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Guaricci AI, Neglia D, Acampa W, Andreini D, Baggiano A, Bianco F, Carrabba N, Conte E, Gaudieri V, Mushtaq S, Napoli G, Pergola V, Pontone G, Pedrinelli R, Mercuro G, Indolfi C, Guglielmo M. Computed tomography and nuclear medicine for the assessment of coronary inflammation: clinical applications and perspectives. J Cardiovasc Med (Hagerstown) 2023; 24:e67-e76. [PMID: 37052223 DOI: 10.2459/jcm.0000000000001433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
There is increasing evidence that in patients with atherosclerotic cardiovascular disease (ASCVD) under optimal medical therapy, a persisting dysregulation of the lipid and glucose metabolism, associated with adipose tissue dysfunction and inflammation, predicts a substantial residual risk of disease progression and cardiovascular events. Despite the inflammatory nature of ASCVD, circulating biomarkers such as high-sensitivity C-reactive protein and interleukins may lack specificity for vascular inflammation. As known, dysfunctional epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) produce pro-inflammatory mediators and promote cellular tissue infiltration triggering further pro-inflammatory mechanisms. The consequent tissue modifications determine the attenuation of PCAT as assessed and measured by coronary computed tomography angiography (CCTA). Recently, relevant studies have demonstrated a correlation between EAT and PCAT and obstructive coronary artery disease, inflammatory plaque status and coronary flow reserve (CFR). In parallel, CFR is well recognized as a marker of coronary vasomotor function that incorporates the haemodynamic effects of epicardial, diffuse and small-vessel disease on myocardial tissue perfusion. An inverse relationship between EAT volume and coronary vascular function and the association of PCAT attenuation and impaired CFR have already been reported. Moreover, many studies demonstrated that 18F-FDG PET is able to detect PCAT inflammation in patients with coronary atherosclerosis. Importantly, the perivascular FAI (fat attenuation index) showed incremental value for the prediction of adverse clinical events beyond traditional risk factors and CCTA indices by providing a quantitative measure of coronary inflammation. As an indicator of increased cardiac mortality, it could guide early targeted primary prevention in a wide spectrum of patients. In this review, we summarize the current evidence regarding the clinical applications and perspectives of EAT and PCAT assessment performed by CCTA and the prognostic information derived by nuclear medicine.
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Affiliation(s)
- Andrea Igoren Guaricci
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari
| | - Danilo Neglia
- Cardiovascular Department, Fondazione Toscana Gabriele Monasterio (FTGM), Pisa
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS
- Department of Clinical Sciences and Community Health, Cardiovascular Section, Milan
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS
- Department of Clinical Sciences and Community Health, Cardiovascular Section, Milan
| | - Francesco Bianco
- Cardiovascular Sciences Department - AOU 'Ospedali Riuniti', Ancona
| | - Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS
- Department of Biomedical Sciences for Health, University of Milan, Milan
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples
| | | | - Gianluigi Napoli
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari
| | - Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova
| | | | | | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Pandey NN, Sharma S, Jagia P, Kumar S. Epicardial fat attenuation, not volume, predicts obstructive coronary artery disease and high risk plaque features in patients with atypical chest pain. Br J Radiol 2020; 93:20200540. [PMID: 32706985 DOI: 10.1259/bjr.20200540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE This study sought to investigate the association between volume and attenuation of epicardial fat and presence of obstructive coronary artery disease (CAD) and high-risk plaque features (HRPF) on CT angiography (CTA) in patients with atypical chest pain and whether the association, if any, is independent of conventional cardiovascular risk factors and coronary artery calcium score (CACS). METHODS Patients referred for coronary CTA with atypical chest pain and clinical suspicion of CAD were included in the study. Quantification of CACS, epicardial fat volume (EFV) and epicardial fat attenuation (EFat) was performed on non-contrast images. CTA was evaluated for presence of obstructive CAD and presence of HRPF. RESULTS 255 patients (median age [interquartile range; IQR]: 51[41-60] years, 51.8% males) were included. On CTA, CAD, obstructive CAD (≥50% stenosis) and CTA-derived HRPFs was present in 133 (52.2%), 37 (14.5%) and 82 (32.2%) patients respectively. A significantly lower EFat was seen in patients with obstructive CAD than in those without (-86HU [IQR:-88 to -82 HU] vs -84 [IQR:-87 HU to -82 HU]; p = 0.0486) and in patients with HRPF compared to those without (-86 HU [IQR:-88 to -83 HU] vs -83 HU [-86 HU to -81.750 HU]; p < 0.0001). EFat showed significant association with obstructive CAD (unadjusted Odd's ratio (OR) [95% CI]: 0.90 [0.81-0.99];p = 0.0248) and HRPF (unadjusted OR [95% CI]: 0.83 [0.76-0.90];p < 0.0001) in univariate analysis, which remained significant in multivariate analysis. However, EFV did not show any significant association with neither obstructive CAD nor HRPF in multivariate analysis. Adding EFat to conventional coronary risk factors and CACS in the pre-test probability models increased the area-under curve (AUC) for prediction of both obstructive CAD (AUC[95% CI]: 0.76 [0.70-0.81] vs 0.71 [0.65-0.77)) and HRPF (AUC [95% CI]: 0.92 [0.88-0.95] vs 0.89 [0.85-0.93]), although not reaching statistical significance. CONCLUSION EFat, but not EFV, is an independent predictor of obstructive CAD and HRPF. Addition of EFat to traditional cardiovascular risk factors and CACS improves estimation for pretest probability of obstructive CAD and HRPF. ADVANCES IN KNOWLEDGE EFat is an important attribute of epicardial fat as it reflects the "quality" of fat, taking into account the effects of brown-white fat transformation and fibrosis, as opposed to mere evaluation of "quantity" of fat by EFV. Our study shows that EFat is a better predictor of obstructive CAD and HRPF than EFV and can thus explain the inconsistent association of increased EFV alone with CAD.
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Affiliation(s)
- Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi-110029, India
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Nammas W, Saraste A. Perivascular fat attenuation, inflammation, and coronary artery function. Eur Heart J Cardiovasc Imaging 2020; 21:606-607. [DOI: 10.1093/ehjci/jeaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wail Nammas
- Heart Center, Turku University Hospital, Hämeentie 11, 20520 Turku, Finland
- PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Antti Saraste
- Heart Center, Turku University Hospital, Hämeentie 11, 20520 Turku, Finland
- PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
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Wong CX, Ganesan AN, Selvanayagam JB. Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions. Eur Heart J 2018; 38:1294-1302. [PMID: 26935271 DOI: 10.1093/eurheartj/ehw045] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/25/2016] [Indexed: 12/17/2022] Open
Abstract
Obesity is increasingly recognized as a major modifiable determinant of atrial fibrillation (AF). Although body mass index and other clinical measures are useful indications of general adiposity, much recent interest has focused on epicardial fat, a distinct adipose tissue depot that can be readily assessed using non-invasive imaging techniques. A growing body of data from epidemiological and clinical studies has demonstrated that epicardial fat is consistently associated with the presence, severity, and recurrence of AF across a range of clinical settings. Evidence from basic science and translational studies has also suggested that arrhythmogenic mechanisms may involve adipocyte infiltration, pro-fibrotic, and pro-inflammatory paracrine effects, oxidative stress, and other pathways. Despite these advances, however, significant uncertainty exists and many questions remain unanswered. In this article, we review our present understanding of epicardial fat, including its classification and quantification, existing evidence implicating its role in AF, potential mechanisms, implications for clinicians, and future directions for research.
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Affiliation(s)
- Christopher X Wong
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Anand N Ganesan
- Department of Cardiology, Flinders Medical Centre & Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia 5043, Australia
| | - Joseph B Selvanayagam
- Department of Cardiology, Flinders Medical Centre & Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia 5043, Australia
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Tsaban G, Wolak A, Avni-Hassid H, Gepner Y, Shelef I, Henkin Y, Schwarzfuchs D, Cohen N, Bril N, Rein M, Serfaty D, Kenigsbuch S, Tene L, Zelicha H, Yaskolka-Meir A, Komy O, Bilitzky A, Chassidim Y, Ceglarek U, Stumvoll M, Blüher M, Thiery J, Dicker D, Rudich A, Stampfer MJ, Shai I. Dynamics of intrapericardial and extrapericardial fat tissues during long-term, dietary-induced, moderate weight loss. Am J Clin Nutr 2017; 106:984-995. [PMID: 28814394 DOI: 10.3945/ajcn.117.157115] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background: In view of evidence linking pericardial fat accumulation with increased cardiovascular disease risk, strategies to reduce its burden are needed. Data comparing the effects of specific long-term dietary interventions on pericardial fat tissue mobilization are sparse.Objective: We sought to evaluate intrapericardial-fat (IPF) and extrapericardial-fat (EPF) changes during weight-loss interventions by different dietary regimens.Design: During 18 mo of a randomized controlled trial, we compared a Mediterranean/low-carbohydrate (MED/LC) diet plus 28 g walnuts/d with a calorically equal low-fat (LF) diet among randomly assigned participants with moderate abdominal obesity. We performed whole-body MRI and volumetrically quantified IPF and EPF among 80 participants to follow the 18-mo changes.Results: The participants [mean age: 48.6 y; mean body mass index (BMI; in kg/m2); 31.7; 90% men] had baseline IPF and EPF (mean ± SD) volumes of 172.4 ± 53.3 mL and 194.9 ± 71.5 mL, respectively. The 18-mo moderate weight loss of 3.7 kg was similar in both groups, but the reduction in waist circumference was higher in the MED/LC group (-6.9 ± 6.6 cm) than in the LF diet group (-2.3 ± 6.5 cm; P = 0.01). After 18 mo, the IPF volume had reduced twice as much in the MED/LC group compared with the LF group [-37 ± 26.2 mL (-22% ± 15%) compared with -15.5 ± 26.2 mL (-8% ± 15%), respectively; P < 0.05, after adjustment for changes in weight or visceral adipose tissue]. The EPF volume had reduced similarly in both groups [-41.6 ± 30.2 mL (-23% ± 16%) in the MED/LC group compared with -37.9 ± 28.3 mL (-19% ± 14%) in the LF group; P > 0.1]. After controlling for weight loss, IPF and EPF volume reduction paralleled changes in lipid profile but not with improved glycemic profile variables: the IPF relative reduction was associated with a decrease in triglycerides (TGs) (β = 0.090; 95% CI: 0.026, 0.154; P = 0.007) and the ratio of TGs to high-density lipoprotein (HDL) cholesterol (β = 2.689; 95% CI: 0.373, 5.003; P = 0.024), and the EPF relative reduction was associated with an increase in HDL cholesterol (β = -0.452; 95% CI: -0.880, -0.023; P = 0.039) and a decrease in total cholesterol and HDL cholesterol (β = 3.766; 95% CI: 1.092, 6.440; P = 0.007).Conclusions: Moderate but persistent dietary-induced weight loss substantially decreased both IPF and EPF volumes. Reduction of pericardial adipose tissues is independently associated with an improved lipid profile. The Mediterranean diet, rich in unsaturated fats and restricted carbohydrates, is superior to an LF diet in terms of the IPF burden reduction. This trial was registered at clinicaltrials.gov as NCT01530724.
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Affiliation(s)
- Gal Tsaban
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Soroka University Medical Center, Beer-Sheva, Israel
| | - Arik Wolak
- Cardiac Imaging Unit, Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Hila Avni-Hassid
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yftach Gepner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Shelef
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Yaakov Henkin
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Dan Schwarzfuchs
- Soroka University Medical Center, Beer-Sheva, Israel.,Nuclear Research Center Negev, Dimona, Israel
| | - Noa Cohen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nitzan Bril
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Rein
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Serfaty
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shira Kenigsbuch
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lilac Tene
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hila Zelicha
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Yaskolka-Meir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oded Komy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avital Bilitzky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Uta Ceglarek
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Matthias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Joachim Thiery
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Dror Dicker
- Internal Medicine D, Rabin Medical Center, Campus Golda, Petach Tikva, Israel; and
| | - Assaf Rudich
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard School of Public Health, Boston, MA
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;
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Rodriguez-Granillo GA, Carrascosa P, Deviggiano A, Capunay C, De Zan MC, Goldsmit A, Campisi R. Pericardial fat volume is related to atherosclerotic plaque burden rather than to lesion severity. Eur Heart J Cardiovasc Imaging 2017; 18:795-801. [DOI: 10.1093/ehjci/jew139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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7
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Epicardial adipose tissue and myocardial ischemia assessed by computed tomography perfusion imaging and invasive fractional flow reserve. J Cardiovasc Comput Tomogr 2017; 11:46-53. [DOI: 10.1016/j.jcct.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/29/2016] [Indexed: 01/24/2023]
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8
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Hannukainen JC, Lautamäki R, Mari A, Pärkkä JP, Bucci M, Guzzardi MA, Kajander S, Tuokkola T, Knuuti J, Iozzo P. Elevated Glucose Oxidation, Reduced Insulin Secretion, and a Fatty Heart May Be Protective Adaptions in Ischemic CAD. J Clin Endocrinol Metab 2016; 101:2701-10. [PMID: 27045985 PMCID: PMC4929844 DOI: 10.1210/jc.2015-4091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Insulin resistance, β-cell dysfunction, and ectopic fat deposition have been implicated in the pathogenesis of coronary artery disease (CAD) and type 2 diabetes, which is common in CAD patients. We investigated whether CAD is an independent predictor of these metabolic abnormalities and whether this interaction is influenced by superimposed myocardial ischemia. METHODS AND RESULTS We studied CAD patients with (n = 8) and without (n = 14) myocardial ischemia and eight non-CAD controls. Insulin sensitivity and secretion and substrate oxidation were measured during fasting and oral glucose tolerance testing. We used magnetic resonance imaging/spectroscopy, positron emission and computerized tomography to characterize CAD, cardiac function, pericardial and abdominal adipose tissue, and myocardial, liver, and pancreatic triglyceride contents. Ischemic CAD was characterized by elevated oxidative glucose metabolism and a proportional decline in β-cell insulin secretion and reduction in lipid oxidation. Cardiac function was preserved in CAD groups, whereas cardiac fat depots were elevated in ischemic CAD compared to non-CAD subjects. Liver and pancreatic fat contents were similar in all groups and related with surrounding adipose masses or systemic insulin sensitivity. CONCLUSIONS In ischemic CAD patients, glucose oxidation is enhanced and correlates inversely with insulin secretion. This can be seen as a mechanism to prevent glucose lowering because glucose is required in oxygen-deprived tissues. On the other hand, the accumulation of cardiac triglycerides may be a physiological adaptation to the limited fatty acid oxidative capacity. Our results underscore the urgent need of clinical trials that define the optimal/safest glycemic range in situations of myocardial ischemia.
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Affiliation(s)
- J C Hannukainen
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - R Lautamäki
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - A Mari
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - J P Pärkkä
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - M Bucci
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - M A Guzzardi
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - S Kajander
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - T Tuokkola
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - J Knuuti
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
| | - P Iozzo
- Turku PET Center (J.C.H., R.L., J.P.P., M.B., S.K., T.T., J.K., P.I.), University of Turku, 20014 Turku, Finland; Heart Center (R.L.), Turku University Hospital, 20520 Turku, Finland; Institute of Neuroscience (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (M.A.G., P.I.), National Research Council, 56124 Pisa, Italy
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Iozzo P. Metabolic imaging in obesity: underlying mechanisms and consequences in the whole body. Ann N Y Acad Sci 2015; 1353:21-40. [PMID: 26335600 DOI: 10.1111/nyas.12880] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Obesity is a phenotype resulting from a series of causative factors with a variable risk of complications. Etiologic diversity requires personalized prevention and treatment. Imaging procedures offer the potential to investigate the interplay between organs and pathways underlying energy intake and consumption in an integrated manner, and may open the perspective to classify and treat obesity according to causative mechanisms. This review illustrates the contribution provided by imaging studies to the understanding of human obesity, starting with the regulation of food intake and intestinal metabolism, followed by the role of adipose tissue in storing, releasing, and utilizing substrates, including the interconversion of white and brown fat, and concluding with the examination of imaging risk indicators related to complications, including type 2 diabetes, liver pathologies, cardiac and kidney diseases, and sleep disorders. The imaging modalities include (1) positron emission tomography to quantify organ-specific perfusion and substrate metabolism; (2) computed tomography to assess tissue density as an indicator of fat content and browning/ whitening; (3) ultrasounds to examine liver steatosis, stiffness, and inflammation; and (4) magnetic resonance techniques to assess blood oxygenation levels in the brain, liver stiffness, and metabolite contents (triglycerides, fatty acids, glucose, phosphocreatine, ATP, and acetylcarnitine) in a variety of organs.
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Affiliation(s)
- Patricia Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy.,The Turku PET Centre, University of Turku, Turku, Finland
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Thoracic fat volume is independently associated with coronary vasomotion. Eur J Nucl Med Mol Imaging 2015; 43:280-287. [PMID: 26283503 DOI: 10.1007/s00259-015-3160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Thoracic fat has been associated with an increased risk of coronary artery disease (CAD). As endothelium-dependent vasoreactivity is a surrogate of cardiovascular events and is impaired early in atherosclerosis, we aimed at assessing the possible relationship between thoracic fat volume (TFV) and endothelium-dependent coronary vasomotion. METHODS Fifty healthy volunteers without known CAD or major cardiovascular risk factors (CRFs) prospectively underwent a (82)Rb cardiac PET/CT to quantify myocardial blood flow (MBF) at rest, and MBF response to cold pressor testing (CPT-MBF) and adenosine (i.e., stress-MBF). TFV was measured by a 2D volumetric CT method and common laboratory blood tests (glucose and insulin levels, HOMA-IR, cholesterol, triglyceride, hsCRP) were performed. Relationships between CPT-MBF, TFV and other CRFs were assessed using non-parametric Spearman rank correlation testing and multivariate linear regression analysis. RESULTS All of the 50 participants (58 ± 10y) had normal stress-MBF (2.7 ± 0.6 mL/min/g; 95 % CI: 2.6-2.9) and myocardial flow reserve (2.8 ± 0.8; 95 % CI: 2.6-3.0) excluding underlying CAD. Univariate analysis revealed a significant inverse relation between absolute CPT-MBF and sex (ρ = -0.47, p = 0.0006), triglyceride (ρ = -0.32, p = 0.024) and insulin levels (ρ = -0.43, p = 0.0024), HOMA-IR (ρ = -0.39, p = 0.007), BMI (ρ = -0.51, p = 0.0002) and TFV (ρ = -0.52, p = 0.0001). MBF response to adenosine was also correlated with TFV (ρ = -0.32, p = 0.026). On multivariate analysis, TFV emerged as the only significant predictor of MBF response to CPT (p = 0.014). CONCLUSIONS TFV is significantly correlated with endothelium-dependent and -independent coronary vasomotion. High TF burden might negatively influence MBF response to CPT and to adenosine stress, even in persons without CAD, suggesting a link between thoracic fat and future cardiovascular events.
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Epicardial fat volume quantification by noncontrast CT: Trimming away the fat from the meat. J Cardiovasc Comput Tomogr 2015; 9:310-2. [DOI: 10.1016/j.jcct.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 04/23/2015] [Accepted: 05/02/2015] [Indexed: 11/22/2022]
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Bakkum MJ, Danad I, Romijn MAJ, Stuijfzand WJA, Leonora RM, Tulevski II, Somsen GA, Lammertsma AA, van Kuijk C, van Rossum AC, Raijmakers PG, Knaapen P. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function. Eur J Nucl Med Mol Imaging 2015; 42:1562-73. [PMID: 26054890 PMCID: PMC4521095 DOI: 10.1007/s00259-015-3087-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/11/2015] [Indexed: 12/14/2022]
Abstract
Purpose Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. Methods A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [15O]H2O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Results Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg×ml−1×min−1×g−1, p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR. Conclusion EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors. Electronic supplementary material The online version of this article (doi:10.1007/s00259-015-3087-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M. J. Bakkum
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I. Danad
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - M. A. J. Romijn
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - W. J. A. Stuijfzand
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - R. M. Leonora
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I. I. Tulevski
- />Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - G. A. Somsen
- />Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - A. A. Lammertsma
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C. van Kuijk
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - A. C. van Rossum
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - P. G. Raijmakers
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - P. Knaapen
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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13
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Hartiala O, Magnussen CG, Bucci M, Kajander S, Knuuti J, Ukkonen H, Saraste A, Rinta-Kiikka I, Kainulainen S, Kähönen M, Hutri-Kähönen N, Laitinen T, Lehtimäki T, Viikari JS, Hartiala J, Juonala M, Raitakari OT. Coronary heart disease risk factors, coronary artery calcification and epicardial fat volume in the Young Finns Study. Eur Heart J Cardiovasc Imaging 2015; 16:1256-63. [DOI: 10.1093/ehjci/jev085] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/18/2015] [Indexed: 01/11/2023] Open
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14
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Tanami Y, Jinzaki M, Kishi S, Matheson M, Vavere AL, Rochitte CE, Dewey M, Chen MY, Clouse ME, Cox C, Kuribayashi S, Lima JAC, Arbab-Zadeh A. Lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population: results from the CORE320 multicenter study. Circ Cardiovasc Imaging 2015; 8:e002676. [PMID: 25752899 DOI: 10.1161/circimaging.114.002676] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Epicardial fat may play a role in the pathogenesis of coronary artery disease (CAD). We explored the relationship of epicardial fat volume (EFV) with the presence and severity of CAD or myocardial perfusion abnormalities in a diverse, symptomatic patient population. METHODS AND RESULTS Patients (n=380) with known or suspected CAD who underwent 320-detector row computed tomographic angiography, nuclear stress perfusion imaging, and clinically driven invasive coronary angiography for the CORE320 international study were included. EFV was defined as adipose tissue within the pericardial borders as assessed by computed tomography using semiautomatic software. We used linear and logistic regression models to assess the relationship of EFV with coronary calcium score, stenosis severity by quantitative coronary angiography, and myocardial perfusion abnormalities by single photon emission computed tomography (SPECT). Median EFV among patients (median age, 62.6 years) was 102 cm(3) (interquartile range: 53). A coronary calcium score of ≥1 was present in 83% of patients. Fifty-nine percent of patients had ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography, and 49% had abnormal myocardial perfusion results by SPECT. There were no significant associations between EFV and coronary artery calcium scanning, presence severity of ≥50% stenosis by quantitative coronary angiography, or abnormal myocardial perfusion by SPECT. CONCLUSIONS In a diverse population of symptomatic patients referred for invasive coronary angiography, we did not find associations of EFV with the presence and severity of CAD or with myocardial perfusion abnormalities. The clinical significance of quantifying EFV remains uncertain but may relate to the pathophysiology of acute coronary events rather than the presence of atherosclerotic disease.
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Affiliation(s)
- Yutaka Tanami
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Masahiro Jinzaki
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Satoru Kishi
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Matthew Matheson
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Andrea L Vavere
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Carlos E Rochitte
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Marc Dewey
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Marcus Y Chen
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Melvin E Clouse
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Christopher Cox
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Sachio Kuribayashi
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Joao A C Lima
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.)
| | - Armin Arbab-Zadeh
- From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.).
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15
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Tanındı A, Kocaman SA, Erkan AF, Uğurlu M, Alhan A, Töre HF. Epicardial adipose tissue thickness is associated with myocardial infarction and impaired coronary perfusion. Anatol J Cardiol 2014; 15:224-31. [PMID: 24981296 PMCID: PMC5337059 DOI: 10.5152/akd.2014.5277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: Epicardial adipose tissue (EAT) is associated with the presence, severity and extent of atherosclerotic coronary artery disease (CAD) in addition to subclinical atherosclerosis. We investigated if EAT thickness is related to acute myocardial infarction in patients with CAD. We also searched for the association between EAT thickness and objective coronary flow and myocardial perfusion parameters such as Thrombolysis in Myocardial Infarction Frame count (TFC) and myocardial blush grade (MBG). Methods: Two-hundred consecutive patients with stable angina pectoris or acute coronary syndrome who were admitted to Ufuk University Faculty of Medicine, Dr Ridvan Ege Hospital cardiology department were included in this observational, cross-sectional study. EAT thickness was evaluated by conventional transthoracic echocardiography. Coronary angiography was performed to determine the coronary involvement and perfusion. Results: Mean EAT thicknesses were 5.4±1.9 mm, 6.3±1.8 mm, and 8.5±1.4 mm in the stable angina pectoris (SAP), unstable angina pectoris (USAP) and acute myocardial infarction groups, respectively (p<0.001). With increasing EAT thickness, TFC increases whereas mean MBG values decrease (for EAT thickness <5 mm, 5-7 mm, >7 mm; mean TFC: 21.6±2.2, 25.3±3.3 and 35.2±7.7; and MBG values: 2.98±0.14, 2.83±0.57 and 1.7±1.16, respectively; both p<0.001). Cut-off EAT value to predict AMI was identified as 7.8 mm (ROC analysis AUC: 0.876; p<0.001, 95% CI: 0.822-0.927). Sensitivity and specificity of EAT cut-off value 7.8 mm to predict AMI were 81.8% and 82.5% respectively. Conclusion: Increased EAT is associated with AMI and it may prove beneficial for choosing patients who would need more aggressive approach in terms of risk reduction using echocardiography which is a relatively cheap and readily available tool as a follow-up parameter.
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Affiliation(s)
- Aslı Tanındı
- Department of Cardiology, Faculty of Medicine, Ufuk University; Ankara-Turkey.
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16
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Brinkley TE, Leng X, Chughtai HL, Nicklas BJ, Kritchevsky SB, Ding J, Kitzman DW, Hundley WG. Periaortic fat and cardiovascular risk: a comparison of high-risk older adults and age-matched healthy controls. Int J Obes (Lond) 2014; 38:1397-402. [PMID: 24525960 PMCID: PMC4143481 DOI: 10.1038/ijo.2014.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
Objective Fat accumulation around the heart and aorta may impact cardiovascular (CV) health. The purpose of this study was to conduct a systematic investigation to examine potential associations of these fat depots with risk factors for CV events, which has not been done before. Methods Pericardial fat, periaortic fat around the ascending aorta (AA), descending aorta (DA) and aortic arch, and abdominal subcutaneous and visceral fat were measured by MRI in older adults with (n=385, 69±8 years, 52% female) and without (n=50, 69±8 years, 58% female) risk factors for a CV event. Results Individuals with CV risk factors exhibited greater fat volumes across all fat depots compared to those without risk factors. In analysis of covariance accounting for age, gender, race/ethnicity, diabetes, hypertension, coronary artery disease, smoking, and BMI, individuals with risk factors possessed higher epicardial, pericardial, AA, DA, and abdominal visceral fat (p<0.05). When matched one-to-one on age, gender, race/ethnicity, and BMI, AA and DA fat were higher in those with versus without CV risk factors (p<0.01). Conclusions Older adults with a high risk for CV events have greater periaortic fat than low-risk adults, even after accounting for BMI. More studies are needed to determine whether greater periaortic fat predicts future CV events.
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Affiliation(s)
- T E Brinkley
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - X Leng
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - H L Chughtai
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - B J Nicklas
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - S B Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - J Ding
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - D W Kitzman
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - W G Hundley
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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17
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Arterial and fat tissue inflammation are highly correlated: a prospective 18F-FDG PET/CT study. Eur J Nucl Med Mol Imaging 2014; 41:934-45. [PMID: 24442596 DOI: 10.1007/s00259-013-2653-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/28/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE There is evidence that the link between obesity and cardiovascular disease might relate to inflammation in both fat tissue and the arterial wall. (18)F-FDG uptake on PET is a surrogate marker of vessel wall inflammation. The aim of the study was to measure FDG uptake in both regions using PET and identify links between adipose and arterial inflammation. METHODS Included in the study were 173 cardiovascular patients who were prospectively imaged with FDG PET/CT. Arterial FDG uptake was measured in the carotid arteries and ascending aorta. The same was done in fat tissue in the neck, the presternal region (both subcutaneous) and the pericardium. FDG uptake was quantified as average maximal target-to-background ratio (mean TBR max). Multivariate regression analyses were performed to identify significant associations between arterial and adipose tissue FDG uptake and clinical variables as given by the standardized correlation coefficient (β). RESULTS FDG uptake values in all fat tissue regions were highly predictive of vascular FDG uptake in both the carotids (β 0.262, p < 0.0001, in the neck subcutaneous region) and aorta (β 0.22, p = 0.008, in the chest pericardial region; β 0.193, p = 0.019, in the chest subcutaneous region). Obesity was significantly associated with elevated FDG uptake in adipose tissue (β 0.470, p < 0.0001, in the neck subcutaneous region; β 0.619, p = 0.028, in the chest subcutaneous region; β 0.978, p = 0.035, in the chest pericardial region). CONCLUSION FDG uptake in diverse fat tissue regions was significantly associated with arterial FDG uptake, a reasonable surrogate of inflammation. Increasing body weight significantly predicted the level of fatty inflammation. FDG PET therefore provides imaging evidence of an inflammatory link between fat tissue and the vasculature in patients with cardiovascular disease.
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18
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Alexopoulos N, Katritsis D, Raggi P. Visceral adipose tissue as a source of inflammation and promoter of atherosclerosis. Atherosclerosis 2014; 233:104-12. [PMID: 24529130 DOI: 10.1016/j.atherosclerosis.2013.12.023] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/31/2022]
Abstract
The current epidemic of obesity with the associated increasing incidence of insulin resistance, diabetes mellitus and atherosclerosis affecting a large proportion of the North American and Western populations, has generated a strong interest in the potential role of visceral adipose tissue in the development of atherosclerosis and its complications. The intra-abdominal and epicardial space are two compartments that contain visceral adipose tissue with a similar embryological origin. These visceral fats are highly inflamed in obese patients, patients with the metabolic syndrome and in those with established coronary artery disease; additionally they are capable of secreting large quantities of pro-inflammatory cytokines and free fatty acids. There is accumulating evidence to support a direct involvement of these regional adipose tissue deposits in the development of atherosclerosis and its complicating events, as will be reviewed in this article.
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Affiliation(s)
| | | | - Paolo Raggi
- Division of Cardiology, Department of Medicine, University of Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
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19
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Effect of type 2 diabetes mellitus on epicardial adipose tissue volume and coronary vasomotor function. Am J Cardiol 2014; 113:90-7. [PMID: 24169015 DOI: 10.1016/j.amjcard.2013.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 12/27/2022]
Abstract
Patients with coronary artery disease and/or type 2 diabetes mellitus (DM) generally exhibit more epicardial adipose tissue (EAT) than healthy controls. Recently, it has been proposed that EAT affects vascular function and structure by secreting proinflammatory and vasoactive substances, thereby potentially contributing to the development of cardiovascular disease. In the present study, the interrelation of EAT, coronary vasomotor function, and coronary artery calcium was investigated in patients with and without DM, who were evaluated for coronary artery disease. Myocardial blood flow (MBF) was assessed at rest and during adenosine-induced hyperemia using [(15)O]-water positron emission tomography combined with computed tomography to quantify coronary artery calcium and EAT in 199 patients (46 with DM). In this cohort (mean age 58 ± 10 years), the patients with DM had a greater body mass index, heart rate, and systolic blood pressure at rest (all p <0.05). Coronary artery calcium and the EAT volumes were comparable between those with and without DM. Both patient groups showed comparable MBF at rest and coronary vascular resistance. A lower hyperemic MBF and coronary flow reserve (CFR) and greater hyperemic coronary vascular resistance (all p <0.05) was observed in the patients with DM. A pooled analysis showed a positive association of EAT volume with hyperemic coronary vascular resistance but not with the MBF at rest, hyperemic MBF, or coronary vascular resistance at rest. In the group analysis, the EAT volume was inversely associated with hyperemic MBF (r = -0.16, p = 0.05) and CFR (r = -0.17, p = 0.04) and positively with hyperemic coronary vascular resistance (r = 0.26, p = 0.002) only in patients without DM. Multivariate regression analysis, adjusted for age, gender, and body mass index, showed an independent association between the EAT volume and hyperemic MBF (β = -0.16, p = 0.02), CFR (β = -0.16, p = 0.04), and hyperemic coronary vascular resistance (β = 0.25, p <0.001) in the non-DM group. In conclusion, these results suggest a role for EAT in myocardial microvascular dysfunction; however, once DM has developed, other factors might be more dominant in contributing to impaired myocardial microvascular dysfunction.
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20
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Alam MS, Green R, de Kemp R, Beanlands RS, Chow BJW. Epicardial adipose tissue thickness as a predictor of impaired microvascular function in patients with non-obstructive coronary artery disease. J Nucl Cardiol 2013; 20:804-12. [PMID: 23749262 DOI: 10.1007/s12350-013-9739-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/23/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine if increased epicardial adipose tissue (EAT) measured by cardiac CT could be associated with impaired myocardial flow reserve (MFR) in patients with non-obstructive coronary artery disease (CAD). BACKGROUND Studies have shown that EAT volume is related to epicardial obstructive CAD, myocardial ischemia and major adverse cardiac events. However, the association between EAT with coronary microvascular dysfunction and impaired MFR has not been well clarified. METHODS Consecutive patients who underwent Rb-82 positron emission tomography (PET), coronary artery calcium (CAC) scoring and non-invasive coronary computed tomography angiography (CCTA) were screened. PET scans were analysed for standard myocardial perfusion (MPI) and MFR. CCTA results were analysed and only patients with non-obstructive CAD (<50% luminal diameter stenosis) were included. EAT thickness and volumes were measured from CT scans. RESULTS Of 137 patients without obstructive CAD by CCTA and with normal Rb-82 PET relative MPI, 26 (19.0%) patients had impaired MFR < 2 and 87 (64%) patients had CAC. EAT(thickness), EAT(volume) and CAC values were higher in patients with impaired MFR < 2 than those with normal MFR ≥ 2 (6.7 ± 1.6 mm vs 4.4 ± 1.0 mm, P < .0001; 119.0 ± 25.3 cm(3) vs 105.8 ± 30.5 cm(3), P < .04 and 508.9 ± 554.3 vs 167.8 ± 253.9, P < .0001, respectively). However, EAT(thickness) had a stronger negative correlation with MFR than EAT(volume) and CAC (r = -0.78 vs r = -0.25 and ρ = -0.32, P < .0001). With multivariable logistic regression analysis, only EAT(thickness) was independently associated with impaired MFR (OR 20.7, 95% CI 4.9-87.9, P < .0001). Importantly, the receiver-operator characteristic (ROC) curves demonstrated a superior performance of EAT(thickness) vs EAT(volume) and EAT(thickness) vs CAC in detecting impaired MFR (AUC: 0.945 vs 0.625, difference between AUC: 0.319, P < .0001; AUC: 0.945 vs 0.710, difference between AUC: 0.235, P < .0006, respectively). On ROC curve analysis, an EAT(thickness) cut-off value > 5.6 mm was optimal in detecting impaired MFR with a sensitivity and specificity of 81% and 92%, respectively. CONCLUSIONS Increased EAT appears to be associated with impaired MFR. This parameter may help improve detection of patients at risk of microvascular dysfunction.
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Affiliation(s)
- Mohammed S Alam
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
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Sun L, Liu C, Xu X, Ying Z, Maiseyeu A, Wang A, Allen K, Lewandowski RP, Bramble LA, Morishita M, Wagner JG, Dvonch J, Sun Z, Yan X, Brook RD, Rajagopalan S, Harkema JR, Sun Q, Fan Z. Ambient fine particulate matter and ozone exposures induce inflammation in epicardial and perirenal adipose tissues in rats fed a high fructose diet. Part Fibre Toxicol 2013; 10:43. [PMID: 23968387 PMCID: PMC3765456 DOI: 10.1186/1743-8977-10-43] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 08/14/2013] [Indexed: 12/23/2022] Open
Abstract
Background Inflammation and oxidative stress play critical roles in the pathogenesis of inhaled air pollutant-mediated metabolic disease. Inflammation in the adipose tissues niches are widely believed to exert important effects on organ dysfunction. Recent data from both human and animal models suggest a role for inflammation and oxidative stress in epicardial adipose tissue (EAT) as a risk factor for the development of cardiovascular disease. We hypothesized that inhalational exposure to concentrated ambient fine particulates (CAPs) and ozone (O3) exaggerates inflammation and oxidative stress in EAT and perirenal adipose tissue (PAT). Methods Eight- week-old Male Sprague–Dawley rats were fed a normal diet (ND) or high fructose diet (HFr) for 8 weeks, and then exposed to ambient AIR, CAPs at a mean of 356 μg/m3, O3 at 0.485 ppm, or CAPs (441 μg/m3) + O3 (0.497 ppm) in Dearborn, MI, 8 hours/day, 5 days/week, for 9 days over 2 weeks. Results EAT and PAT showed whitish color in gross, and less mitochondria, higher mRNA expression of white adipose specific and lower brown adipose specific genes than in brown adipose tissues. Exposure to CAPs and O3 resulted in the increase of macrophage infiltration in both EAT and PAT of HFr groups. Proinflammatory genes of Tnf-α, Mcp-1 and leptin were significantly upregulated while IL-10 and adiponectin, known as antiinflammatory genes, were reduced after the exposures. CAPs and O3 exposures also induced an increase in inducible nitric oxide synthase (iNOS) protein expression, and decrease in mitochondrial area in EAT and PAT. We also found significant increases in macrophages of HFr-O3 rats. The synergetic interaction of HFr and dirty air exposure on the inflammation was found in most of the experiments. Surprisingly, exposure to CAPs or O3 induced more significant inflammation and oxidative stress than co-exposure of CAPs and O3 in EAT and PAT. Conclusion EAT and PAT are both white adipose tissues. Short-term exposure to CAPs and O3, especially with high fructose diet, induced inflammation and oxidative stress in EAT and PAT in rats. These findings may provide a link between air-pollution exposure and accelerated susceptibility to cardiovascular disease and metabolic complications.
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Miao CY, Li ZY. The role of perivascular adipose tissue in vascular smooth muscle cell growth. Br J Pharmacol 2012; 165:643-58. [PMID: 21470202 DOI: 10.1111/j.1476-5381.2011.01404.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Adipose tissue is the largest endocrine organ, producing various adipokines and many other substances. Almost all blood vessels are surrounded by perivascular adipose tissue (PVAT), which has not received research attention until recently. This review will discuss the paracrine actions of PVAT on the growth of underlying vascular smooth muscle cells (VSMCs). PVAT can release growth factors and inhibitors. Visfatin is the first identified growth factor derived from PVAT. Decreased adiponectin and increased tumour necrosis factor-α in PVAT play a pathological role for neointimal hyperplasia after endovascular injury. PVAT-derived angiotensin II, angiotensin 1-7, reactive oxygen species, complement component 3, NO and H(2) S have a paracrine action on VSMC contraction, endothelial or fibroblast function; however, their paracrine actions on VSMC growth remain to be directly verified. Factors such as monocyte chemoattractant protein-1, interleukin-6, interleukin-8, leptin, resistin, plasminogen activator inhibitor type-1, adrenomedullin, free fatty acids, glucocorticoids and sex hormones can be released from adipose tissue and can regulate VSMC growth. Most of them have been verified for their secretion by PVAT; however, their paracrine functions are unknown. Obesity, vascular injury, aging and infection may affect PVAT, causing adipocyte abnormality and inflammatory cell infiltration, inducing imbalance of PVAT-derived growth factors and inhibitors, leading to VSMC growth and finally resulting in development of proliferative vascular disease, including atherosclerosis, restenosis and hypertension. In the future, using cell-specific gene interventions and local treatments may provide definitive evidence for identification of key factor(s) involved in PVAT dysfunction-induced vascular disease and thus may help to develop new therapies. LINKED ARTICLES This article is part of a themed section on Fat and Vascular Responsiveness. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-3.
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Affiliation(s)
- Chao-Yu Miao
- Department of Pharmacology, Second Military Medical University, Shanghai, China.
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Brinkley TE, Jerosch-Herold M, Folsom AR, Carr JJ, Hundley WG, Allison MA, Bluemke DA, Burke GL, Szklo M, Ding J. Pericardial fat and myocardial perfusion in asymptomatic adults from the Multi-Ethnic Study of Atherosclerosis. PLoS One 2011; 6:e28410. [PMID: 22174800 PMCID: PMC3235122 DOI: 10.1371/journal.pone.0028410] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/07/2011] [Indexed: 12/13/2022] Open
Abstract
Background Pericardial fat has adverse effects on the surrounding vasculature. Previous studies suggest that pericardial fat may contribute to myocardial ischemia in symptomatic individuals. However, it is unknown if pericardial fat has similar effects in asymptomatic individuals. Methods We determined the association between pericardial fat and myocardial blood flow (MBF) in 214 adults with no prior history of cardiovascular disease from the Minnesota field center of the Multi-Ethnic Study of Atherosclerosis (43% female, 56% Caucasian, 44% Hispanic). Pericardial fat volume was measured by computed tomography. MBF was measured by MRI at rest and during adenosine-induced hyperemia. Myocardial perfusion reserve (PR) was calculated as the ratio of hyperemic to resting MBF. Results Gender-stratified analyses revealed significant differences between men and women including less pericardial fat (71.9±31.3 vs. 105.2±57.5 cm3, p<0.0001) and higher resting MBF (1.12±0.23 vs. 0.93±0.19 ml/min/g, p<0.0001), hyperemic MBF (3.49±0.76 vs. 2.65±0.72 ml/min/g, p<0.0001), and PR (3.19±0.78 vs. 2.93±0.89, p = 0.03) in women. Correlations between pericardial fat and clinical and hemodynamic variables were stronger in women. In women only (p = 0.01 for gender interaction) higher pericardial fat was associated with higher resting MBF (p = 0.008). However, this association was attenuated after accounting for body mass index or rate-pressure product. There were no significant associations between pericardial fat and hyperemic MBF or PR after multivariate adjustment in either gender. In logistic regression analyses there was also no association between impaired coronary vasoreactivity, defined as having a PR <2.5, and pericardial fat in men (OR, 1.18; 95% CI, 0.82–1.70) or women (OR, 1.11; 95% CI, 0.68–1.82). Conclusions Our data fail to support an independent association between pericardial fat and myocardial perfusion in adults without symptomatic cardiovascular disease. Nevertheless, these findings highlight potentially important differences between asymptomatic and symptomatic individuals with respect to the underlying subclinical disease burden.
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Affiliation(s)
- Tina E Brinkley
- Department of Internal Medicine, Wake Forest School of Medicine; Winston-Salem, North Carolina, United States of America.
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Iacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011; 22:450-7. [PMID: 21852149 PMCID: PMC4978122 DOI: 10.1016/j.tem.2011.07.003] [Citation(s) in RCA: 355] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/05/2011] [Accepted: 07/07/2011] [Indexed: 12/13/2022]
Abstract
Epicardial adipose tissue is an unusual visceral fat depot with anatomical and functional contiguity to the myocardium and coronary arteries. Under physiological conditions, epicardial adipose tissue displays biochemical, mechanical and thermogenic cardioprotective properties. Under pathological circumstances, epicardial fat can locally affect the heart and coronary arteries through vasocrine or paracrine secretion of proinflammatory cytokines. What influences this equilibrium remains unclear. Improved local vascularization, weight loss, and targeted pharmaceutical interventions could help to return epicardial fat to its physiological role. This review focuses on the emerging physiological and pathophysiological aspects of the epicardial fat and its numerous and innovative clinical applications. Particular emphasis is placed on the paracrine/endocrine properties of epicardial fat and its role in the development and progression of atherosclerosis.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA.
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