mesenchymal transition in contributing to the phenotypic drift of mineralizing vascular progenitors. In this brief overview, we discuss preclinical disease models that provide mechanistic insights-and point to challenges and opportunities to translate these insights into new therapeutic strategies for our patients afflicted with diabetes mellitus and its arteriosclerotic complications.
Collapse
MESH Headings
- Animals
- Animals, Genetically Modified
- Arteries/metabolism
- Arteries/pathology
- Atherosclerosis/etiology
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/genetics
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/metabolism
- Diabetic Angiopathies/etiology
- Diabetic Angiopathies/metabolism
- Diabetic Angiopathies/pathology
- Diet, High-Fat
- Disease Models, Animal
- Female
- Genetic Predisposition to Disease
- Humans
- Hyperlipidemias/complications
- Hyperlipidemias/genetics
- Male
- Phenotype
- Plaque, Atherosclerotic
- Rats
- Signal Transduction
- Translational Research, Biomedical
- Vascular Calcification/etiology
- Vascular Calcification/metabolism
- Vascular Calcification/pathology
Collapse
Affiliation(s)
- John N Stabley
- From the Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Dwight A Towler
- From the Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
44
|
Abstract
Advances in atherosclerosis imaging technology and research have provided a range of diagnostic tools to characterize high-risk plaque in vivo; however, these important vascular imaging methods additionally promise great scientific and translational applications beyond this quest. When combined with conventional anatomic- and hemodynamic-based assessments of disease severity, cross-sectional multimodal imaging incorporating molecular probes and other novel noninvasive techniques can add detailed interrogation of plaque composition, activity, and overall disease burden. In the catheterization laboratory, intravascular imaging provides unparalleled access to the world beneath the plaque surface, allowing tissue characterization and measurement of cap thickness with micrometer spatial resolution. Atherosclerosis imaging captures key data that reveal snapshots into underlying biology, which can test our understanding of fundamental research questions and shape our approach toward patient management. Imaging can also be used to quantify response to therapeutic interventions and ultimately help predict cardiovascular risk. Although there are undeniable barriers to clinical translation, many of these hold-ups might soon be surpassed by rapidly evolving innovations to improve image acquisition, coregistration, motion correction, and reduce radiation exposure. This article provides a comprehensive review of current and experimental atherosclerosis imaging methods and their uses in research and potential for translation to the clinic.
Collapse
Affiliation(s)
- Jason M Tarkin
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Marc R Dweck
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Nicholas R Evans
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Richard A P Takx
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Adam J Brown
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Ahmed Tawakol
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Zahi A Fayad
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - James H F Rudd
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.).
| |
Collapse
|
45
|
Aortic flow propagation velocity, epicardial fat thickness, and osteoprotegerin level to predict subclinical atherosclerosis in patients with nonalcoholic fatty liver disease. Anatol J Cardiol 2016; 16:974-979. [PMID: 27025201 PMCID: PMC5324920 DOI: 10.14744/anatoljcardiol.2016.6706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in Western countries and an independent risk factor for atherosclerotic heart disease. Appropriate noninvasive parameters are lacking for optimal risk stratification of cardiovascular disease in these patients. We evaluated several recently discovered noninvasive parameters for atherosclerosis in patients with nonalcoholic fatty liver disease: epicardial fat thickness, aortic flow propagation velocity, and osteoprotegerin level. Methods: Forty-one patients (27 men and 14 women; mean age, 37.9±8.9 years) with nonalcoholic fatty liver disease and 37 control subjects (17 men and 20 women; mean age, 34.5±8.6 years) were enrolled in this observational case-control study. Patients with nonalcoholic fatty liver disease diagnosed at a gastroenterology outpatient clinic were included. Patients with cardiac pathology other than hypertension were excluded. Epicardial fat thickness and aortic flow propagation velocity were measured by echocardiography. The serum concentration of osteoprotegerin was measured using a commercial enzyme-linked immunosorbent assay kit. Results: Nonalcoholic fatty liver disease patients exhibited a significantly lower aortic flow propagation velocity (155.17±30.00 vs. 179.00±18.14 cm/s, p=0.000) and significantly higher epicardial fat thickness (0.51±0.25 vs. 0.29±0.09 cm, p=0.000) than control subjects. Osteoprotegerin levels were higher, but not significant, in patients with nonalcoholic fatty liver disease (28.0±13.0 vs. 25.2±10.8 pg/mL, p=0.244). Binary logistic regression analysis showed that aortic flow propagation velocity (OR, –0.973; 95% CI, 0.947–0.999) and waist circumference (OR, –1.191; 95% CI, 1.088–1.303) were independent predictors of nonalcoholic fatty liver disease. Conclusion: In this study, epicardial fat thickness and osteoprotegerin level were higher and aortic flow propagation velocity was lower in patients with nonalcoholic fatty liver disease. Early detection of abnormal epicardial fat thickness and aortic flow propagation velocity may warrant a search for undetected cardiovascular disease in patients with nonalcoholic fatty liver disease. (Anatol J Cardiol 2016; 16: 974-9)
Collapse
|
46
|
Chu CY, Lee WH, Hsu PC, Lee MK, Lee HH, Chiu CA, Lin TH, Lee CS, Yen HW, Voon WC, Lai WT, Sheu SH, Su HM. Association of Increased Epicardial Adipose Tissue Thickness With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation. Medicine (Baltimore) 2016; 95:e2874. [PMID: 26986099 PMCID: PMC4839880 DOI: 10.1097/md.0000000000002874] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The thickness of epicardial adipose tissue (EAT) was reported to be highly associated with the incidence and severity of atrial fibrillation (AF). This study was conducted to analyze the ability of EAT thickness in predicting adverse cardiovascular (CV) events in AF. In 190 persistent AF patients, we performed a comprehensive transthoracic echocardiographic examination with assessment of EAT thickness. The definition of CV events included CV mortality, hospitalization for heart failure, myocardial infarction, and stroke. There were 69 CV events including 19 CV deaths, 32 hospitalizations for heart failure, 3 myocardial infarctions, and 15 strokes during a mean follow-up of 29 (25th-75th percentile: 17-36) months. The multivariable analysis demonstrates that chronic heart failure, increased left ventricular (LV) mass index and the ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity, decreased body mass index, and increased EAT thickness (per 1-mm increase, odds ratio 1.224, 95% confidence interval [CI] 1.096-1.368, P < 0.001) were associated with adverse CV events. Additionally, the addition of EAT thickness to a model containing CHA2DS2-VASc score, left atrial volume index, and LV systolic and diastolic function significantly improved the values in predicting CV events (global χ increase 14.65, P < 0.001 and integrated discrimination improvement 0.10, 95% CI 0.04-0.16, P < 0.001). In AF, EAT thickness was useful in predicting adverse CV events. Additionally, EAT thickness could provide incremental value for CV outcome prediction over traditional clinical and echocardiographic parameters in AF.
Collapse
Affiliation(s)
- Chun-Yuan Chu
- From the Faculty of Medicine, College of Medicine (C-YC, W-HL, P-CH, T-HL, C-SL, H-WY, W-CV, W-TL, S-HS, H-MS); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital (C-YC, W-HL, P-CH, M-KL, H-HL, C-AC, T-HL, C-SL, H-WY, W-CV, W-TL, S-HS, H-MS); and Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (W-HL, M-KL, H-MS), Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Baragetti A, Pisano G, Bertelli C, Garlaschelli K, Grigore L, Fracanzani AL, Fargion S, Norata GD, Catapano AL. Subclinical atherosclerosis is associated with Epicardial Fat Thickness and hepatic steatosis in the general population. Nutr Metab Cardiovasc Dis 2016; 26:141-153. [PMID: 26777475 DOI: 10.1016/j.numecd.2015.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Abdominal obesity and hepatic steatosis are ectopic fat depots associated with Metabolic Syndrome (MetS). Epicardial Fat Thickness (EFT) is a newly discovered one, increasing with obesity, insulin resistance and MetS. Therefore we studied whether different ectopic fat markers, and EFT in particular, are associated with MetS and markers of subclinical cardiovascular disease. METHODS AND RESULTS 868 subjects from the PLIC Study were included, EFT, aortic calcifications, carotid Intima-Media Thickness (c-IMT) and echocardiographic parameters were determined by ultrasound; extra-cardiac atherosclerotic lesions were defined in presence of plaques at both carotid and aortic levels. Hepatic steatosis degrees were defined according to a scoring system. Abdominal adiposity was determined using Dual X-ray Absorbimetry (DEXA). Independently from age, women showed higher EFT versus men (4.5 (0.20-9.00) mm vs 4.00 (0.10-8.00) mm, p = 0.013); EFT was thicker in post-menopausal women (independently from hormone-replacement therapy). EFT, liver steatosis and abdominal adiposity increased with MetS (p < 0.001). EFT was the only ectopic fat marker associated with cardiac dysfunction (OR = 1.340 [1.088-1.651 95% C.I., p = 0.006); liver steatosis and EFT were associated with extra-cardiac plaques (OR = 2.529 [1.328-4.819] 95% C.I., p < 0.001 and OR = 1.195 [1.008-1.299] 95% C.I., p = 0.042; respectively). On top of cardiovascular risk factors, only EFT improved the discrimination of subjects with cardiac dysfunction and atherosclerotic plaques. CONCLUSIONS EFT is associated with left ventricular dysfunction and subclinical atherosclerosis. Our data suggest that EFT may represent an additional tool for the stratification of cardiovascular risk.
Collapse
Affiliation(s)
- A Baragetti
- Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Milan, Italy; Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - G Pisano
- Dipartimento di Medicina Interna, Centro Studi Malattie Metaboliche del Fegato - Cà Granda IRCCS Fondazione Ospedale Policlinico, Milan, Italy
| | - C Bertelli
- Dipartimento di Medicina Interna, Centro Studi Malattie Metaboliche del Fegato - Cà Granda IRCCS Fondazione Ospedale Policlinico, Milan, Italy
| | - K Garlaschelli
- Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - L Grigore
- Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - A L Fracanzani
- Dipartimento di Medicina Interna, Centro Studi Malattie Metaboliche del Fegato - Cà Granda IRCCS Fondazione Ospedale Policlinico, Milan, Italy
| | - S Fargion
- Dipartimento di Medicina Interna, Centro Studi Malattie Metaboliche del Fegato - Cà Granda IRCCS Fondazione Ospedale Policlinico, Milan, Italy
| | - G D Norata
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry Queen's Mary University, London, United Kingdom.
| | - A L Catapano
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy; Multimedica Hospital - IRCCS, Sesto San Giovanni, Milan, Italy.
| |
Collapse
|
48
|
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
Collapse
|