The relationship between coronary artery disease and pericoronary epicardial adipose tissue thickness

Fatty infiltration and ventricular premature beats originating from right ventricular outflow tract: association or causality?

BACKGROUND

Anatomical evidence reveals heterogeneous fat distribution in both atrial and ventricular myocardium that are considered normal, but at the same time arrhythmogenic, and numerous cardiac pathophysiological conditions are associated with myocardial fat deposits. The relationship between fatty infiltration, especially in the epicardial layer and its pathophysiological implication is not completely understood.

AIM

The aim of this study was to establish a positive or negative relationship between the ventricular burden and several parameters related to right ventricle (RV) adipose tissue - the RV thickness, RV indexed mass, body mass index (BMI), age, gender.

PATIENTS, MATERIALS AND METHODS

Twenty-three patients with documented premature ventricular contractions (PVCs) originating from right ventricular outflow tract based on electrocardiography (ECG) evaluation were hospitalized between January 2018-November 2022 for electrophysiological study and PVCs ablation. Data obtained after collecting the clinical characteristics, ECG, RV measurements from transthoracic echocardiography (TTE), cardiac computed tomography (CT) and magnetic resonance imaging (MRI) were analyzed.

RESULTS

A weak positive relationship between the ventricular burden and BMI (r=0.14, p=0.49), tricuspid annular plane systolic excursion (TAPSE) (r=0.07, p=0.7), the RV thickness (r=0.03, p=0.8), epicardial adipose tissue (r=0.13, p=0.55), RV mass indexed (r=0.05, p=0.82) was observed. No clear cut-off of the PVCs burden could be established in terms related to the increase in BMI, RV thickness, epicardial adipose tissue, RV mass indexed.

CONCLUSIONS

No significant positive or negative relationship between the ventricular burden and the RV thickness, RV indexed mass were found in individuals with a high PVCs originating from right ventricular outflow tract (RVOT) burden.

The relation between pericoronary fat thickness and density quantified by coronary computed tomography angiography with coronary artery disease severity

OBJECTIVE

To study the correlation between epicardial fat thickness (EFT), pericoronary fat thickness (PCFT), and pericoronary fat density (PCFD) with the existence and severity of coronary artery disease (CAD).

METHODS

This cross-sectional study included 210 patients referred for multislice CT angiography. Group I normal CTCA, Group II patients had non-obstructive atherosclerosis, and Group III patients had obstructive atherosclerosis. All patients underwent a clinical examination, history taking, and multislice CT angiography.

RESULTS

The mean EFT was significantly greater in group III (10.43 ± 2.31 mm) compared to groups II (6.30 ± 1.61 mm) and I (5.06 ± 1.14 mm). The mean PCFT was significantly greater in group III (17.96 ± 2.89 mm) compared to group II (11.47 ± 2.51 mm) and group I (9.67 ± 1.99 mm). PCFD was significantly higher adjacent to the lesion (-80.47 ± 29.14) compared to the normal segment (-109.03 ± 35.24), higher in the obstructive group (-59.44 ± 20.10) compared to the non-obstructive group (-101.51 ± 20.23), but lower in calcified lesions (-89.58 ± 28.94) compared to non-calcified (-75.01 ± 29.20), and mixed lesions (-74.83 ± 26.90). EFT and PCFT cut-off values for predicting obstructive CAD were 8.3 and 12.4 mm, respectively, with 87.1% and 92.9% sensitivity and 92.9% and 86.4% specificity, respectively.

CONCLUSION

There is a significant association between epicardial fat thickness, pericoronary fat thickness and density with the severity of coronary artery disease.

Epicardial and pericoronary adipose tissue in severe COVID-19 infection

OBJECTIVE

To investigate the association between epicardial and pericoronary adipose tissue thicknesses measured with computed tomography (CT) and severity of COVID-19 infection.

METHODS

We recruited 504 patients admitted with RT-PCR-proven diagnosis of COVID-19 infection and underwent simultaneous Chest CT scanning. Epicardial adipose tissue thickness (EAT) and pericardial adipose tissue thickness (PCAT) were measured by CT. Comparisons were performed between ICU admitting and non-ICU admitting patients were performed.

RESULTS

Of 504 patients, 423 patients were hospitalised in normal wards or followed as outpatient, and 81 patients were admitted to ICU. EAT and PCAT were significantly increased in ICU patients (5.98[5.06-7.13] mm vs. 8.05[6.90-9.89] mm, p < 0.001 and 9.3[7.4-11.5] mm vs. 11.2[10.3-13.2] mm, p < 0.001, respectively). In multiple logistic regression analyses, EAT and PCAT were independent predictors of ICU admission. A cut-off point of 6.64 mm EAT has a sensitivity of 82.7% and a specificity of 66.7% (AUC = 0.789, 95% CI: 0.744-0.833, p < 0.001) and a cut-off point of 9.85 mm PCAT has a sensitivity of 91.4% and a specificity of 61.2% (AUC = 0.744, 95% CI: 0.700-0.788, p < 0.001).

CONCLUSION

We found that both increased EAT and PCAT were associated with the severity of COVID-19 infection defined as the need for ICU admission.

Cardiac CT scanning in coronary artery disease: Epicardial fat volume and its correlation with coronary artery lesions and left ventricular function

Coronary artery disease (CAD) is a major and common disease that poses a threat to human health. Recent studies suggested that epicardial fat may have an important role in the pathogenesis of CAD. Therefore, the association between epicardial fat volume (EFV) and left ventricular function with CAD was investigated in the present study. A total of 61 patients with suspected CAD who underwent CT scanning were enrolled. Baseline data, parameters of left heart function and EFV of the subjects were collected and analyzed. The degree of coronary artery lesions was assessed using the Gensini score. Pearson's correlation analysis and a logistic regression model were applied to assess the association between EFV and risk factors for CAD, the Gensini score and left ventricular function index. A total of 29 female and 32 male subjects with a median age of 63 years were enrolled. The median body mass index (BMI) of the subjects was 23.37 kg/m² and the median EFV was 86.41 cm³. It was revealed that risk factors of CAD, specially hypertension, diabetes mellitus, dyslipidemia, history of myocardial infarction and smoking, had no significant association with the EFV (P>0.05); however, the EFV was significantly positively correlated with the BMI (r=0.479, P<0.0001), interventricular septal thickness (r=0.436, P=0.004), left ventricular posterior wall thickness (r=0.350, P=0.0058), left ventricular end diastolic diameter (r=0.265, P=0.0388), left ventricular mass (r=0.445, P=0.0003) and left ventricular mass index (r=0.371, P=0.0035). However, no correlation was identified between the EFV and the Gensini score (r=0.131, P=0.3137). In conclusion, the EFV measured by cardiac CT scanning was positively correlated with the BMI and left ventricular function, but was not associated with the presence of CAD according to the Gensini scores.

Advantages and disadvantages of different methods for diagnosis of visceral obesity

This analytical review is devoted to the study of visceral obesity as a risk factor for the development and progression of cardiovascular diseases. The presented review discusses the evolution of methods for diagnosis of visceral obesity, their advantages and limitation for various ectopic fat depots.

Correlation between coronary atherosclerosis calcification and epicardial adipose tissue volume in patients with nephropathy

Correlation between coronary atherosclerosis calcification and epicardial adipose tissue (EAT) volume in patients with nephropathy was investigated. A total of 529 patients with high risk of coronary atherosclerotic nephropathy were selected from August 2013 to September 2016 in Xianyang Central Hospital to serve as research subjects, and their clinical data were retrospectively analyzed. All patients underwent coronary artery and EAT examination using dual-source CT. Correlation between EAT and severity of coronary atherosclerosis, calcification, lesions, and BMI were analyzed. Volume of EAT in patients with atherosclerosis was significantly higher than that in patients without atherosclerosis (p<0.05). EAT volume was positively correlated with BMI (r=0.61, p<0.05), calcification scores (r=0.72, p<0.05) and the number of coronary artery lesions (r=0.64, p<0.05) in patients with nephropathy. Coronary atherosclerosis calcification score, number of lesions and BMI are positively correlated with the EAT volume in patients with nephropathy. Detection of EAT volume may serve as a predictor of the occurrence and develop-ment of coronary atherosclerosis in the future.

Epicardial fat thickness can predict severity and multivessel distribution in Egyptian patients with atherosclerotic coronary artery stenosis

Background

Epicardial fat, in addition to its secretory function, may have an important role in predicting and stratifying cardiovascular risk. There is a paucity of data regarding correlation between epicardial fat thickness and coronary artery disease in Egypt.

Aim of the study

To study the relationship between epicardial fat thickness (EFT) measured by trans-thoracic echocardiography (TTE) and severity of coronary artery disease (CAD) and its distribution in Egyptian population.

Methods

Our study was a prospective observational case control study that was conducted upon 150 patients with stable CAD presented to the cardiology departments in Ain Shams University hospitals and Al-Zaitoun Specialized hospital from March to October, 2015. EFT was measured by TTE for all patients at the same day of performing invasive coronary angiography (CA). We studied the statistical correlation between EFT and presence of CAD, also we tried to find if EFT is related to severity of CAD (according to Gensini score) or its distribution.

Results

The study population was divided according to CA results to 2 groups; patients’ group having atherosclerotic CAD consisting of 100 patients and control group consisting of 50 patients with normal coronaries. All the well- known risk factors of CAD (male sex, smoking, hypertension, diabetes, dyslipidemia, increased body mass index) were significantly more prevalent in the patients’ group. Patients had significantly lower systolic and diastolic functions. EFT was significantly correlated to presence of CAD (P < 0.001) with a cut-off value of 5.5 mm. EFT was significantly correlated to severity of CAD assessed by Gensini score (P < 0.001). Also we found a significant positive correlation between EFT and number of vessels affected (P <  0.001).

Conclusion

EFT is a good predictor of CAD severity and multivessel affection in Egyptian patients. It is also a potentially promising predictor for the presence of CAD.

Maximal pericoronary adipose tissue thickness is associated with hypertension in nonobese patients with acute or chronic illness

BACKGROUND/AIMS

Recent studies have shown an association of epicardial fat thickness with diabetes and hypertension (HTN) in asymptomatic populations. However, there is lack of information as to whether there is similar association between pericoronary adipose tissue (PAT) and HTN in the patients who have acute or chronic illness.

METHODS

This study included 214 nonobese patients hospitalized with acute or chronic noncardiogenic illness. PAT thicknesses were measured from fat tissues surrounding left and right coronary arteries in enhanced, chest computed tomography scans, yielding the maximal PAT value from left and right coronary arteries was used for analysis. Baseline data from hypertensive (n = 81) and normotensive (n = 133) patients were collected and compared.

RESULTS

PAT is positively correlated with age (r = 0.377, p <0.001), body mass index (BMI; r = 0.305, p < 0.001), systolic blood pressure (r = 0.216, p = 0.001), and total cholesterol (r = 0.200, p = 0.006). The hypertensive group was older (69.58 ± 11.69 years vs. 60.29 ± 14.98 years), and had higher PAT content (16.30 ± 5.37 mm vs. 13.06 ± 5.58 mm) and BMI (23.14 ± 3.32 kg/m² vs. 20.96 ± 3.28 kg/m) than the normotensive group (all p < 0.001). Multivariate analysis showed that age (odds ratio [OR], 2.193; p = 0.016), PAT thickness (OR, 1.065; p = 0.041), and BMI (25 ≤ BMI < 30 kg/m² ; OR, 6.077; p = 0.001) were independent risk factors for HTN.

CONCLUSIONS

In nonobese patients with noncardiogenic acute or chronic illness, PAT thickness is independently correlated with HTN, age, and BMI.

Aberrant Epicardial Adipose Tissue Extracellular Matrix Remodeling in Patients with Severe Ischemic Cardiomyopathy: Insight from Comparative Quantitative Proteomics

There is ample evidence indicating that epicardial adipose tissue (EAT) volume and thickness is positively associated with coronary artery disease (CAD). However, the exact pathological changes in the human EAT after myocardial ischemia remains largely unclear. In the current study, we applied a comparative quantitative proteomics to elucidate the altered biological processes in the EAT of ischemic cardiomyopathy (ICM) patients. A total of 1649 proteins were successfully quantified in our study, among which 165 proteins were significantly changed (ratio <0.8 or >1.2 fold and p < 0.05 in both repetitions) in EAT of ICM individuals. Gene ontology (GO) enrichment analysis revealed that cardiac structure and cellular metabolism were over-represented among these regulated proteins. The hypertrophic cardiomyopathy, adrenergic signaling in cardiomyocytes, extracellular matrix (ECM)-receptor interaction, phagosome, Glycolysis/Gluconeogenesis, and PPAR signaling pathway were highlighted by the KEGG PATHWAY analysis. More importantly, we found that the proteins responsible for extracellular matrix organization were dramatically increased in EAT of ICM patients. In addition, the picrosirius red (PSR) staining results showed that the collagen fiber content was prominently increased, which indicated the EAT of ICM individuals underwent extracellular matrix remodeling and ERK1/2 activation maybe responsible for these pathological changes partially.

Perivascular adipose tissue as a regulator of vascular disease pathogenesis: identifying novel therapeutic targets

Adipose tissue (AT) is an active endocrine organ with the ability to dynamically secrete a wide range of adipocytokines. Importantly, its secretory profile is altered in various cardiovascular disease states. AT surrounding vessels, or perivascular AT (PVAT), is recognized in particular as an important local regulator of vascular function and dysfunction. Specifically, PVAT has the ability to sense vascular paracrine signals and respond by secreting a variety of vasoactive adipocytokines. Due to the crucial role of PVAT in regulating many aspects of vascular biology, it may constitute a novel therapeutic target for the prevention and treatment of vascular disease pathogenesis. Signalling pathways in PVAT, such as those using adiponectin, H₂ S, glucagon-like peptide 1 or pro-inflammatory cytokines, are among the potential novel pharmacological therapeutic targets of PVAT.

LINKED ARTICLES

This article is part of a themed section on Molecular Mechanisms Regulating Perivascular Adipose Tissue - Potential Pharmacological Targets? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.20/issuetoc.

'Browning' the cardiac and peri-vascular adipose tissues to modulate cardiovascular risk

Excess visceral adiposity, in particular that located adjacent to the heart and coronary arteries is associated with increased cardiovascular risk. In the pathophysiological state, dysfunctional adipose tissue secretes an array of factors modulating vascular function and driving atherogenesis. Conversely, brown and beige adipose tissues utilise glucose and lipids to generate heat and are associated with improved cardiometabolic health. The cardiac and thoracic perivascular adipose tissues are now understood to be composed of brown adipose tissue in the healthy state and undergo a brown-to-white transition i.e. during obesity which may be a driving factor of cardiovascular disease. In this review we discuss the risks of excess cardiac and vascular adiposity and potential mechanisms by which restoring the brown phenotype i.e. “re-browning” could potentially be achieved in clinically relevant populations.

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Epicardial, paracardial and thoracic perivascular adipose tissues resemble BAT at birth.

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Despite ‘whitening’ in early life these depots remain metabolically active and potentially thermogenic into adulthood.

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Obesity induces further ‘whitening’ and inflammation in these depots likely driving the atherogenesis.

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Maintaining or inducing the brown phenotype in these depots could prevent atherosclerotic disease.

Epicardial fat thickness: A surrogate marker of coronary artery disease - Assessment by echocardiography

OBJECTIVE

Epicardial fat is considered as indicator of cardiovascular risk. Several studies have tested the association between epicardial fat thickness (EFT) and coronary artery disease. The aim of our study is to test the hypothesis that echocardiographic EFT is a marker of coronary artery disease.

METHODS

One hundred and ten patients (70 males and 40 females with mean age of 51.5±10.6 and 52.6±9.6, respectively) admitted for coronary angiogram underwent assessment of epicardial fat thickness by echocardiography. Routine clinical examination, evaluation of risk factor profile, and anthropometric variables were also done. Epicardial fat thickness was measured on the free wall of right ventricle in parasternal long- and short-axis views at end-systole for 3 cardiac cycles.

RESULTS

Mean epicardial fat thickness in angiographically normal patients and acute coronary syndromes were 4.4±1.2 and 6.9±1.9, respectively. Epicardial fat thickness in males and females were not statistically different. Burden of coronary arterial lesions denoted by Gensini score shows linear association with epicardial fat thickness and the severity of the coronary disease.

CONCLUSION

Epicardial fat is independently and linearly associated with CAD and its severity.

The Relationship Between Epicardial Adipose Tissue Thickness and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction

We investigated the relationship between epicardial adipose tissue (EAT) and infarct-related artery (IRA) patency before mechanical reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Patients (n = 640) were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow grade. Impaired flow was defined as TIMI grades 0, 1, and 2, and normal flow was defined as TIMI 3. On the admission angiography, 65 (10.2%) patients had TIMI 3 flow, and the remaining 575 (89.8%) had TIMI 0, 1, or 2 flow. The impaired flow group patients had a higher incidence of diabetes mellitus (53.7% vs 41.5%, P = .035), higher EAT thickness (5.66 ± 1.84 vs 4.87 ± 2.09 mm, P = .001), and lower ejection fraction (43.1% ± 8.9% vs 47.4% ± 9.1%, P = .025). Multivariate stepwise logistic regression analysis showed that IRA patency was independently associated with EAT thickness (odds ratio [OR] 0.785; 95% confidence interval [CI] 0.712-0.858; P = .001) and neutrophil–lymphocyte ratio (OR 0.815; 95% CI 0.732-0.917; P = .025). Thickness of EAT was an independent predictor of lower TIMI flow in IRA in patients with STEMI.