Epicardial Adipose Tissue Thickness and Its Association With the Presence and Severity of Coronary Artery Disease in Clinical Setting: A Cross-Sectional Observational Study

The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration

Epicardial adipose tissue (EAT) is a fat deposit surrounding the heart and located under the visceral layer of the pericardium. Due to its unique features, the contribution of EAT to the pathogenesis of cardiovascular and metabolic disorders is extensively studied. Especially, EAT can be associated with the onset and development of coronary artery disease, myocardial infarction and post-infarct heart failure which all are significant problems for public health. In this article, we focus on the mechanisms of how EAT impacts acute coronary syndromes. Particular emphasis was placed on the role of inflammation and adipokines secreted by EAT. Moreover, we present how EAT affects the remodeling of the heart following myocardial infarction. We further review the role of EAT as a source of stem cells for cardiac regeneration. In addition, we describe the imaging assessment of EAT, its prognostic value, and its correlation with the clinical characteristics of patients.

Epicardial adipose tissue, metabolic disorders, and cardiovascular diseases: recent advances classified by research methodologies

Epicardial adipose tissue (EAT) is located between the myocardium and visceral pericardium. The unique anatomy and physiology of the EAT determines its great potential in locally influencing adjacent tissues such as the myocardium and coronary arteries. Classified by research methodologies, this study reviews the latest research progress on the role of EAT in cardiovascular diseases (CVDs), particularly in patients with metabolic disorders. Studies based on imaging techniques demonstrated that increased EAT amount in patients with metabolic disorders is associated with higher risk of CVDs and increased mortality. Then, in-depth profiling studies indicate that remodeled EAT may serve as a local mediator of the deleterious effects of cardiometabolic conditions and plays a crucial role in CVDs. Further, in vitro coculture studies provided preliminary evidence that the paracrine effect of remodeled EAT on adjacent cardiomyocytes can promote the occurrence and progression of CVDs. Considering the important role of EAT in CVDs, targeting EAT might be a potential strategy to reduce cardiovascular risks. Several interventions have been proved effective in reducing EAT amount. Our review provides valuable insights of the relationship between EAT, metabolic disorders, and CVDs, as well as an overview of the methodological constructs of EAT-related studies.

Epicardial fat volume, an independent risk factor for major adverse cardiovascular events, had an incremental prognostic value to myocardial perfusion imaging in Chinese populations with suspected or known coronary artery disease with a normal left ventricular ejection fraction

Background

Most coronary artery disease (CAD) patients with a normal left ventricular ejection fraction (LVEF) experience a poor prognosis. Single-photon emission computerized tomography (SPECT)-myocardial perfusion imaging (MPI), a routine examination, is useful in assessing risk and predicting major adverse cardiovascular events (MACEs) in populations with suspected or known CAD. SPECT/CT is a "one-stop shop" examination, which, through non-contrast CT, can produce attenuation correction for MPI and obtain information on coronary artery calcium (CAC) and epicardial fat volume (EFV) simultaneously. This study aims to investigate the predictive and incremental value of EFV to MPI for MACE in Chinese populations with suspected or known CAD with a normal LVEF.

Methods and results

We retrospectively studied 290 suspected or known CAD inpatients with a normal LVEF who underwent SPECT/CT between February 2014 and December 2017. Abnormal MPI was defined as a summed stress score ≥4 or summed difference score ≥2. EFV and CAC were calculated using non-contrast CT. The end date of follow-ups was in February 2022. The follow-up information was obtained from the clinical case notes of the patients or reviews of telephone calls. MACE was defined as cardiac death, late coronary revascularization ≥3 months after MPI, non-fatal myocardial infarction, angina-related rehospitalization, heart failure, and stroke. During the 76-month follow-up, the event rate was 32.0% (93/290). Univariate and multivariate Cox regression analyses concluded that high EFV (>108.3 cm3) [hazard ratio (HR): 3.3, 95% CI: 2.1-5.2, P < 0.000] and abnormal MPI (HR: 1.8, 95% CI: 1.1-2.8, P = 0.010) were independent risk factors for MACE. The event-free survival of patients with high EFV was significantly lower than that of the low EFV group (log-rank test P < 0.001). In the subgroup with normal MPI, high EFV was associated with reduced event-free survival (log-rank P < 0.01), with a higher annualized event rate (8.3% vs. 1.9%). Adding high EFV to MPI could predict MACEs more effectively, with a higher concordance index (0.56-0.69, P < 0.01), higher global chi square (7.2-41.4, P < 0.01), positive integrated discrimination improvement (0.10, P < 0.01), and net reclassification index (0.37, P < 0.01).

Conclusions

In Chinese populations with suspected or known CAD with normal LVEF, high EFV was an independent risk factor for MACE after adjusting for traditional risk factors, CAC and MPI. In subgroups with normal MPI, EFV could also improve risk stratification. Adding EFV to MPI had an incremental value for predicting MACE.

Epicardial Fat Volume as a Good Predictor for Multivessel Coronary Artery Disease

INTRODUCTION

Epicardial adipose tissue may have an important role in the pathogenesis of coronary artery disease (CAD).

AIM

We aimed to study the association between epicardial fat volume (EFV) and presence of obstructive as well as multivessel CAD.

METHODS

A total of 87 adult subjects with suspected CAD who underwent both quantified by multidetector computerized tomography (MDCT) and Invasive Coronary Angiography (ICA) were enrolled in this observational study. EVF was measured by MDCT by calculating the sum of cross- sectional areas of fat multiplied by slice thickness. EFV measurement and its association with the presence of obstructive CAD (defined as coronary artery stenosis > 70%) was evaluated.

RESULTS

Overall, 89.6% patients had obstructive CAD with higher EFV as compared to 10.3% patients with non-obstructive CAD (57 ± 20.14 cm3 vs. 44 ± 7.4 cm3; P < 0.001). Furthermore, EFV was significantly increased in group II as compared with group I (74 ± 24.3 ml vs. 53 ± 16.2 ml; P < 0.003). On the hand, the coronary calcium score (CAC) was insignificantly increased in group II as compared with group I (486.1 vs. 211.2; P = 0.10). Multivariate analysis revealed that, EFV might be an independent risk factor for not only the presence of obstructive CAD (odds ratio [OR], 1.062; 95% CI 1.018- 1.108; P < 0.005) but also in predicting multivessel disease affection.

CONCLUSIONS

Our results demonstrated that, EFV was significantly increased not only with obstructive CAD, independent of other traditional risk factors and CAC score, but also it can be considered a good predictor of multivessel disease occurrence.

Obesity and the risk of cardiometabolic diseases

The prevalence of obesity has reached pandemic proportions, and now approximately 25% of adults in Westernized countries have obesity. Recognized as a major health concern, obesity is associated with multiple comorbidities, particularly cardiometabolic disorders. In this Review, we present obesity as an evolutionarily novel condition, summarize the epidemiological evidence on its detrimental cardiometabolic consequences and discuss the major mechanisms involved in the association between obesity and the risk of cardiometabolic diseases. We also examine the role of potential moderators of this association, with evidence for and against the so-called 'metabolically healthy obesity phenotype', the 'fatness but fitness' paradox or the 'obesity paradox'. Although maintenance of optimal cardiometabolic status should be a primary goal in individuals with obesity, losing body weight and, particularly, excess visceral adiposity seems to be necessary to minimize the risk of cardiometabolic diseases.

Role of obesity and blood pressure in epicardial adipose tissue thickness in children

BACKGROUND

Elevated body mass index (BMI) has been associated with cardiac changes, such as higher epicardial adipose tissue (EAT) thickness. This fat has been identified as a predictive factor of cardiovascular diseases during adulthood. However, few studies have tested the association of multiple cardiovascular risk factors (high weight or blood pressure) with EAT in adolescents and children. Therefore, the main objective of this current research was to determine the impact of BMI, overweight, obesity, and blood pressure on EAT thickness in children.

METHODS

A descriptive cross-sectional study focused on elementary and high school students aged 6-16 years was carried out by utilizing diverse measurements and instruments, such as echocardiography.

RESULTS

EAT thickness (N = 228) was linked to sex (more predominant in boys 2.3 ± 0.6; p = 0.044), obesity (2.3 ± 0.6; p < 0.001), and hypertension (2.6 ± 0.6; p = 0.036). The logistic regression indicated that age, sex, and BMI seemed to be more relevant factors in EAT thickness in children (adjusted R square = 0.22; p < 0.001).

CONCLUSIONS

This paper examined the associations of sex, age, and cardiovascular risk factors (arthrometric measures and blood pressure) with EAT thickness, indicating that it is necessary to assess whether the findings are associated with future events.

IMPACT

Excessive weight gain and blood pressure in the early stages of life have been associated with adipose tissue. This increase in weight and blood pressure has been attributed to alterations in the epicardial adipose tissue linked to anthropometric markers in adults, but no related study has been implemented in Spanish children. This study revealed how higher epicardial adipose tissue is linked to body mass index, other anthropometric parameters, and blood pressure in Spanish children. These measurements are related to high epicardial adipose tissue thickness, which in early stages does not imply pathology but increases the risk of developing cardiovascular diseases.

Anthropometric indices and cut-off points for screening of metabolic syndrome among South African taxi drivers

Background

Detecting the early onset of metabolic syndrome (MetS) allows for quick intervention which may slow progression to a variety of health consequences, hence, determining the best measurement to detect MetS is essential.

Aim

This research aimed at examining the MetS predictive power of anthropometric indices, such as body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), body shape index (ABSI), body roundness index (BRI), percentage body fat (%BF), conicity index (CI), and Clínica Universidad de Navarra-body adiposity estimator (CUN-BAE) to determine the cut-off points to identify male South African taxi drivers with MetS.

Method

A cross-sectional study was conducted among 185 male taxi drivers. Their weight, height, WC, blood lipid profile were measured. International Diabetes Federation (IDF) definition was used to define MetS. Receiver Operating Characteristic (ROC) curves were used to compare the predictive ability of Anthropometric indices to detect MetS.

Results

The mean age of the participants was 39.84 years. Overall, 41.6% (N = 77) of the participants presented with MetS. The mean values for BMI, WC, WHtR, %BF, BRI, CUN-BAE, ABSI and CI were 28.60 ± 6.20 kg/m², 99.13 ± 17.59 cm, 0.58 ± 0.10, 27.28 ± 8.28%, 5.09 ± 2.33, 27.78 ± 8.34, 0.08 ± 0.01 and 1.70 ± 0.19, respectively. The mean values for these indices were significantly (p < 0.001) higher in participants with MetS. The highest area under the curve (AUC) outcomes for screening MetS were for the %BF and CUN-BAE, followed by the BMI and WHtR, and lastly the BRI. All these anthropometric indices had outstanding discriminatory powers for predicting MetS with AUCs and sensitivity values above 80%. The BMI, WHtR, %BF, BRI, and CUN-BAE, had cut-off points for detection of metS in South African men at 28.25 kg/m², 0.55, 25.29%, 4.55, and 27.10, respectively. Based on the logistic regression models abnormal BMI, WHtR, %BF, BRI, CUN-BAE, TG, FBG, systolic BP, diastolic BP and WC showed increased risk of MetS.

Conclusion

While the %BF, CUN-BAE, BMI, WC, WHtR, BRI, CI and CUN-BAE could predict MetS among South African male taxi drivers, these indices were less effective in predicting the individual MetS risk factors such as TG, BP, and FBG.

Epicardial Adipose Tissue as an Independent Cardiometabolic Risk Factor for Coronary Artery Disease

During the last decades, visceral adiposity has been at the forefront of scientific research because of its complex role in the pathogenesis of cardiovascular diseases. Epicardial adipose tissue (EAT) is the visceral lipid compartment between the myocardium and the visceral pericardium. Due to their unobstructed anatomic vicinity, epicardial fat and myocardium are nourished by the same microcirculation. It is widely known that EAT serves as an energy lipid source and thermoregulator for the human heart. In addition to this, epicardial fat exerts highly protective effects since it releases a great variety of anti-inflammatory molecules to the adjacent cardiac muscle. Taking into account the unique properties of human EAT, it is undoubtedly a key factor in cardiac physiology since it facilitates complex heart functions. Under pathological circumstances, however, epicardial fat promotes coronary atherosclerosis in a variety of ways. Therefore, the accurate estimation of epicardial fat thickness and volume could be utilized as an early detecting method and future medication target for coronary artery disease (CAD) elimination. Throughout the years, several therapeutic approaches for dysfunctional human EAT have been proposed. A balanced healthy diet, aerobic and anaerobic physical activity, bariatric surgery, and pharmacological treatment with either traditional or novel antidiabetic and antilipidemic drugs are some of the established medical approaches. In the present article, we review the current knowledge regarding the anatomic and physiological characteristics of epicardial fat. In addition to this, we describe the pathogenic mechanisms which refer to the crosstalk between epicardial fat alteration and coronary arterial atherosclerosis development. Lastly, we present both lifestyle and pharmacological methods as possible treatment options for EAT dysfunction.

Thigh Intramuscular Fat on Prognosis of Patients With Nonischemic Cardiomyopathy

Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also ectopic fat has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with nonischemic cardiomyopathy. We investigated whether ectopic fat in the thigh affects the prognosis of nonischemic cardiomyopathy. This prospective study recruited 145 patients diagnosed with nonischemic cardiomyopathy between September 2017 and January 2020. Finally, 93 patients with a reduced ejection fraction were enrolled. The clinical end points were cardiovascular death or unexpected rehospitalization because of a cardiac event. Using computed tomography, the percentage of intramuscular fat (%IMF) in the thigh was measured in all patients. Patients were divided into 2 groups based on the median %IMF. The results of Spearman's correlation coefficient analysis revealed a correlation among %IMF and peak oxygen uptake (Spearman r = -0.221, p = 0.036). Kaplan-Meier analysis results showed significantly higher risk of adverse events in the high %IMF group (log-rank p = 0.013). Multivariate Cox regression analysis results revealed the %IMF as an independent factor for adverse events (hazard ratio 1.361; 95% confidence interval 1.043 to 1.745; p = 0.018). In conclusion, %IMF may have adverse consequences such as increased cardiac events in patients with nonischemic cardiomyopathy with a reduced ejection fraction.

Dysregulated Epicardial Adipose Tissue as a Risk Factor and Potential Therapeutic Target of Heart Failure with Preserved Ejection Fraction in Diabetes

Cardiovascular (CV) disease and heart failure (HF) are the leading cause of mortality in type 2 diabetes (T2DM), a metabolic disease which represents a fast-growing health challenge worldwide. Specifically, T2DM induces a cluster of systemic metabolic and non-metabolic signaling which may promote myocardium derangements such as inflammation, fibrosis, and myocyte stiffness, which represent the hallmarks of heart failure with preserved ejection fraction (HFpEF). On the other hand, several observational studies have reported that patients with T2DM have an abnormally enlarged and biologically transformed epicardial adipose tissue (EAT) compared with non-diabetic controls. This expanded EAT not only causes a mechanical constriction of the diastolic filling but is also a source of pro-inflammatory mediators capable of causing inflammation, microcirculatory dysfunction and fibrosis of the underlying myocardium, thus impairing the relaxability of the left ventricle and increasing its filling pressure. In addition to representing a potential CV risk factor, emerging evidence shows that EAT may guide the therapeutic decision in diabetic patients as drugs such as metformin, glucagon-like peptide‑1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 inhibitors (SGLT2-Is), have been associated with attenuation of EAT enlargement.

Expression profiles of long noncoding and messenger RNAs in epicardial adipose tissue derived from patients with coronary atherosclerosis

BACKGROUND

Given its close anatomical location to the heart and its endocrine properties, attention on epicardial adipose tissue (EAT) has increased.

OBJECTIVE

This study investigated the expression profiles of long noncoding RNAs (lncRNAs) and messenger RNAs (mRNAs) in EAT derived from patients with coronary artery disease (CAD).

METHODS

EAT samples from 8 CAD and 8 non-CAD patients were obtained during open-heart surgery. The expression of lncRNAs and mRNAs in each EAT sample was investigated using microarray analysis and further verified using reverse transcription-quantitative polymerase chain reaction.

RESULTS

Overall, 1,093 differentially expressed mRNAs and 2,282 differentially expressed lncRNAs were identified in EAT from CAD vs non-CAD patients. Analysis using Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes showed that these differentially expressed genes were mainly enriched in various inflammatory, immune, and metabolic processes. They were also involved in osteoclast differentiation, B cell receptor and adipocytokine signaling, and insulin resistance pathways. Additionally, lncRNA-mRNA and lncRNA-target pathway networks were built to identify potential core genes (e.g. Lnc-CCDC68-2:1, AC010148.1, NONHSAT104810) involved in atherosclerosis pathogenesis.

CONCLUSION

In summary, lncRNA and mRNA profiles in EAT were markedly different between CAD and non-CAD patients. Our study identifies several potential key genes and pathways that may participate in atherosclerosis development.

A systematic review exploring the significance of measuring epicardial fat thickness in correlation to B-type natriuretic peptide levels as prognostic and diagnostic markers in patients with or at risk of heart failure

Emerging evidence suggests that epicardial fat thickness (EFT) may be a critical feature to understand cardiac health and determine the risk of heart failure. The current review critically assesses and discusses evidence on the efficiency of measuring EFT, in comparison to the well-known markers B-type natriuretic peptide (BNP) and its N-terminal fragment pro-B-type natriuretic peptide (NT-proBNP), as a prognostic and diagnostic approach in individuals with or at risk of heart failure. A systematic approach was undertaken to search major databases, PubMed, Scopus, Google Scholar and the Cochrane library to identify studies that quantified EFT and serum BNP/NT-proBNP levels in individuals with or at risk of heart failure. Twelve studies met the inclusion criteria and a total of 1983 participants were included in this systematic review. Evidence shows a clear association between increased EFT and elevated BNP/NT-proBNP levels in individuals with metabolic disease and suggests that both methods can be used for heart failure diagnosis and prognosis. However, due to the broad spectrum of challenges linked with measuring EFT, BNP/Pro-BNP is the predominant method used for heart failure diagnosis and prognosis in clinical practice. Nonetheless, measuring EFT provides a powerful and reproducible diagnostic tool for risk stratification and heart failure diagnosis and prognosis. Importantly, measuring EFT proves valuable to validate BNP/NT-proBNP levels to predict heart failure, especially due to its non-invasive nature.

Ventricular Weight Increases Proportionally With Total Heart Weight in Postmortem Population

Heart weight is routinely measured at postmortem examination and is critical to determine whether the heart is enlarged (ie, cardiomegaly). Cardiomegaly has the potential to cause sudden death by being electrically unstable, resulting in fatal arrhythmias. The majority of fatal cardiac arrhythmias is ventricular in origin and is assumed that ventricular size is disproportionately larger in cardiomegaly. This prospective study compared ventricular weight (VW) and total heart weight (THW) in 40 consecutive cases. The results, unexpectedly, showed that VW increases proportionally and linearly with THW in normal and enlarged hearts (THW, >500 g) and did not increase disproportionally with increased THW. The ratio of VW/THW did not have any significant correlation or difference with sex, height, weight, and cardiac causes of death but did have a negative correlation with age. Further studies are indicated to document the morphological changes when the heart enlarges, which may aid in understanding the pathophysiology of sudden death from cardiomegaly.

Association of Epicardial Fat Volume With Increased Risk of Obstructive Coronary Artery Disease in Chinese Patients With Suspected Coronary Artery Disease

Background Epicardial adipose tissue may be associated with the pathogenesis of coronary artery disease (CAD), but its effect on obstructive CAD risk is uncertain. Therefore, we aimed to examine the relationship between epicardial adipose tissue and obstructive CAD in Chinese patients with suspected CAD. Methods and Results The present study enrolled 194 consecutive inpatients with suspected CAD who underwent both noncontrast computed tomography and coronary angiography. We measured epicardial fat volume (EFV) and evaluated its association with obstructive CAD, which was defined as coronary stenosis severity ≥70%. Overall, 44.3% patients had obstructive CAD and tend to have higher EFV. Age, body mass index, triglycerides, incidence of hypertension, and hyperlipidemia were higher across tertiles of EFV (P for trend <0.05). In univariate regression analysis, a per-SD increase in EFV was independently associated with obstructive CAD (odds ratio [OR], 2.31; 95% CI, 1.61-3.32; P<0.001). Consistent with these findings, EFV was still significantly related to obstructive CAD as continuous variable after adjustment for all traditional risk factors and coronary artery calcium (OR per SD, 2.82; 95% CI, 1.68-4.74; P<0.001). Generalized additive model indicated that EFV was linearly associated with risk of obstructive CAD. E-value analysis suggested robustness to unmeasured confounding. Conclusions Our results suggested that in Chinese patients with suspected CAD, EFV was significantly and positively associated with the risk of obstructive CAD, independent of traditional risk factors and coronary artery calcium.

Diagnostic Values of Epicardial Adipose Tissue Thickness with Right Common Carotid Artery Elasticity and Intima-Media Thickness for Middle-Aged and Elderly Patients with Coronary Heart Disease

Background

Coronary heart disease (CHD) is the most common cardiovascular disease which greatly threatens the health of middle-aged and elderly people.

Objective

To explore the correlations of epicardial adipose tissue (EAT) thickness with right common carotid artery elasticity and intima-media thickness (IMT) in middle-aged and elderly patients with CHD by ultrasound.

Methods

A total of 132 patients diagnosed with CHD by coronary angiography (CAG) from February 2019 to August 2020 were enrolled and divided into single-vessel disease group (n=38), double-vessel disease group (n=52), and three-vessel disease group (n=42), and 52 healthy subjects were selected as control group. Their general data, biochemical indices, EAT thickness, right common carotid artery elasticity indices, and IMT were compared. The correlations of EAT thickness with right common carotid artery elasticity indices and IMT were studied by Pearson's analysis. The predictive values of EAT thickness and IMT for CHD were analyzed by receiver operating characteristic curves.

Results

With increasing number of diseased branches, EAT thickness, stiffness parameters β (β), strain elastic modulus (Ep), pulse wave velocity β (PWV-β) and IMT increased, arterial compliance (AC) decreased (P<0.05), but argumentation index (AI) did not change significantly. EAT thickness had significant positive correlations with β, Ep, PWV-β and IMT, negative correlation with AC, and no significant correlation with AI. The areas under the curves of EAT thickness and IMT for predicting CHD were 0.806 and 0.784, respectively.

Conclusion

EAT thickness is significantly correlated with right common carotid artery elasticity and IMT in middle-aged and elderly patients with CHD, and EAT thickness and IMT have high predictive values. The three indices are crucial for CHD diagnosis.

Increased epicardial adipose tissue thickness associated with increased metabolic risk and the presence of heart failure in patients with Chronic Chagas disease

BACKGROUND

It has been described that Trypanosoma cruzi is capable of promoting metabolic disturbances currently considered as cardiovascular risk factors. Moreover, it has been observed that the protozoa can remain in adipose tissue and alter its immune endocrine functions. The aim of this study was to characterize the thickness of epicardial adipose tissue (EAT) in patients with chronic Chagas disease (CCD) concerning their cardiovascular metabolic risk profile compared with those without CCD.

METHODS

A cross-sectional study was performed including T. cruzi seropositive individuals categorized according to a standard CCD classification and a matched seronegative control group. Complete clinical examination, metabolic laboratory tests and transthoracic echocardiography to assess cardiac function and to quantify EAT were performed.

RESULTS

Fifty-five individuals aged 46.7±11.9 y, 34 with CCD and 21 in the control group, were included. The CCD group presented higher EAT thickness in relation to controls (4.54±1.28 vs 3.22±0.99 mm; p=0.001), which was significantly associated with the presence of insulin resistance (OR=3, 95% CI 1.58 to 5.73; p<0.001). This group presented lower levels of plasmatic adiponectin than controls, especially in those patients with EAT ≥4.5 mm (p=0.005) who also presented with heart failure more frequently (p=0.01).

CONCLUSION

In patients with CCD, a higher EAT thickness is observed and is associated with an increased metabolic risk profile indicated mainly by insulin resistance.

Visceral fat in different locations assessed by ultrasound: Correlation with computed tomography and cut-off values in patients with metabolic syndrome

The aim of this study was to evaluate the correlation between ultrasound measurements of visceral adipose tissue (VAT) in different locations and visceral fat area parameters estimated by computed tomography (CT), as well as to determine the cut-off values of ultrasound measurements in patients with metabolic syndrome and in normal controls. Altogether, 304 patients aged 18 to 65 years were enrolled in the study. Ultrasound measurements of visceral fat volume were performed using a number of already described techniques. The correlations of ultrasound indices of VAT and СТ (104 patients) ranged from 0.420 to 0.726. For the most effective diagnostic VAT ultrasound indices, the cut-off values in metabolic syndrome were (200 patients): 21.12 cm² for the inferior part of perirenal fat (AUC = 0.983); and 47.00, 61.3 and 72.7 mm for the distance between the internal surface of the rectus abdominis muscle and the anterior wall of the aorta, the posterior wall of the aorta and the lumbar vertebra (AUC = 0.960, 0.966, 0.968, respectively). Ultrasound VAT measurements highly correlated with CT results. Cut-off VAT values, determined by ultrasound for the patients with metabolic syndrome, yielded good diagnostic operational characteristics.

Study of correlation between epicardial fat thickness and severity of coronary artery disease

Epicardial fat thickness (EFT) reflects visceral adiposity and is associated with coronary artery disease (CAD). This study aimed to assess the correlation of echocardiographic EFT with the severity of CAD and to determine the EFT cut-off to predict CAD. EFT was measured in 503 patients undergoing coronary angiogram. Mean EFT was significantly higher in the CAD group than control group (5.55 ± 1.21 mm vs 3.25 ± 1.15 mm, p < 0.0001). EFT correlated with Gensini score (r = 0.906, p < 0.001). EFT cut-off ≥ 4.75 mm had 87% sensitivity and 63% specificity for prediction of significant CAD (AUC: 0.831, p < 0.001).

Vascular-specific epicardial adipose tissue in predicting functional myocardial ischemia for patients with stable chest pain

The relationship between vascular-specific epicardial adipose tissue (vEAT) volume and myocardial ischemia measured by fractional flow reserve (FFR) was not well investigated. Patients with typical and atypical chest pain undergoing coronary computed tomographic angiography scan followed by invasive coronary angiography in combination with FFR examination within one month were retrospectively included. EAT volume and CT attenuation was calculated. The patient with FFR ≤ 0.8 in at least one vessel was referred to as functional ischemia. The mean age of all patients was 61.7 ± 8.9 years and 66.7% of patients were male. There was a significant difference for left anterior descending branch (LAD) vEAT volume between patients with and without functional myocardial ischemia (28.7 ± 10.6 cm³ vs. 23.9 ± 8.7 cm³, p = 0.005). After adjusted by cardiac risk factors and CAD-RADS categories in multivariable logistic regression analysis, LAD-vEAT volume ≥ 24.6 cm³ (OR 3.355, 95% CI 1.546-7.281, p = 0.002) remained an independent predictor of functional ischemia. After adding LAD-vEAT volume ≥ 24.6 cm³ to a prediction model composed with cardiac risk factors and CAD-RADS categories, receiver operating characteristic curve analysis showed significantly improved areas under curve (AUC) for the new model (AUC: 0.795, p = 0.0319) compared with the previous ones. Moreover, the new model revealed significance in net reclassification improvement (NRI: 0.186, p = 0.037). In conclusion, LAD-vEAT volume measurements have incremental predictive performance beyond cardiac risk factors and CAD-RADS categories in identifying significant flow-limit ischemia detected by FFR.

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.

NAFLD and cardiovascular diseases: a clinical review

Non-alcoholic fatty liver DISEASE (NAFLD) is the most common chronic liver disease in Western countries and affects approximately 25% of the adult population. Since NAFLD is frequently associated with further metabolic comorbidities such as obesity, type 2 diabetes mellitus, or dyslipidemia, it is generally considered as the hepatic manifestation of the metabolic syndrome. In addition to its potential to cause liver-related morbidity and mortality, NAFLD is also associated with subclinical and clinical cardiovascular disease (CVD). Growing evidence indicates that patients with NAFLD are at substantial risk for the development of hypertension, coronary heart disease, cardiomyopathy, and cardiac arrhythmias, which clinically result in increased cardiovascular morbidity and mortality. The natural history of NAFLD is variable and the vast majority of patients will not progress from simple steatosis to fibrosis and end stage liver disease. However, patients with progressive forms of NAFLD, including non-alcoholic steatohepatitis (NASH) and/or advanced fibrosis, as well as NAFLD patients with concomitant types 2 diabetes are at highest risk for CVD. This review describes the underlying pathophysiological mechanisms linking NAFLD and CVD, discusses the role of NAFLD as a metabolic dysfunction associated cardiovascular risk factor, and focuses on common cardiovascular manifestations in NAFLD patients.

Association of epicardial fat thickness assessed by echocardiography with the severity of coronary artery disease

Introduction: Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD.

Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion.

Results: PLAX (EFT_S) (EFT in systole) and PLAX (EFT_d) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFT_S) (P = 0.05), PLAX (EFT_d) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score.

Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

Relation between quantity and quality of peri-coronary epicardial adipose tissue and its underlying hemodynamically significant coronary stenosis

BACKGROUND

We aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia.

METHODS

We enrolled 45 patients (55 lesions) with known or suspected coronary artery disease who underwent coronary computed tomography angiography (CTA) followed by invasive fractional flow reserve (FFR) assessment within 30 days. EAT volume (index) and density in patient-, vessel- and lesion-level were measured on CTA images. Lesion-specific ischemia was defined as a lesion with stenosis diameter > 90% or FFR ≤0.80. Multivariate analysis determined the independent association of EAT parameters with lesion-specific ischemia.

RESULTS

Mean age of the patients was 60 years, and 75% were male. Overall, 55.6% of patients had ischemic lesions and a mean FFR baseline value of 0.82 ± 0.10. Total EAT volume index was significantly higher in patients with functionally or anatomically significant stenosis. Specifically, peri-lesion EAT volume index, not the density, was positively correlated with lesion-specific ischemia independent of luminal stenosis and plaque characteristics (hazard ratio 1.56, 95% confidence interval 1.04-2.33, P = 0.032; per 0.1 ml/m² increase). Moreover, peri-lesion EAT volume was negatively correlated with lesion FFR values, whereas total EAT volume was positively correlated with fat accumulation and glucose metabolism. In addition, there was no association of EAT volume or density with myocardial ischemia in vessel-level analysis.

CONCLUSIONS

Lesion-specific EAT volume index, but not density, seems positively and independently associated with myocardial ischemia, while its incremental diagnostic value of lesion-specific ischemia should be further investigated.

Epicardial adipose thickness in youth with type 1 diabetes

BACKGROUND AND OBJECTIVE

Epicardial adipose thickness (EAT) is increased in adults with type 1 diabetes (T1D) and is thought to contribute to cardiovascular disease (CVD) in this population. Given that CVD risk factors emerge early in life, the purpose of this study was to identify whether EAT is increased in pediatric patients with T1D compared with non-diabetic controls.

METHODS

Anthropometric data, blood pressure (BP), and EAT were evaluated in 20 youth with T1D and 20 age, sex, and body mass index (BMI) matched healthy controls between the ages of 5 and 18 years.

RESULTS

EAT was 18.5% higher among youth with T1D compared to healthy controls (1.65 ± 0.44 mm vs 1.37 ± 0.27 mm, P = .02). In the entire cohort, EAT was correlated with age (r = 0.71, P < .001), BMI (r = .69, P < .001), waist circumference (r = 0.60, P < .001), systolic BP (r = .34, P = .03), and diastolic BP (r = 0.41, P = .009). Among youth with T1D, there were no significant correlations between EAT and HbA1c (r = -0.16, P = .50), insulin dose (r = .09, P = .71), or duration of disease (r = 0.06, P = .82).

CONCLUSIONS

Youth with T1D exhibited significantly higher EAT compared to controls. Increased EAT was associated with adiposity and BP, but not duration of disease, insulin dose, or glycemic control. Increased EAT may represent a pathophysiologic mechanism leading to premature CVD in pediatric patients with T1D.

Investigation of the Relationship between Asthma and Visceral Obesity by Epicardial Fat Thickness Measurement

OBJECTIVES

Obesity is a risk factor defined in recent years for asthma. It is associated not only with asthma but also with many cardiovascular diseases. Visceral obesity is a more significant risk factor than general obesity in cardiovascular diseases. Although the association of visceral obesity with cardiovascular diseases is well known, the relationship in patients with asthma is not fully understood. The aim of the present study was to investigate whether there is a relationship between asthma and visceral fat by using epicardial fat thickness (EFT) measurement.

MATERIALS AND METHODS

A total of 401 subjects (229 patients with persistent asthma and 172 controls) were enrolled in the study. In our study, EFT was measured, recorded by echocardiography, and was evaluated whether there was a statistical significant difference between the two groups.

RESULTS

The mean EFT was 5.84±0.79 mm in the patient group and 5.71±0.93 mm in the control group. There was no statistically significant difference between the groups (p=0.145). Similarly, when we compared control and asthma severity subgroups, we did not find statistically significant differences (control group mean 5.71±0.93 mm, mild group mean 5.86±0.81 mm, moderate group mean 5.8±0.84 mm, and severe group mean 5.83±0.67 mm, p=0.505).

CONCLUSION

In the present study, we observed that the EFT did not increase in patients with asthma compared with the normal population. Based on our results, we suggest that visceral obesity may not be a significant risk factor for asthma.

Relation of systolic and diastolic epicardial adipose tissue thickness with presence and severity of coronary artery disease (The EAT CAD study)

Background:

Recent studies have shown EAT to be an indicator of cardiovascular risk and atherosclerotic plaque development. However, such data is sparse from Indian sub-continent. The present study evaluated the relationship of EAT as determined by echocardiography to the presence and severity of coronary artery disease (CAD).

Materials and Methods:

This was a cross-sectional observational study constituting 500 patients including 250 with angiographically normal coronary arteries (non-CAD group), and 250 patients with significant CAD on coronary angiogram (CAD group). CAD severity was assessed by Gensini and SYNTAX scores.

Results:

The mean systolic and diastolic EAT thickness in the CAD group (5.7 ± 1.5 mm and 4.3 ± 1.1 mm) were significantly higher than the non-CAD group (4.2 ± 1.2 mm and 3.2 ± 1.2 mm), both P < 0.001. EAT thickness showed a significant positive correlation with waist circumference, LDL-C levels, Gensini score, and SYNTAX score. On multivariate logistic regression analysis, both systolic and diastolic EAT thickness were found to be independent predictor of CAD in addition traditional risk factors. Receiver operating characteristics (ROC) analysis showed that systolic EAT thickness of 5 mm and diastolic EAT thickness of 4 mm had similar sensitivity (85% vs 83%, respectively) and specificity (70% vs 72%, respectively) to detect presence of CAD.

Conclusion:

Systolic and diastolic EAT thicknesses are increased in CAD patients and related to both presence and severity of CAD. EAT, being modifiable, may be an attractive target for future interventions to reduce CV risk and has potential to monitor the response to life-style modification and therapy. However, larger and prospective studies required to validate these findings.

Association between epicardial adipose tissue thickness and parameters of target organ damage in patients undergoing coronary angiography

Epicardial adipose tissue (EAT), metabolically active visceral fat, is easily measurable using transthoracic echocardiography (TTE). This study aimed to clarify the relationship between EAT thickness and parameters for target organ damage (TOD). A total of 338 consecutive patients (64.5 ± 10.9 years, 58.0% men) undergoing invasive coronary angiography in a stable condition were prospectively enrolled. TTE was performed, and the EAT thickness was measured perpendicular to the right ventricular free wall at end-systole. We investigated TOD parameters, including the estimated glomerular filtration rate, proteinuria, left ventricular (LV) mass index (LVMI), septal e' velocity, E/e', brachial-ankle pulse wave velocity, ankle-brachial index, aortic pulse pressure (APP), and presence of coronary artery disease (CAD). APP and CAD were assessed by invasive cardiac catheterization. Most patients (77.5%) had significant CAD (≥50% stenosis). In Pearson's bivariate correlation analyses, the EAT thickness was significantly correlated with the septal e' velocity (r = -0.203, P < 0.001) and E/e' (r = 0.217, P < 0.001), but not with other TOD parameters (P > 0.05). Multiple linear regression analysis showed that the correlations of the EAT thickness with septal e' velocity (β = -0.172, P = 0.047) and E/e' (β = 0.207, P = 0.011) remained significant even after adjusting for potential confounders. EAT thickness is more closely related to LV diastolic function than other TOD parameters, including renal function, LVMI, arterial stiffness, peripheral artery disease, and CAD. These findings provide additional evidence for the potential role of EAT in the pathogenesis of LV diastolic dysfunction.

The Effect of Periplaque Fat on Coronary Plaque Vulnerability in Patients with Stable Coronary Artery Disease – a 128-multislice CT-based Study

Background: The role of periplaque fat (PPF), as a fragment of the total epicardial adipose tissue, measured in the vicinity of a target coronary lesion, more specifically within the close proximity of a vulnerable plaque, has yet to be evaluated.

The study aimed to evaluate the interrelation between PPF and coronary plaque vulnerability in patients with stable coronary artery disease (CAD). Secondary objective: evaluation of the relationship between the total pericardial fat and markers for plaque vulnerability.

Materials and methods: We prospectively enrolled 77 patients with stable CAD, who underwent 128-multislice computed tomography coronary angiography (CTCA), and who presented minimum one lesion with >50% stenosis. CTCA analysis included measurements of: total pericardial fat and PPF volumes, coronary plaque characteristics, markers for plaque vulnerability – positive remodeling (PR), low attenuation plaque (LAP), spotty calcifications (SC,) napkin ring sign (NRS). Study subjects were divided into two categories: Group 1 – 1 marker of plaque vulnerability (n = 36, 46.75%) and Group 2 – ≥1 marker of vulnerability (n = 41, 53.25%).

Results: The mean age of the population was 61.77 ± 11.28 years, and 41 (53.24%) were males. The analysis of plaque characteristics showed that Group 2 presented significantly longer plaques (16.26 ± 4.605 mm vs. 19.09 ± 5.227 mm, p = 0.02), remodeling index (0.96 ± 0.20 vs. 1.18 ± 0.33, p = 0.0009), and vessel volume (p = 0.027), and more voluminous plaques (147.5 ± 71.74 mm3 vs. 207.7 ± 108.9 mm3, p = 0.006) compared to Group 1. Group 2 presented larger volumes of PPF (512.2 ± 289.9 mm3 vs. 710.9 ± 361.9 mm3, p = 0.01) and of thoracic fat volume (1,616 ± 614.8 mm3 vs. 2,000 ± 850.9 mm3, p = 0.02), compared to Group 1, but no differences were found regarding the total pericardial fat (p = 0.49). Patients with 3 or 4 vulnerability markers (VM) presented significantly larges PPF volumes compared to those with 1 or 2 VM, respectively (p = 0.008). There was a significant positive correlation between PPF volume and the non-calcified (r = 0.474, 95% CI 0.2797–0.6311, p <0.0001), lipid-rich (r = 0.316, 95% CI 0.099–0.504, p = 0.005), and fibro-fatty (r = 0.452, 95% CI 0.2541–0.6142, p <0.0001) volumes. The total pericardial fat was significantly correlated only with the volume of lipid-rich plaques (p = 0.02).

Conclusions: Periplaque fat volume was associated with a higher degree of coronary plaque vulnerability. PPF was correlated with lipid-rich, fibro-fatty, and non-calcified plaque-related volumes, as markers for enhanced plaque vulnerability. PPF volume, assessed with native cardiac computed tomography, could become a novel marker for coronary plaque vulnerability.

Is echocardiographic epicardial fat thickness increased in patients with coronary artery disease? A systematic review and meta-analysis

Background

The relation of epicardial fat thickness (EFT) to coronary artery disease (CAD) has recently been reported in multiple studies. Echocardiography is a safe and relatively inexpensive and accessible approach to assess regional EFT, which can be performed easily in many centers.

Objective

To determine the association between echocardiographic EFT and the presence or the absence of CAD.

Methods

This was a systematic review and meta-analysis conducted on literature available in electronic databases up to March 2018. The articles measuring EFT by echocardiography in the right ventricular (RV) free wall were included in the study. The quality of the enrolled items was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. The analyses were performed using the Comprehensive Meta-Analysis version 2 software. Cochran’s Q test and I² index were used to evaluate heterogeneity.

Results

This meta-analysis was performed on 13 studies involving 2,436 patients (1,622 with CAD, and 814 without CAD). The maximum EFT reported by echocardiography was 12.9±2.7 mm in the CAD group and 8.4±2.5 mm in the non-CAD group. The minimum EFT reported by echocardiography was 2.2±1.8 mm in the CAD group and 1.8±1.4 mm in the non-CAD group. The heterogeneity was found among the researched studies (I²=91.8%, p=0.000, Q-value=146.43, df [Q] =12) using the random effect model. The patients with CAD had a significantly higher echocardiographic EFT than those without CAD (SMD=1.03, 95% CI= 0.70–1.37, p=0.000).

Conclusion

According to the findings of this meta-analysis, the echocardiographic EFT in the subjects with CAD was significantly higher than that of those without CAD. The measurement of echocardiographic EFT seems to be an acceptable strategy for risk stratification of heart diseases considering ease of use, cost-effectiveness and non-exposure characteristics, compared to other imaging interventions.

The interplay between adipose tissue and the cardiovascular system: is fat always bad?

Obesity is a risk factor for cardiovascular disease (CVD). However, clinical research has revealed a paradoxically protective role for obesity in patients with chronic diseases including CVD, suggesting that the biological 'quality' of adipose tissue (AT) may be more important than overall AT mass or body weight. Importantly, AT is recognised as a dynamic organ secreting a wide range of biologically active adipokines, microRNAs, gaseous messengers, and other metabolites that affect the cardiovascular system in both endocrine and paracrine ways. Despite being able to mediate normal cardiovascular function under physiological conditions, AT undergoes a phenotypic shift characterised by acquisition of pro-oxidant and pro-inflammatory properties in cases of CVD. Crucially, recent evidence suggests that AT depots such as perivascular AT and epicardial AT are able to modify their phenotype in response to local signals of vascular and myocardial origin, respectively. Utilisation of this unique property of certain AT depots to dynamically track cardiovascular biology may reveal novel diagnostic and prognostic tools against CVD. Better understanding of the mechanisms controlling the 'quality' of AT secretome, as well as the communication links between AT and the cardiovascular system, is required for the efficient management of CVD.

Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium

Epicardial adipose tissue has unique properties that distinguish it from other depots of visceral fat. Rather than having distinct boundaries, the epicardium shares an unobstructed microcirculation with the underlying myocardium, and in healthy conditions, produces cytokines that nourish the heart. However, in chronic inflammatory disorders (especially those leading to heart failure with preserved ejection fraction), the epicardium becomes a site of deranged adipogenesis, leading to the secretion of proinflammatory adipokines that can cause atrial and ventricular fibrosis. Accordingly, in patients at risk of heart failure with preserved ejection fraction, drugs that promote the accumulation or inflammation of epicardial adipocytes may lead to heart failure, whereas treatments that ameliorate the proinflammatory characteristics of epicardial fat may reduce the risk of heart failure. These observations suggest that epicardial adipose tissue is a transducer of the adverse effects of systemic inflammation and metabolic disorders on the heart, and thus, represents an important target for therapeutic interventions.

Clinical importance of epicardial adipose tissue

Different visceral fat compartments have several systemic effects and may play a role in the development of both insulin resistance and cardiovascular diseases. In the last couple of years special attention has been paid to the epicardial adipose tissue (EAT), which can be quantified by non-invasive cardiac imaging techniques. The epicardial fat is a unique fat compartment between the myocardium and the visceral pericardium sharing a common embryologic origin with the visceral fat depot. Epicardial adipose tissue has several specific roles, and its local effects on cardiac function are incorporated in the complex pathomechanism of coronary artery disease. Importantly, EAT may produce several adipocytokines and chemokines that may influence - through paracrine and vasocrine effects - the development and progression of coronary atherosclerosis. Epicardial adipose tissue volume has a relatively strong genetic dependence, similarly to other visceral fat depots. In this article, the anatomical and physiological as well as pathophysiological characteristics of the epicardial fat compartment are reviewed.

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.

Epicardial Adipose Tissue (EAT) Thickness Is Associated with Cardiovascular and Liver Damage in Nonalcoholic Fatty Liver Disease

Background and Aims

Epicardial adipose tissue (EAT) has been proposed as a cardiometabolic and hepatic fibrosis risk factor in patients with non alcoholic fatty liver disease (NAFLD). Aim of this study was to evaluate the role of EAT in NAFLD by analyzing 1) the association between EAT, the other metabolic parameters and the severity of steatosis 2) the relationship between cardiovascular (cIMT, cplaques, E/A), liver (presence of NASH and significant fibrosis) damage and metabolic risk factors including EAT 3) the relationship between EAT and genetic factors strongly influencing liver steatosis.

Methods

In a cross-sectional study, we considered 512 consecutive patients with NAFLD (confirmed by biopsy in 100). EAT, severity of steatosis, carotid intima-media thickness (cIMT) and plaques were evaluated by ultrasonography and results analysed by multiple linear and logistic regression models. Variables independently associated with EAT (mm) were female gender (p = 0.003), age (p = 0.001), BMI (p = 0.01), diastolic blood pressure (p = 0.009), steatosis grade 2 (p = 0.01) and 3 (p = 0.04), fatty liver index (p = 0.001) and statin use (p = 0.03). Variables independently associated with carotid IMT were age (p = 0.0001), hypertension (p = 0.009), diabetes (p = 0.04), smoking habits (p = 0.04) and fatty liver index (p = 0.02), with carotid plaques age (p = 0.0001), BMI (p = 0.03), EAT (p = 0.02),) and hypertension (p = 0.02), and with E/A age (p = 0.0001), diabetes (p = 0.005), hypertension (p = 0.04) and fatty liver index (p = 0.004). In the 100 patients with available liver histology non alcoholic steatohepatitis (NASH) was independently associated with EAT (p = 0.04) and diabetes (p = 0.054) while significant fibrosis with EAT (p = 0.02), diabetes (p = 0.01) and waist circumference (p = 0.05). No association between EAT and PNPLA3 and TM6SF2 polymorphisms was found.

Conclusion

In patients with NAFLD, EAT is associated with the severity of liver and vascular damage besides with the known metabolic risk factors.