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Rezaeian P, Backlund JYC, Zaveri M, Nakanishi R, Matsumoto S, Alani A, Razipour A, Lachin JM, Budoff M. Epicardial and intra-thoracic adipose tissue and cardiovascular calcifications in type 1 diabetes (T1D) in epidemiology of diabetes Interventions and Complications (EDIC): A pilot study. Am J Prev Cardiol 2024; 18:100650. [PMID: 38584607 PMCID: PMC10995972 DOI: 10.1016/j.ajpc.2024.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Coronary artery, aortic valve, and descending aorta calcification (CAC, AVC, DAC) are manifestations of atherosclerosis, and cardiac epicardial adipose tissue (EAT) indicates heart adiposity. This study explored the association between cardiac adipose tissue and cardiovascular calcification in participants with long-standing T1D. Methods EAT and intra-thoracic adipose tissue (IAT) were measured in 100 T1D subjects with cardiac computed tomography (CT) scans in the EDIC study. Volume analysis software was used to measure fat volumes. Spearman correlations were calculated between CAC, AVC, DAC with EAT, and IAT. Associations were evaluated using multiple linear and logistic regression models. Results Participants ranged in age from 32 to 57. Mean EAT, and IAT were 38.5 and 50.8 mm3, respectively, and the prevalence of CAC, AVC, and DAC was 43.6 %, 4.7 %, and 26.8 %, respectively. CAC was positively correlated with age (p-value = 0.0001) and EAT (p-value = 0.0149) but not with AVC and DAC; IAT was not associated with calcified lesions. In models adjusted for age and sex, higher levels of EAT and IAT were associated with higher CAC (p-value < 0.0001 for both) and higher AVC (p-values of 0.0111 and 0.0053, respectively), but not with DAC. The associations with CAC remained significant (p-value < 0.0001) after further adjustment for smoking, systolic blood pressure, BMI, and LDL, while the associations with AVC did not remain significant. Conclusion In participants with T1D, higher EAT and IAT levels are correlated with higher CAC scores. EAT and IAT were not independently correlated with DAC or AVC.
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Affiliation(s)
- Panteha Rezaeian
- Torrance Memorial Physician Network-Cedars-Sinai Health System affiliate, Torrance, CA, USA
| | - Jye-Yu C Backlund
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Mohammed Zaveri
- Department of Medicine Emanate Health Medical Group, West Covina, CA, USA
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Suguru Matsumoto
- Department of Cardiology, Kouiki Monbetsu Hospital, Hokkaido, Japan
| | - Anas Alani
- Department of Cardiology, University of Loma Linda, Loma Linda, CA, USA
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John M Lachin
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Matthew Budoff
- Lindquist Research Institute, Harbor-UCLA Medical Center, 1124W Carson St, Torrance, CA 90502, USA
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Kitagawa T, Sentani K, Ikegami Y, Takasaki T, Takahashi S, Nakano Y. Relationship Between Clinical Parameters and Histological Features of Epicardial Adipose Tissue and Aortic Valve Calcification Assessed on Computed Tomography. Circ J 2024:CJ-24-0226. [PMID: 38763753 DOI: 10.1253/circj.cj-24-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND The relationships of the clinical and biological attributes of epicardial adipose tissue (EAT) with aortic valve calcification (AVC) have not been characterized. We evaluated the relationships of the clinical and histological features of EAT with AVC assessed using computed tomography (CT).Methods and Results: We enrolled 43 patients undergoing cardiac CT examination prior to elective cardiac surgery in whom AVC was identified on CT. EAT volume and density, coronary calcium score (CCS), AVC score (AVCS), and coronary atherosclerosis on CT angiography were evaluated in each patient. During cardiac surgery, 2 EAT samples were obtained for immunohistochemistry. The number of CD68- and CD11c-positive macrophages and osteocalcin-positive cells was counted in 6 random high-power fields of EAT sections. EAT density, but not EAT volume normalized to body surface area, was positively correlated with the number of macrophages and osteocalcin-positive cells in EAT. There was a positive correlation between ln(AVCS), but not ln(CCS+1), and the number of macrophages and osteocalcin-positive cells in EAT. Multivariate analysis revealed significant positive correlations for ln(AVCS) with EAT density (β=0.42; P=0.0072) and the number of CD68-positive macrophages (β=0.57; P=0.0022), CD11c-positive macrophages (β=0.62; P=0.0003), and osteocalcin-positive cells (β=0.52; P=0.0021) in EAT. CONCLUSIONS Inflammation and osteogenesis in EAT, reflected by high CT density, are associated with the severity of AVC representing aortic valve degeneration.
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Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences
| | - Yuki Ikegami
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Taiichi Takasaki
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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3
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Cho DH, Park SM. Epicardial Adipose Tissue and Heart Failure, Friend or Foe? Diabetes Metab J 2024; 48:373-384. [PMID: 38310880 DOI: 10.4093/dmj.2023.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024] Open
Abstract
Heart failure (HF) management guidelines recommend individualized assessments based on HF phenotypes. Adiposity is a known risk factor for HF. Recently, there has been an increased interest in organ-specific adiposity, specifically the role of the epicardial adipose tissue (EAT), in HF risk. EAT is easily assessable through various imaging modalities and is anatomically and functionally connected to the myocardium. In pathological conditions, EAT secretes inflammatory cytokines, releases excessive fatty acids, and increases mechanical load on the myocardium, resulting in myocardial remodeling. EAT plays a pathophysiological role in characterizing both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). In HFrEF, EAT volume is reduced, reflecting an impaired metabolic reservoir, whereas in HFpEF, the amount of EAT is associated with worse biomarker and hemodynamic profiles, indicating increased EAT activity. Studies have examined the possibility of therapeutically targeting EAT, and recent studies using sodium glucose cotransporter 2 inhibitors have shown potential in reducing EAT volume. However, further research is required to determine the clinical implications of reducing EAT activity in patients with HF.
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Affiliation(s)
- Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Krauz K, Kempiński M, Jańczak P, Momot K, Zarębiński M, Poprawa I, Wojciechowska M. The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration. Int J Mol Sci 2024; 25:3583. [PMID: 38612394 PMCID: PMC11011833 DOI: 10.3390/ijms25073583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
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.
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Affiliation(s)
- Kamil Krauz
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Marcel Kempiński
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Paweł Jańczak
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Karol Momot
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
| | - Maciej Zarębiński
- Department of Invasive Cardiology, Independent Public Specialist Western Hospital John Paul II, Lazarski University, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland; (M.Z.); (I.P.)
| | - Izabela Poprawa
- Department of Invasive Cardiology, Independent Public Specialist Western Hospital John Paul II, Lazarski University, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland; (M.Z.); (I.P.)
| | - Małgorzata Wojciechowska
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (K.K.); (M.K.); (P.J.); (K.M.)
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5
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Santos da Silva G, Casanova D, Oliva JT, Rodrigues EO. Cardiac fat segmentation using computed tomography and an image-to-image conditional generative adversarial neural network. Med Eng Phys 2024; 124:104104. [PMID: 38418017 DOI: 10.1016/j.medengphy.2024.104104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/17/2023] [Accepted: 01/09/2024] [Indexed: 03/01/2024]
Abstract
In recent years, research has highlighted the association between increased adipose tissue surrounding the human heart and elevated susceptibility to cardiovascular diseases such as atrial fibrillation and coronary heart disease. However, the manual segmentation of these fat deposits has not been widely implemented in clinical practice due to the substantial workload it entails for medical professionals and the associated costs. Consequently, the demand for more precise and time-efficient quantitative analysis has driven the emergence of novel computational methods for fat segmentation. This study presents a novel deep learning-based methodology that offers autonomous segmentation and quantification of two distinct types of cardiac fat deposits. The proposed approach leverages the pix2pix network, a generative conditional adversarial network primarily designed for image-to-image translation tasks. By applying this network architecture, we aim to investigate its efficacy in tackling the specific challenge of cardiac fat segmentation, despite not being originally tailored for this purpose. The two types of fat deposits of interest in this study are referred to as epicardial and mediastinal fats, which are spatially separated by the pericardium. The experimental results demonstrated an average accuracy of 99.08% and f1-score 98.73 for the segmentation of the epicardial fat and 97.90% of accuracy and f1-score of 98.40 for the mediastinal fat. These findings represent the high precision and overlap agreement achieved by the proposed methodology. In comparison to existing studies, our approach exhibited superior performance in terms of f1-score and run time, enabling the images to be segmented in real time.
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Affiliation(s)
- Guilherme Santos da Silva
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil
| | - Dalcimar Casanova
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil
| | - Jefferson Tales Oliva
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil
| | - Erick Oliveira Rodrigues
- Academic Department of Informatics, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil; Graduate Program of Production and Systems Engineering, Universidade Tecnológica Federal do Paraná (UTFPR), Pato Branco, 85503-390, Brazil.
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Akan G, Nyawawa E, Nyangasa B, Turkcan MK, Mbugi E, Janabi M, Atalar F. Severity of coronary artery disease is associated with diminished circANRIL expression: A possible blood based transcriptional biomarker in East Africa. J Cell Mol Med 2024; 28:e18093. [PMID: 38149798 PMCID: PMC10844708 DOI: 10.1111/jcmm.18093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023] Open
Abstract
Antisense Noncoding RNA in the INK4 Locus (ANRIL) is the prime candidate gene at Chr9p21, the well-defined genetic risk locus associated with coronary artery disease (CAD). ANRIL and its transcript variants were investigated for the susceptibility to CAD in adipose tissues (AT) and peripheral blood mononuclear cells (PBMCs) of the study group and the impact of 9p21.3 locus mutations was further analysed. Expressions of ANRIL, circANRIL (hsa_circ_0008574), NR003529, EU741058 and DQ485454 were detected in epicardial AT (EAT) mediastinal AT (MAT), subcutaneous AT (SAT) and PBMCs of CAD patients undergoing coronary artery bypass grafting and non-CAD patients undergoing heart valve surgery. ANRIL expression was significantly upregulated, while the expression of circANRIL was significantly downregulated in CAD patients. Decreased circANRIL levels were significantly associated with the severity of CAD and correlated with aggressive clinical characteristics. rs10757278 and rs10811656 were significantly associated with ANRIL and circANRIL expressions in AT and PBMCs. The ROC-curve analysis suggested that circANRIL has high diagnostic accuracy (AUC: 0.9808, cut-off: 0.33, sensitivity: 1.0, specificity: 0.88). circANRIL has high diagnostic accuracy (AUC: 0.9808, cut-off: 0.33, sensitivity: 1.0, specificity: 0.88). We report the first data demonstrating the presence of ANRIL and its transcript variants expressions in the AT and PBMCs of CAD patients. circANRIL having a synergetic effect with ANRIL plays a protective role in CAD pathogenesis. Therefore, altered circANRIL expression may become a potential diagnostic transcriptional biomarker for early CAD diagnosis.
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Affiliation(s)
- Gokce Akan
- Biochemistry Department, MUHAS Genetics Laboratory, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
- Near East UniversityDESAM Research InstituteMersinNorth CyprusTurkey
| | | | | | | | - Erasto Mbugi
- Biochemistry Department, MUHAS Genetics Laboratory, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | | | - Fatmahan Atalar
- Biochemistry Department, MUHAS Genetics Laboratory, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
- Department of Rare DiseasesIstanbul University, Child Health InstituteIstanbulTurkey
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7
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Esposito F, Mezzanotte V, Tesei C, Luciano A, Gigliotti PE, Nunzi A, Secchi R, Angeloni C, Pitaro M, Meconi F, Cerocchi M, Garaci F, Venditti A, Postorino M, Chiocchi M. CT Images in Follicular Lymphoma: Changes after Treatment Are Predictive of Cardiac Toxicity in Patients Treated with Anthracycline-Based or R-B Regimens. Cancers (Basel) 2024; 16:563. [PMID: 38339313 PMCID: PMC10854703 DOI: 10.3390/cancers16030563] [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: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
The aim of this study is to evaluate changes in epicardial adipose tissue (EAT) and cardiac extracellular volume (ECV) in patients with follicular lymphoma (FL) treated with R-CHOP-like regimens or R-bendamustine. We included 80 patients with FL between the ages of 60 and 80 and, using computed tomography (CT) performed at onset and at the end of treatment, we assessed changes in EAT by measuring tissue density at the level of the cardiac apex, anterior interventricular sulcus and posterior interventricular sulcus of the heart. EAT is known to be associated with metabolic syndrome, increased calcium in the coronary arteries and therefore increased risk of coronary artery disease. We also evaluated changes in ECV, which can be used as an early imaging marker of cardiac fibrosis and thus myocardial damage. The R-CHOP-like regimen was associated with lower EAT values (p < 0.001), indicative of a less active metabolism and more adipose tissue, and an increase in ECV (p < 0.001). Furthermore, in patients treated with anthracyclines and steroids (R-CHOP-like) there is a greater decrease in ejection fraction (EF p < 0.001) than in the R-B group. EAT and ECV may represent early biomarkers of cardiological damage, and this may be considered, to our knowledge, the first study investigating radiological and cardiological parameters in patients with FL.
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Affiliation(s)
- Fabiana Esposito
- Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (V.M.); (C.T.); (A.N.); (R.S.); (A.V.); (M.P.)
| | - Valeria Mezzanotte
- Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (V.M.); (C.T.); (A.N.); (R.S.); (A.V.); (M.P.)
| | - Cristiano Tesei
- Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (V.M.); (C.T.); (A.N.); (R.S.); (A.V.); (M.P.)
| | - Alessandra Luciano
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy; (A.L.); (P.E.G.); (C.A.); (M.P.); (M.C.); (F.G.); (M.C.)
| | - Paola Elda Gigliotti
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy; (A.L.); (P.E.G.); (C.A.); (M.P.); (M.C.); (F.G.); (M.C.)
| | - Andrea Nunzi
- Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (V.M.); (C.T.); (A.N.); (R.S.); (A.V.); (M.P.)
| | - Roberto Secchi
- Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (V.M.); (C.T.); (A.N.); (R.S.); (A.V.); (M.P.)
| | - Cecilia Angeloni
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy; (A.L.); (P.E.G.); (C.A.); (M.P.); (M.C.); (F.G.); (M.C.)
| | - Maria Pitaro
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy; (A.L.); (P.E.G.); (C.A.); (M.P.); (M.C.); (F.G.); (M.C.)
| | - Federico Meconi
- Fondazione Policlinico di Roma Tor Vergata, 00133 Rome, Italy;
| | - Martina Cerocchi
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy; (A.L.); (P.E.G.); (C.A.); (M.P.); (M.C.); (F.G.); (M.C.)
| | - Francesco Garaci
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy; (A.L.); (P.E.G.); (C.A.); (M.P.); (M.C.); (F.G.); (M.C.)
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (V.M.); (C.T.); (A.N.); (R.S.); (A.V.); (M.P.)
| | - Massimiliano Postorino
- Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (V.M.); (C.T.); (A.N.); (R.S.); (A.V.); (M.P.)
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy; (A.L.); (P.E.G.); (C.A.); (M.P.); (M.C.); (F.G.); (M.C.)
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Romano AD, La Marca A, Villani R, Sangineto M, Manuppelli V, Brunetti ND, Vendemiale G, Serviddio G. Exploring the Relationship between Epicardial Fat Thickness and Coronary Revascularization: Implications for Cardiovascular Health. J Clin Med 2023; 13:247. [PMID: 38202255 PMCID: PMC10779954 DOI: 10.3390/jcm13010247] [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: 11/29/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND this study aimed to assess the complex relationship between EAT thickness, as measured with echocardiography, and the severity of coronary artery disease (CAD). We investigated whether individuals with higher EAT thickness underwent coronary revascularization. Subsequently, we conducted a three-year follow-up to explore any potential modifications in EAT depots post-angioplasty. METHODS we conducted a prospective and retrospective cross-sectional observational study involving 150 patients consecutively referred for acute coronary syndrome, including ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. Upon admission (T0), all patients underwent coronary angiography to assess the number of pathologic coronary vessels. Percutaneous transluminal coronary angioplasty (PTCA) was performed based on angiogram results if indicated. The sample was categorized into two groups: non-revascularized (no-PTCA) and revascularized (PTCA). Transthoracic echocardiograms to measure epicardial fat thickness were conducted at admission (T0) and after a 3-year follow-up (T1). RESULTS AND CONCLUSIONS findings revealed a positive correlation between EAT thickness and the severity of coronary artery disease (CAD), with patients undergoing PTCA showing decreased EAT thickness after three years. Echocardiography demonstrated reliability in assessing EAT, offering potential for risk stratification. The study introduces a cut-off value of 0.65 cm as a diagnostic tool for cardiovascular risk. Incorporating EAT measurements into clinical practice may lead to more precise risk stratification and tailored treatment strategies, ultimately reducing the burden of cardiovascular disease.
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Affiliation(s)
- Antonino Davide Romano
- Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti 71122 Foggia, Italy; (A.L.M.); (R.V.); (M.S.); (G.S.)
| | - Antonella La Marca
- Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti 71122 Foggia, Italy; (A.L.M.); (R.V.); (M.S.); (G.S.)
| | - Rosanna Villani
- Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti 71122 Foggia, Italy; (A.L.M.); (R.V.); (M.S.); (G.S.)
| | - Moris Sangineto
- Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti 71122 Foggia, Italy; (A.L.M.); (R.V.); (M.S.); (G.S.)
| | - Vincenzo Manuppelli
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122 Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122 Foggia, Italy
| | - Gianluigi Vendemiale
- Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti 71122 Foggia, Italy; (A.L.M.); (R.V.); (M.S.); (G.S.)
| | - Gaetano Serviddio
- Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti 71122 Foggia, Italy; (A.L.M.); (R.V.); (M.S.); (G.S.)
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Song Y, Tan Y, Deng M, Shan W, Zheng W, Zhang B, Cui J, Feng L, Shi L, Zhang M, Liu Y, Sun Y, Yi W. Epicardial adipose tissue, metabolic disorders, and cardiovascular diseases: recent advances classified by research methodologies. MedComm (Beijing) 2023; 4:e413. [PMID: 37881786 PMCID: PMC10594046 DOI: 10.1002/mco2.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Epicardial adipose tissue (EAT) is located between the myocardium and visceral pericardium. The unique anatomy and physiology of the EAT determines its great potential in locally influencing adjacent tissues such as the myocardium and coronary arteries. Classified by research methodologies, this study reviews the latest research progress on the role of EAT in cardiovascular diseases (CVDs), particularly in patients with metabolic disorders. Studies based on imaging techniques demonstrated that increased EAT amount in patients with metabolic disorders is associated with higher risk of CVDs and increased mortality. Then, in-depth profiling studies indicate that remodeled EAT may serve as a local mediator of the deleterious effects of cardiometabolic conditions and plays a crucial role in CVDs. Further, in vitro coculture studies provided preliminary evidence that the paracrine effect of remodeled EAT on adjacent cardiomyocytes can promote the occurrence and progression of CVDs. Considering the important role of EAT in CVDs, targeting EAT might be a potential strategy to reduce cardiovascular risks. Several interventions have been proved effective in reducing EAT amount. Our review provides valuable insights of the relationship between EAT, metabolic disorders, and CVDs, as well as an overview of the methodological constructs of EAT-related studies.
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Affiliation(s)
- Yujie Song
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Yanzhen Tan
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Meng Deng
- Department of General MedicineXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wenju Shan
- Department of General MedicineXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wenying Zheng
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Bing Zhang
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Jun Cui
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Lele Feng
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Lei Shi
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Miao Zhang
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Yingying Liu
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Yang Sun
- Department of General MedicineXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wei Yi
- Department of Cardiovascular SurgeryXijing HospitalThe Fourth Military Medical UniversityXi'anChina
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Kuno T, Arce J, Fattouh M, Sarkar S, Skendelas JP, Daich J, Schenone AL, Zhang L, Rodriguez CJ, Virani SS, Slomka PJ, Shaw LJ, Williamson EE, Berman DS, Garcia MJ, Dey D, Slipczuk L. Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population. Am J Prev Cardiol 2023; 15:100578. [PMID: 37675408 PMCID: PMC10477443 DOI: 10.1016/j.ajpc.2023.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation. Methods The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death. Results A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797). Conclusion The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.
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Affiliation(s)
- Toshiki Kuno
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Javier Arce
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Michael Fattouh
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Sharmila Sarkar
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - John P Skendelas
- Cardiothoracic and Vascular Surgery Department, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jonathan Daich
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Carlos J Rodriguez
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Piotr J Slomka
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Daniel S Berman
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, United States
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, United States
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Montefiore Medical Center/Albert Einstein Colalege of Medicine, Cardiology Division. 111 E210th, Bronx, NY 10467, United States
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11
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Mukherjee AG, Renu K, Gopalakrishnan AV, Jayaraj R, Dey A, Vellingiri B, Ganesan R. Epicardial adipose tissue and cardiac lipotoxicity: A review. Life Sci 2023; 328:121913. [PMID: 37414140 DOI: 10.1016/j.lfs.2023.121913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
Epicardial adipose tissue (EAT) has morphological and physiological contiguity with the myocardium and coronary arteries, making it a visceral fat deposit with some unique properties. Under normal circumstances, EAT exhibits biochemical, mechanical, and thermogenic cardioprotective characteristics. Under clinical processes, epicardial fat can directly impact the heart and coronary arteries by secreting proinflammatory cytokines via vasocrine or paracrine mechanisms. It is still not apparent what factors affect this equilibrium. Returning epicardial fat to its physiological purpose may be possible by enhanced local vascularization, weight loss, and focused pharmacological therapies. This review centers on EAT's developing physiological and pathophysiological dimensions and its various and pioneering clinical utilities.
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Affiliation(s)
- Anirban Goutam Mukherjee
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, India
| | - Kaviyarasi Renu
- Centre of Molecular Medicine and Diagnostics (COMManD), Department of Biochemistry, Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, India.
| | - Rama Jayaraj
- Jindal Institute of Behavioral Sciences (JIBS), Jindal Global Institution of Eminence Deemed to Be University, 28, Sonipat 131001, India; Director of Clinical Sciences, Northern Territory Institute of Research and Training, Darwin, NT 0909, Australia
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, West Bengal 700073, India
| | - Balachandar Vellingiri
- Stem cell and Regenerative Medicine/Translational Research, Department of Zoology, School of Basic Sciences, Central University of Punjab (CUPB), Bathinda 151401, Punjab, India
| | - Raja Ganesan
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Republic of Korea
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12
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Soghomonian A, Gaborit B, Carbone F, Castinetti F, Dutour A. Editorial: Cardiac fat in metabolic and endocrine diseases. Front Endocrinol (Lausanne) 2023; 14:1271565. [PMID: 37727453 PMCID: PMC10506075 DOI: 10.3389/fendo.2023.1271565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Astrid Soghomonian
- Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
- Endocrinology, Metabolic Diseases and Nutrition Department, AP-HM, Marseille, France
| | - Bénédicte Gaborit
- Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
- Endocrinology, Metabolic Diseases and Nutrition Department, AP-HM, Marseille, France
| | - Federico Carbone
- First Clinic of internal Medicine, Department of Internal Medicine, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova – Italian Cardiovascular Network, Genova, Italy
| | - Frédéric Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
- Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares Hypophysaires HYPO, AP-HM, Marseille, France
| | - Anne Dutour
- Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
- Endocrinology, Metabolic Diseases and Nutrition Department, AP-HM, Marseille, France
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13
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Pugliese L, Ricci F, Sica G, Scaglione M, Masala S. Non-Contrast and Contrast-Enhanced Cardiac Computed Tomography Imaging in the Diagnostic and Prognostic Evaluation of Coronary Artery Disease. Diagnostics (Basel) 2023; 13:2074. [PMID: 37370969 DOI: 10.3390/diagnostics13122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
In recent decades, cardiac computed tomography (CT) has emerged as a powerful non-invasive tool for risk stratification, as well as the detection and characterization of coronary artery disease (CAD), which remains the main cause of morbidity and mortality in the world. Advances in technology have favored the increasing use of cardiac CT by allowing better performance with lower radiation doses. Coronary artery calcium, as assessed by non-contrast CT, is considered to be the best marker of subclinical atherosclerosis, and its use is recommended for the refinement of risk assessment in low-to-intermediate risk individuals. In addition, coronary CT angiography (CCTA) has become a gate-keeper to invasive coronary angiography (ICA) and revascularization in patients with acute chest pain by allowing the assessment not only of the extent of lumen stenosis, but also of its hemodynamic significance if combined with the measurement of fractional flow reserve or perfusion imaging. Moreover, CCTA provides a unique incremental value over functional testing and ICA by imaging the vessel wall, thus allowing the assessment of plaque burden, composition, and instability features, in addition to perivascular adipose tissue attenuation, which is a marker of vascular inflammation. There exists the potential to identify the non-obstructive lesions at high risk of progression to plaque rupture by combining all of these measures.
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Affiliation(s)
- Luca Pugliese
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Francesca Ricci
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, 80131 Napoli, Italy
| | - Mariano Scaglione
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Salvatore Masala
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
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14
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Song XT, Wei YL, Rui YF, Fan L. Echocardiographic evaluation of the effect of dapagliflozin on epicardial adipose tissue and left ventricular systolic function in type 2 diabetes mellitus. J Diabetes Complications 2023; 37:108509. [PMID: 37235925 DOI: 10.1016/j.jdiacomp.2023.108509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND AIMS Epicardial adipose tissue (EAT) is associated with cardiovascular disease, and sodium-glucose cotransporter-2 inhibitors (SGLT-2I) have been reported to reduce the occurrence of cardiovascular events. This study was designed to investigate the effect of an SGLT-2 inhibitor (dapagliflozin) on EAT and left ventricular (LV) systolic function in type 2 diabetes mellitus (T2DM) patients during a 6-month follow-up. METHODS Twenty-seven T2DM patients who received dapagliflozin for the first time were enrolled in this study to measure EAT thickness and evaluate LV function before and after 6 months of SGLT-2 administration. The thickness of EAT was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of the pericardium at end-systole by echocardiography. LV systolic function was evaluated by LV global longitudinal strain (LV GLS) obtained through two-dimensional speckle tracking echocardiography (2D-STE) technology. RESULTS After a 6-month follow-up, twenty-five patients completed this study. The values of EAT thickness, HbA1c, body weight, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly reduced, while the LV GLS value was significantly increased. Moreover, the increase in LV GLS was independently associated with the reduction in EAT thickness, HbA1c, weight, and SBP (all p < 0.05). CONCLUSIONS Dapagliflozin can reduce EAT thickness and improve LV systolic function in T2DM patients. 2D-STE can be used for the early evaluation of the beneficial effect of dapagliflozin on LV systolic function. The improvement in LV systolic function is independently associated with a reduction in EAT thickness.
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Affiliation(s)
- Xiang-Ting Song
- Department of Echocardiography, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Yu-Long Wei
- Department of Risk Management, Suning Bank, Nanjing, Jiangsu 210006, China
| | - Yi-Fei Rui
- Department of Echocardiography, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Li Fan
- Department of Echocardiography, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China.
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15
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Rossi VA, Gruebler M, Monzo L, Galluzzo A, Beltrami M. The Different Pathways of Epicardial Adipose Tissue across the Heart Failure Phenotypes: From Pathophysiology to Therapeutic Target. Int J Mol Sci 2023; 24:6838. [PMID: 37047810 PMCID: PMC10095298 DOI: 10.3390/ijms24076838] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Epicardial adipose tissue (EAT) is an endocrine and paracrine organ constituted by a layer of adipose tissue directly located between the myocardium and visceral pericardium. Under physiological conditions, EAT exerts protective effects of brown-like fat characteristics, metabolizing excess fatty acids, and secreting anti-inflammatory and anti-fibrotic cytokines. In certain pathological conditions, EAT acquires a proatherogenic transcriptional profile resulting in increased synthesis of biologically active adipocytokines with proinflammatory properties, promoting oxidative stress, and finally causing endothelial damage. The role of EAT in heart failure (HF) has been mainly limited to HF with preserved ejection fraction (HFpEF) and related to the HFpEF obese phenotype. In HFpEF, EAT seems to acquire a proinflammatory profile and higher EAT values have been related to worse outcomes. Less data are available about the role of EAT in HF with reduced ejection fraction (HFrEF). Conversely, in HFrEF, EAT seems to play a nutritive role and lower values may correspond to the expression of a catabolic, adverse phenotype. As of now, there is evidence that the beneficial systemic cardiovascular effects of sodium-glucose cotransporter-2 receptors-inhibitors (SGLT2-i) might be partially mediated by inducing favorable modifications on EAT. As such, EAT may represent a promising target organ for the development of new drugs to improve cardiovascular prognosis. Thus, an approach based on detailed phenotyping of cardiac structural alterations and distinctive biomolecular pathways may change the current scenario, leading towards a precision medicine model with specific therapeutic targets considering different individual profiles. The aim of this review is to summarize the current knowledge about the biomolecular pathway of EAT in HF across the whole spectrum of ejection fraction, and to describe the potential of EAT as a therapeutic target in HF.
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Affiliation(s)
- Valentina A. Rossi
- University Heart Center, Department of Cardiology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Martin Gruebler
- Regional Hospital Neustadt, 2700 Wiener Neustadt, Austria
- Faculty of Medicine, Medical University of Graz, 8036 Graz, Austria
- Faculty of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Luca Monzo
- Centre d’Investigations Cliniques Plurithématique 1433 and Inserm U1116, Université de Lorraine, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), 54035 Nancy, France
| | | | - Matteo Beltrami
- Azienda USL Toscana Centro, Cardiology Unit, San Giovanni di Dio Hospital, 50143 Florence, Italy;
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16
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Song XT, Rui YF, Fan L, Yan ZN. Echocardiographic Association of Epicardial Adipose Tissue with Ascending Aorta Elasticity in Patients with Type 2 Diabetes Mellitus. Angiology 2023; 74:325-332. [PMID: 35710356 DOI: 10.1177/00033197221098298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epicardial adipose tissue (EAT) is an emerging cardiovascular risk factor located between the myocardium and visceral pericardium. In order to investigate the association between EAT and ascending aorta elasticity in patients with type 2 diabetes mellitus (T2DM), we prospectively enrolled a total of 135 T2DM patients and 63 age- and gender-matched non-T2DM controls in this study. They all underwent transthoracic echocardiography to measure EAT thickness and ascending aorta inner diameters which were used to calculate ascending aorta elastic parameters: compliance (C), distensibility (D), strain (S), stiffness index (SI), and Peterson's elastic modulus (EM). We found that the values of C, D, and S were significantly lower, while SI, EM, and EAT thickness were significantly higher in T2DM patients compared with non-T2DM controls. Compared with T2DM patients with EAT < 5 mm group, C, D, and S were significantly reduced, SI and EM were significantly increased in T2DM patients with EAT ≥ 5 mm group (all P < .05). Bivariate correlation and multivariate linear regression analysis revealed that EAT was independently associated with ascending aorta elasticity. Our findings suggest that thickened EAT in patients with T2DM is associated with ascending aorta elasticity, independent of blood glucose.
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Affiliation(s)
- Xiang-Ting Song
- Department of Echocardiography, 599923The Affiliated Changzhou No 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yi-Fei Rui
- Department of Echocardiography, 599923The Affiliated Changzhou No 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li Fan
- Department of Echocardiography, 599923The Affiliated Changzhou No 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Zi-Ning Yan
- Department of Echocardiography, 599923The Affiliated Changzhou No 2 People's Hospital of Nanjing Medical University, Changzhou, China
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17
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Pre-diabetes is associated with attenuation rather than volume of epicardial adipose tissue on computed tomography. Sci Rep 2023; 13:1623. [PMID: 36709226 PMCID: PMC9884303 DOI: 10.1038/s41598-023-28679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023] Open
Abstract
The volume of epicardial adipose tissue (EATV) is increased in type-2 diabetes (T2D), while its attenuation (EATA) appears to be decreased. Similar patterns have been suggested in pre-diabetes, but data is scarce. In both pre-diabetes and T2D, any independent role of EATV and EATA in disease development remains to be proven, a task complicated by their substantial co-variation with other anthropometrics, e.g. BMI, waist circumference, and abdominal visceral adipose tissue (VAT). EATV and EATA was quantified in computed tomography (CT) images in a population study (n = 1948) using an automatic technique. Data was available on BMI, waist circumference, abdominal visceral adipose tissue (VAT) area, insulin resistance (IR) and glucose tolerance, the latter ranging from normal (NGT), over pre-diabetes (impaired fasting glucose [IFG, n = 414] impaired glucose tolerance [IGT, n = 321] and their combination [CGI, n = 128]), to T2D. EATV was increased in pre-diabetes, T2D and IR in univariable analyses and when adjusting for BMI, however not when adjusting for waist or VAT. EATA was reduced in pre-diabetes, T2D and IR in univariable analyses and when adjusting for BMI and waist, however not when adjusting for VAT. Adjustment for other co-variates had little influence on the results. In conclusion, EATV is increased and EATA reduced in pre-diabetes, T2D and IR, however, significant co-variation with other anthropometrics, especially VAT, obscures their function in disease development. The current results do not exclude a pathophysiological role of epicardial fat, but future studies need to adjust for anthropometrics, or focus on the microenvironment within the pericardial sac.
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Evsen A, Demir M, Günlü S. Evaluation of epicardial fat tissue and echocardiographic parameters in patients with silent enemy subclinical hypothyroidism. Echocardiography 2022; 39:1426-1433. [PMID: 36266735 DOI: 10.1111/echo.15471] [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: 07/08/2022] [Revised: 09/03/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To evaluate epicardial adipose tissue (EAT) which is known to be closely associated with metabolic syndrome and cardiovascular risk factors (hypertension, diabetes mellitus, obesity, age, smoking) and which is a more specific marker of visceral adiposity than waist circumference using echocardiographic examination in subclinical hypothyroidism which is one of the most common endocrine system diseases in the community but is mostly missed due to its asymptomatic nature. MATERIALS AND METHODS The study included 60 individuals aged 18-65 years, comprising 30 patients with newly diagnosed subclinical hypothyroidism and 30 age- and gender-matched control subjects that had a normal thyroid hormone profile. 2D transthoracic echocardiography was utilized for measuring EAT thickness and other basic echocardiographic parameters. RESULTS No significant difference was found between the two groups with regard to gender, age, body mass index (BMI), and other diameters and measurements obtained by 2D transthoracic echocardiography. EAT thickness was significantly higher in the patient group compared to the control group (p < .001). CONCLUSION Epicardial adipose tissue (EAT) is increased in patients with subclinical hypothyroidism.
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Affiliation(s)
- Ali Evsen
- Department of Cardiology, Dağkapı State Hospital, Diyarbakır, Turkey
| | - Muhammed Demir
- Department of Cardiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Serhat Günlü
- Department of Cardiology, Dağkapı State Hospital, Diyarbakır, Turkey
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Cheładze P, Martuszewski A, Poręba R, Gać P. The Importance of the Assessment of Epicardial Adipose Tissue in Scientific Research. J Clin Med 2022; 11:jcm11195621. [PMID: 36233489 PMCID: PMC9570982 DOI: 10.3390/jcm11195621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Epicardial adipose tissue (EAT) exhibits morphological similarities with pericardial adipose tissue, however, it has different embryological origin and vascularization. EAT is a metabolically active organ and a major source of anti-inflammatory and proinflammatory adipokines, which have a significant impact on cardiac function and morphology. Moreover, it can regulate vascular tone by releasing various molecules. The relationship between EAT and cardiovascular disease and diseases of other organ systems is now considered a common discussion subject. The present clinical review article summarizes the epidemiological findings based on imaging techniques in studies conducted so far. In conclusion, evaluation of the epicardial adipose tissue constitutes a helpful scientific parameter, which can be assessed by means of different diagnostic imaging examinations.
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Affiliation(s)
- Przemysław Cheładze
- Centre for Diagnostic Imaging, 4th Military Hospital, Weigla 5, PL 50-981 Wroclaw, Poland
| | - Adrian Martuszewski
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland
| | - Rafał Poręba
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland
| | - Paweł Gać
- Centre for Diagnostic Imaging, 4th Military Hospital, Weigla 5, PL 50-981 Wroclaw, Poland
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland
- Correspondence: or
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Systematic Review and Meta-Analysis of the Usefulness of Epicardial Fat Thickness as a Non-Invasive Marker of the Presence and Severity of Nonalcoholic Fatty Liver Disease. Biomedicines 2022; 10:biomedicines10092204. [PMID: 36140303 PMCID: PMC9496452 DOI: 10.3390/biomedicines10092204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
We performed a systematic review and meta-analysis to assess the association between epicardial fat thickness (EFT) and nonalcoholic fatty liver disease (NAFLD). This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) and was based on a registered protocol (CRD 4201809 5493). We searched Medline and Embase until December 2021 for studies reporting on the association between EFT and NAFLD. Qualitative reviews, meta-analyses and meta-regressions were performed to explore this association. Effect sizes are reported as standardized mean differences. We included 12 studies, comprising 3610 individuals. EFT was evaluated with trans-thoracic echocardiography in nine studies, two studies using cardiac computed tomography and one study using magnetic resonance imaging (MRI). The presence of NAFLD was evaluated using transabdominal liver ultrasound in nine studies. Other studies used histology, magnetic resonance spectroscopy and MRI-derived proton density fat fraction. Liver biopsy was performed to assess the severity of NAFLD in four studies. The random-effects meta-analysis indicated that, as compared to control patients with lean livers, patients with NAFLD displayed significantly higher EFT (standardized mean difference 0.61, 95% confidence interval: 0.47−0.75, p < 0.0001, I2 = 72%). EFT was further significantly higher in patients with severe liver steatosis versus patients with mild−moderate liver steatosis (standardized mean difference 1.21 95% confidence interval: 0.26−2.16, p < 0.001, I2 S = 96%). Through the meta-regression analysis, we found that patients with increasingly higher blood levels of aspartate aminotransferase displayed an increasingly higher depth of association. The current meta-analysis suggests that EFT may represent a useful surrogate for assessing the presence and severity of NAFLD in a non-invasive manner.
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Krishnan A, Sharma H, Yuan D, Trollope AF, Chilton L. The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review. J Cardiovasc Dev Dis 2022; 9:jcdd9070217. [PMID: 35877579 PMCID: PMC9318726 DOI: 10.3390/jcdd9070217] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 12/07/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a significant burden globally and are especially prevalent in obese and/or diabetic populations. Epicardial adipose tissue (EAT) surrounding the heart has been implicated in the development of CVDs as EAT can shift from a protective to a maladaptive phenotype in diseased states. In diabetic and obese patients, an elevated EAT mass both secretes pro-fibrotic/pro-inflammatory adipokines and forms intramyocardial fibrofatty infiltrates. This narrative review considers the proposed pathophysiological roles of EAT in CVDs. Diabetes is associated with a disordered energy utilization in the heart, which promotes intramyocardial fat and structural remodeling. Fibrofatty infiltrates are associated with abnormal cardiomyocyte calcium handling and repolarization, increasing the probability of afterdepolarizations. The inflammatory phenotype also promotes lateralization of connexin (Cx) proteins, undermining unidirectional conduction. These changes are associated with conduction heterogeneity, together creating a substrate for atrial fibrillation (AF). EAT is also strongly implicated in coronary artery disease (CAD); inflammatory adipokines from peri-vascular fat can modulate intra-luminal homeostasis through an “outside-to-inside” mechanism. EAT is also a significant source of sympathetic neurotransmitters, which promote progressive diastolic dysfunction with eventual cardiac failure. Further investigations on the behavior of EAT in diabetic/obese patients with CVD could help elucidate the pathogenesis and uncover potential therapeutic targets.
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Affiliation(s)
- Anirudh Krishnan
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia; (A.K.); (H.S.); (D.Y.)
| | - Harman Sharma
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia; (A.K.); (H.S.); (D.Y.)
| | - Daniel Yuan
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia; (A.K.); (H.S.); (D.Y.)
| | - Alexandra F. Trollope
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Lisa Chilton
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Correspondence:
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22
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Higher epicardial fat in older adults living with HIV with viral suppression and relationship with liver steatosis, coronary calcium and cardiometabolic risks. AIDS 2022; 36:1073-1081. [PMID: 35212667 DOI: 10.1097/qad.0000000000003204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES HIV infection is associated with ectopic fat deposition, which leads to chronic inflammation and cardiometabolic dysregulation. We assessed the epicardial adipose tissue (EAT) volume and its associated factors among people with HIV (PWH). DESIGN A cross-sectional study. METHODS We conducted a cross-sectional study among PWH aged at least 50 years and age-matched and sex-matched HIV-negative older individuals in Bangkok, Thailand. Participants underwent a noncontrast, cardiac computed tomography (CT) scan to assess coronary artery calcium (CAC) score and EAT between March 2016 and June 2017. Multivariate linear regression analyses were used to investigate HIV-related factors, cardiac and metabolic markers associated with EAT volume. RESULTS Median age was 55 years [interquartile range (IQR) 52-60] and 63% were men. Median duration of antiretroviral therapy (ART) was 16 years with 97% had HIV-1 RNA less than 50 copies/ml and median CD4 + cell count of 617 cells/μl. Median EAT volume was significantly higher in PWH [99 (IQR 75-122) cm 3 ] than HIV-negative individuals [93 (IQR 69-117) cm 3 ], P = 0.022. In adjusted model, factors associated with EAT volume included male sex ( P = 0.045), older age ( P < 0.001), abnormal waist circumference ( P < 0.001) and HOMA-IR ( P = 0.01). In addition, higher CAC score was independently associated with EAT volume. Higher mean EAT volume was seen in PWH with severe liver steatosis than those without steatosis ( P = 0.018). In adjusted PWH-only model, duration of HIV was significantly associated with higher EAT volume ( P = 0.028). CONCLUSION In an aging cohort, PWH had higher EAT volume than HIV-negative controls. EAT was also independently associated with central fat accumulation, insulin resistance, liver steatosis and CAC score.
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Song XT, Zhang PY, Fan L, Rui YF. Epicardial adipose tissue and right ventricular function in type 2 diabetes mellitus using two-dimensional speckle tracking echocardiography. Diab Vasc Dis Res 2022; 19:14791641221118622. [PMID: 35999047 PMCID: PMC9421037 DOI: 10.1177/14791641221118622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue is an emerging cardiovascular risk factor. The aim of this study was to evaluate right ventricular function and investigate its association with EAT in T2DM patients. METHODS 154 T2DM patients were divided into two groups according to EAT thickness: T2DM with EAT <5 mm and T2DM with EAT ≥5 mm. Seventy non-T2DM patients were enrolled as control group. RV function was evaluated using both conventional echocardiography as well as two-dimensional speckle tracking echocardiography. EAT thickness was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of pericardium at end-systole. RESULTS Compared to control group, EAT thickness was significantly higher and RV systolic function and early diastolic function are all impaired in all T2DM patients. In T2DM with EAT ≥5 mm group, RV systolic function and early diastolic function suffered more severe impairment when compared with T2DM with EAT <5 mm group. Multivariate linear regression analysis revealed that EAT was associated with RV systolic and early diastolic dysfunction independent of traditional cardiovascular risk factors. CONCLUSIONS Our research suggest that in T2DM patients RV systolic function and early diastolic function are all impaired which are associated with the thickened EAT.
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Affiliation(s)
- Xiang-ting Song
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Xiang-ting Song, Department of Echocardiography, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No. 29, Xinglong Lane, Tianning District, Changzhou 213003, China.
| | - Ping-yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Li Fan
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Yi-fei Rui
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
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24
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Deep Learning-Based Approach for the Automatic Quantification of Epicardial Adipose Tissue from Non-Contrast CT. Cognit Comput 2022. [DOI: 10.1007/s12559-022-10036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Liao J, Huang L, Qu M, Chen B, Wang G. Artificial Intelligence in Coronary CT Angiography: Current Status and Future Prospects. Front Cardiovasc Med 2022; 9:896366. [PMID: 35783834 PMCID: PMC9247240 DOI: 10.3389/fcvm.2022.896366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/18/2022] [Indexed: 12/28/2022] Open
Abstract
Coronary heart disease (CHD) is the leading cause of mortality in the world. Early detection and treatment of CHD are crucial. Currently, coronary CT angiography (CCTA) has been the prior choice for CHD screening and diagnosis, but it cannot meet the clinical needs in terms of examination quality, the accuracy of reporting, and the accuracy of prognosis analysis. In recent years, artificial intelligence (AI) has developed rapidly in the field of medicine; it played a key role in auxiliary diagnosis, disease mechanism analysis, and prognosis assessment, including a series of studies related to CHD. In this article, the application and research status of AI in CCTA were summarized and the prospects of this field were also described.
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Affiliation(s)
- Jiahui Liao
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- School of Biomedical Engineering, Guangzhou Xinhua University, Guangzhou, China
| | - Lanfang Huang
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Meizi Qu
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Binghui Chen
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- *Correspondence: Binghui Chen
| | - Guojie Wang
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guojie Wang
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26
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Ahmad FA, Metwalley KA, Mohamad IL. Association of Epicardial Fat with Diastolic and Vascular Functions in Children with Type 1 Diabetes. Pediatr Cardiol 2022; 43:999-1010. [PMID: 35088126 DOI: 10.1007/s00246-021-02811-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
We aimed to examine the relationship between epicardial fat thickness (EFT) measured by echocardiography and cardiovascular functional parameters in children with type 1 diabetes mellitus (T1DM). The study included 50 type 1 diabetic children and 50 healthy subjects matched by sex, age, and body mass index. In addition to laboratory tests, all participants underwent transthoracic echocardiography for EFT, cardiac dimensions and left ventricular functions, and ultrasonographic examination for brachial artery flow-mediated dilation (FMD) response and carotid intima-media thickness (CIMT). Multivariate linear regression was used to analyze the relationship between EFT and CIMT, FMD, lateral mitral E' velocity, and mitral E/E' ratio. EFT was significantly increased in diabetic children compared with controls (P < 0.001). In comparison with controls diabetic children had significantly increased mitral A, decreased lateral mitral E', decreased mitral E/A ratio, decreased lateral mitral E'/A' ratio, and increased mitral E/E' ratio (P < 0.001). FMD response was significantly lower in diabetic group versus controls (P < 0.001) and CIMT was significantly increased in diabetics versus controls (P = 0.03). EFT was negatively correlated with lateral mitral E' velocity (r = - 0.613, P < 0.001), positively correlated with mitral E/E' ratio (r = 0.60, P < 0.001), positively correlated with CIMT (r = 0.881, P < 0.001), and negatively correlated with FMD (r = - 0.533, P < 0.001). By multivariate regression analysis, the EFT was independently and positively associated with CIMT mean and E/E' mean and negatively associated with FMD mean and E' mean. The cut-off point for EFT as predictor of endothelial dysfunction was 6.95 mm. Our findings suggest that children with T1DM have subclinical LV diastolic and vascular endothelial dysfunctions associated with increased EFT.
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Song XT, Wang SK, Zhang PY, Fan L, Rui YF. Association between epicardial adipose tissue and left ventricular function in type 2 diabetes mellitus: Assessment using two-dimensional speckle tracking echocardiography. J Diabetes Complications 2022; 36:108167. [PMID: 35272930 DOI: 10.1016/j.jdiacomp.2022.108167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/20/2022] [Accepted: 03/02/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Epicardial adipose tissue (EAT) is the visceral fat between the myocardium and the visceral pericardium. Dysfunctional EAT can cause cardiovascular diseases. The aim of this study was to investigate the association between EAT and left ventricular function in type 2 diabetes mellitus (T2DM) patients by two-dimensional speckle tracking echocardiography (2D-STE). METHODS We prospectively enrolled 116 T2DM patients who were divided into two groups according to their left ventricular global longitudinal strain (GLS): 53 with GLS <18% and 63 with GLS ≥18%. The thickness of EAT was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of pericardium at end-systole. LV systolic function was evaluated by GLS measured by 2D-STE. LV diastolic function was defined as the ratio of the early diastolic transmitral flow velocity (E) to average mitral annular velocity (e¯). RESULTS Compared with patients with GLS ≥18% group, the age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobinA1c (HbA1c), E/e¯, and thickness of EAT were higher in patients with GLS <18% group (all P < 0.05). Multivariate linear regression analysis revealed that the thickness of EAT was independently associated with left ventricular GLS and E/e¯. CONCLUSIONS Thickened EAT is associated with impaired left ventricular function in T2DM patients. To investigate the association between EAT and left ventricular function can help us gain a deeper understanding of the pathogenesis of impaired cardiac function in T2DM patients.
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Affiliation(s)
- Xiang-Ting Song
- Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China; Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China; Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Shu-Kui Wang
- Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
| | - Ping-Yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
| | - Li Fan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
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Fu X, Almenglo C, Fernandez ÁL, Martínez-Cereijo JM, Iglesias-Alvarez D, Duran-Muñoz D, García-Caballero T, Gonzalez-Juanatey JR, Rodriguez-Mañero M, Eiras S. The Effect of Mineralocorticoid Receptor 3 Antagonists on Anti-Inflammatory and Anti-Fatty Acid Transport Profile in Patients with Heart Failure. Cells 2022; 11:cells11081264. [PMID: 35455943 PMCID: PMC9027091 DOI: 10.3390/cells11081264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Epicardial fat thickness is associated with cardiovascular disease. Mineralocorticoid receptor antagonist (MRA), a pharmaceutical treatment for CVD, was found to have an effect on adipose tissue. Our aim was to analyse the main epicardial fat genesis and inflammation-involved cell markers and their regulation by risk factors and MRA. We included blood and epicardial or subcutaneous fat (EAT or SAT) from 71 patients undergoing heart surgery and blood from 66 patients with heart failure. Cell types (transcripts or proteins) were analysed by real-time polymerase chain reaction or immunohistochemistry. Plasma proteins were analysed by Luminex technology or enzyme-linked immunoassay. Our results showed an upregulation of fatty acid transporter levels after aldosterone-induced genesis. The MRA intake was the main factor associated with lower levels in epicardial fat. On the contrary, MRA upregulated the levels and its secretion of the anti-inflammatory marker intelectin 1 and reduced the proliferation of epicardial fibroblasts. Our results have shown the local MRA intake effect on fatty acid transporters and anti-inflammatory marker levels and the proliferation rate on epicardial fat fibroblasts. They suggest the role of MRA on epicardial fat genesis and remodelling in patients with cardiovascular disease. Translational perspective: the knowledge of epicardial fat genesis and its modulation by drugs might be useful for improving the treatments of cardiovascular disease.
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Affiliation(s)
- Xiaoran Fu
- Translational Cardiology Group, Health Research Institute, 15706 Santiago de Compostela, Spain;
| | - Cristina Almenglo
- Cardiology Group, Health Research Institute, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (C.A.); (D.I.-A.); (J.R.G.-J.)
| | - Ángel Luis Fernandez
- Heart Surgery Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Á.L.F.); (J.M.M.-C.); (D.D.-M.)
- CIBERCV Madrid, Department of Morphological Sciences, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - José Manuel Martínez-Cereijo
- Heart Surgery Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Á.L.F.); (J.M.M.-C.); (D.D.-M.)
| | - Diego Iglesias-Alvarez
- Cardiology Group, Health Research Institute, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (C.A.); (D.I.-A.); (J.R.G.-J.)
| | - Darío Duran-Muñoz
- Heart Surgery Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Á.L.F.); (J.M.M.-C.); (D.D.-M.)
- CIBERCV Madrid, Department of Morphological Sciences, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Tomás García-Caballero
- Morphological Sciences Department, Medicine Faculty, University of Santiago de Compostela and Pathology Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | - Jose Ramón Gonzalez-Juanatey
- Cardiology Group, Health Research Institute, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (C.A.); (D.I.-A.); (J.R.G.-J.)
- CIBERCV Madrid, Department of Morphological Sciences, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Cardiology Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Moises Rodriguez-Mañero
- Translational Cardiology Group, Health Research Institute, 15706 Santiago de Compostela, Spain;
- CIBERCV Madrid, Department of Morphological Sciences, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Cardiology Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Correspondence: (M.R.-M.); (S.E.); Tel.: +34-616903275 (M.R.-M.); +34-981955074 (S.E.)
| | - Sonia Eiras
- Translational Cardiology Group, Health Research Institute, 15706 Santiago de Compostela, Spain;
- CIBERCV Madrid, Department of Morphological Sciences, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Correspondence: (M.R.-M.); (S.E.); Tel.: +34-616903275 (M.R.-M.); +34-981955074 (S.E.)
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Bartoli A, Fournel J, Ait-Yahia L, Cadour F, Tradi F, Ghattas B, Cortaredona S, Million M, Lasbleiz A, Dutour A, Gaborit B, Jacquier A. Automatic Deep-Learning Segmentation of Epicardial Adipose Tissue from Low-Dose Chest CT and Prognosis Impact on COVID-19. Cells 2022; 11:cells11061034. [PMID: 35326485 PMCID: PMC8947414 DOI: 10.3390/cells11061034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To develop a deep-learning (DL) pipeline that allowed an automated segmentation of epicardial adipose tissue (EAT) from low-dose computed tomography (LDCT) and investigate the link between EAT and COVID-19 clinical outcomes. Methods: This monocentric retrospective study included 353 patients: 95 for training, 20 for testing, and 238 for prognosis evaluation. EAT segmentation was obtained after thresholding on a manually segmented pericardial volume. The model was evaluated with Dice coefficient (DSC), inter-and intraobserver reproducibility, and clinical measures. Uni-and multi-variate analyzes were conducted to assess the prognosis value of the EAT volume, EAT extent, and lung lesion extent on clinical outcomes, including hospitalization, oxygen therapy, intensive care unit admission and death. Results: The mean DSC for EAT volumes was 0.85 ± 0.05. For EAT volume, the mean absolute error was 11.7 ± 8.1 cm3 with a non-significant bias of −4.0 ± 13.9 cm3 and a correlation of 0.963 with the manual measures (p < 0.01). The multivariate model providing the higher AUC to predict adverse outcome include both EAT extent and lung lesion extent (AUC = 0.805). Conclusions: A DL algorithm was developed and evaluated to obtain reproducible and precise EAT segmentation on LDCT. EAT extent in association with lung lesion extent was associated with adverse clinical outcomes with an AUC = 0.805.
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Affiliation(s)
- Axel Bartoli
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
- Correspondence: ; Tel.: +33-6-64-53-16-82
| | - Joris Fournel
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
| | - Léa Ait-Yahia
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
| | - Farah Cadour
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
| | - Farouk Tradi
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
| | - Badih Ghattas
- I2M—UMR CNRS 7373, Luminy Faculty of Sciences, Aix-Marseille University, 163 Avenue de Luminy, Case 901, 13009 Marseille, France;
| | - Sébastien Cortaredona
- IHU Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France; (S.C.); (M.M.)
- VITROME, SSA, IRD, Aix-Marseille University, 13005 Marseille, France
| | - Matthieu Million
- IHU Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005 Marseille, France; (S.C.); (M.M.)
- MEPHI, IRD, AP-HM, Aix Marseille University, 13005 Marseille, France
| | - Adèle Lasbleiz
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Anne Dutour
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Bénédicte Gaborit
- C2VN, INRAE, INSERM, Aix Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France; (A.L.); (A.D.); (B.G.)
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, AP-HM, 13915 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Hôpital de la TIMONE, AP-HM, 13005 Marseille, France; (L.A.-Y.); (F.C.); (F.T.); (A.J.)
- CRMBM—UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13005 Marseille, France;
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Abstract
Interest in epicardial adipose tissue (EAT) is growing rapidly, and research in this area appeals to a broad, multidisciplinary audience. EAT is unique in its anatomy and unobstructed proximity to the heart and has a transcriptome and secretome very different from that of other fat depots. EAT has physiological and pathological properties that vary depending on its location. It can be highly protective for the adjacent myocardium through dynamic brown fat-like thermogenic function and harmful via paracrine or vasocrine secretion of pro-inflammatory and profibrotic cytokines. EAT is a modifiable risk factor that can be assessed with traditional and novel imaging techniques. Coronary and left atrial EAT are involved in the pathogenesis of coronary artery disease and atrial fibrillation, respectively, and it also contributes to the development and progression of heart failure. In addition, EAT might have a role in coronavirus disease 2019 (COVID-19)-related cardiac syndrome. EAT is a reliable potential therapeutic target for drugs with cardiovascular benefits such as glucagon-like peptide 1 receptor agonists and sodium–glucose co-transporter 2 inhibitors. This Review provides a comprehensive and up-to-date overview of the role of EAT in cardiovascular disease and highlights the translational nature of EAT research and its applications in contemporary cardiology. In this Review, Iacobellis provides a comprehensive overview of the role of epicardial adipose tissue (EAT) in cardiovascular disease, including coronary artery disease, heart failure and atrial fibrillation, discusses imaging techniques for EAT assessment and highlights the therapeutic potential of targeting EAT in cardiovascular disease. Epicardial adipose tissue (EAT) has anatomical and functional interactions with the heart owing to the shared circulation and the absence of muscle fascia separating the two organs. EAT can be clinically measured with cardiac imaging techniques that can help to predict and stratify cardiovascular risk. Regional distribution of EAT is important because pericoronary EAT and left atrial EAT differently affect the risk of coronary artery diseases and atrial fibrillation, respectively. EAT has a role in the development of several cardiovascular diseases through complex mechanisms, including gene expression profile, pro-inflammatory and profibrotic proteome, neuromodulation, and glucose and lipid metabolism. EAT could be a potential therapeutic target for novel cardiometabolic medications that modulate adipose tissue such as glucagon-like peptide 1 receptor agonists and sodium–glucose co-transporter 2 inhibitors. EAT might be a reservoir of severe acute respiratory syndrome coronavirus 2 and an amplifier of coronavirus disease 2019 (COVID-19)-related cardiac syndrome.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miami, FL, USA.
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31
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Browning Epicardial Adipose Tissue: Friend or Foe? Cells 2022; 11:cells11060991. [PMID: 35326442 PMCID: PMC8947372 DOI: 10.3390/cells11060991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
The epicardial adipose tissue (EAT) is the visceral fat depot of the heart which is highly plastic and in direct contact with myocardium and coronary arteries. Because of its singular proximity with the myocardium, the adipokines and pro-inflammatory molecules secreted by this tissue may directly affect the metabolism of the heart and coronary arteries. Its accumulation, measured by recent new non-invasive imaging modalities, has been prospectively associated with the onset and progression of coronary artery disease (CAD) and atrial fibrillation in humans. Recent studies have shown that EAT exhibits beige fat-like features, and express uncoupling protein 1 (UCP-1) at both mRNA and protein levels. However, this thermogenic potential could be lost with age, obesity and CAD. Here we provide an overview of the physiological and pathophysiological relevance of EAT and further discuss whether its thermogenic properties may serve as a target for obesity therapeutic management with a specific focus on the role of immune cells in this beiging phenomenon.
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Turkmen K, Ozer H, Kusztal M. The Relationship of Epicardial Adipose Tissue and Cardiovascular Disease in Chronic Kidney Disease and Hemodialysis Patients. J Clin Med 2022; 11:jcm11051308. [PMID: 35268399 PMCID: PMC8911356 DOI: 10.3390/jcm11051308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular diseases remain the most common cause of morbidity and mortality in chronic kidney disease patients undergoing hemodialysis. Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Additionally, EAT has been proposed as a novel cardiovascular risk in the general population and in end-stage renal disease patients. It has also been shown that EAT, more than other subcutaneous adipose tissue deposits, acts as a highly active organ producing several bioactive adipokines, and proinflammatory and proatherogenic cytokines. Therefore, increased visceral adiposity is associated with proinflammatory activity, impaired insulin sensitivity, increased risk of atherosclerosis, and high morbidity and mortality in hemodialysis patients. In the present review, we aimed to demonstrate the role of EAT in the pathophysiological mechanisms of increased cardiovascular morbidity and mortality in hemodialysis patients.
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Affiliation(s)
- Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Meram Medical Faculty, Necmettin Erbakan University, Konya 42090, Turkey;
- Correspondence: ; Tel.: +90-5384927877
| | - Hakan Ozer
- Division of Nephrology, Department of Internal Medicine, Meram Medical Faculty, Necmettin Erbakan University, Konya 42090, Turkey;
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland;
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Iacobellis G, Basilico S, Malavazos AE. Targeting Epicardial Fat in Obesity and Diabetes Pharmacotherapy. Handb Exp Pharmacol 2022; 274:93-108. [PMID: 35156138 DOI: 10.1007/164_2021_577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Epicardial adipose tissue surrounds and infiltrates the heart. Epicardial fat displays unique anatomic, genetic, and biomolecular properties. People with obesity and in particular, those with abdominal obesity and associated type 2 diabetes mellitus, have an increased amount of epicardial adipose tissue (EAT). Epicardial fat works well as therapeutic target due to its fast-responding metabolism, organ fat specificity, and easy measurability. Epicardial fat responds to thiazolidinediones (TZD), glucagon-like peptide 1-receptor agonists (GLP1A), sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP4i), and statins. Modulating epicardial fat morphology and genetic profile with targeted pharmacological agents suggests novel strategies in the pharmacotherapy of diabetes and obesity.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - Sara Basilico
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, Milan, Italy
| | - Alexis Elias Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, Milan, Italy
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Monti CB, Schiaffino S, Galimberti Ortiz MDM, Capra D, Zanardo M, De Benedictis E, Luporini AG, Spagnolo P, Secchi F, Sardanelli F. Potential role of epicardial adipose tissue as a biomarker of anthracycline cardiotoxicity. Insights Imaging 2021; 12:161. [PMID: 34741673 PMCID: PMC8571675 DOI: 10.1186/s13244-021-01069-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/07/2021] [Indexed: 01/21/2023] Open
Abstract
Background We investigated the radiodensity of epicardial (EAT), subcutaneous (SAT), and visceral adipose tissue (VAT) before and after treatment with anthracyclines in a population of breast cancer (BC) patients, and in controls not treated with anthracyclines, to detect a potential role of EAT density as a biomarker of changes related to chemotherapy cardiotoxicity. Methods We reviewed BC patients treated with anthracyclines who underwent CT before (CT-t0) and after (CT-t1) chemotherapy, and age- and sex-matched controls who underwent two CT examinations at comparable intervals. On non-contrast scans, EAT was segmented contouring the pericardium and thresholding between -190 and -30 Hounsfield units (HU), and SAT and VAT were segmented with two 15-mm diameter regions of interest thresholded between -195 and -45 HU. Results Thirty-two female patients and 32 controls were included. There were no differences in age (p = 0.439) and follow-up duration (p = 0.162) between patients and controls. Between CT-t0 and CT-t1, EAT density decreased in BC patients (-66 HU, interquartile range [IQR] -71 to -63 HU, to -71 HU, IQR -75 to -66 HU, p = 0.003), while it did not vary in controls (p = 0.955). SAT density increased from CT-t0 to CT-t1 in BC patients (-107 HU, IQR -111 to -105 HU, to -105 HU, IQR -110 to -100 HU, p = 0.014), whereas it did not change in controls (p = 0.477). VAT density did not vary in either BC patients (p = 0.911) or controls (p = 0.627). Conclusions EAT density appears to be influenced by anthracycline treatment for BC, well known for its cardiotoxicity, shifting towards lower values indicative of a less active metabolism.
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Affiliation(s)
- Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Maria Del Mar Galimberti Ortiz
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Elena De Benedictis
- Unit of Medical Oncology, Policlinico Di Monza, Via Amati 111, 20900, Monza, Italy
| | - Alberto Gianluigi Luporini
- Unit of Medical Oncology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Pietro Spagnolo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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35
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Lasbleiz A, Gaborit B, Soghomonian A, Bartoli A, Ancel P, Jacquier A, Dutour A. COVID-19 and Obesity: Role of Ectopic Visceral and Epicardial Adipose Tissues in Myocardial Injury. Front Endocrinol (Lausanne) 2021; 12:726967. [PMID: 34484128 PMCID: PMC8415546 DOI: 10.3389/fendo.2021.726967] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
In March 2020, the WHO declared coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a global pandemic. Obesity was soon identified as a risk factor for poor prognosis, with an increased risk of intensive care admissions and mechanical ventilation, but also of adverse cardiovascular events. Obesity is associated with adipose tissue, chronic low-grade inflammation, and immune dysregulation with hypertrophy and hyperplasia of adipocytes and overexpression of pro-inflammatory cytokines. However, to implement appropriate therapeutic strategies, exact mechanisms must be clarified. The role of white visceral adipose tissue, increased in individuals with obesity, seems important, as a viral reservoir for SARS-CoV-2 via angiotensin-converting enzyme 2 (ACE2) receptors. After infection of host cells, the activation of pro-inflammatory cytokines creates a setting conducive to the "cytokine storm" and macrophage activation syndrome associated with progression to acute respiratory distress syndrome. In obesity, systemic viral spread, entry, and prolonged viral shedding in already inflamed adipose tissue may spur immune responses and subsequent amplification of a cytokine cascade, causing worse outcomes. More precisely, visceral adipose tissue, more than subcutaneous fat, could predict intensive care admission; and lower density of epicardial adipose tissue (EAT) could be associated with worse outcome. EAT, an ectopic adipose tissue that surrounds the myocardium, could fuel COVID-19-induced cardiac injury and myocarditis, and extensive pneumopathy, by strong expression of inflammatory mediators that could diffuse paracrinally through the vascular wall. The purpose of this review is to ascertain what mechanisms may be involved in unfavorable prognosis among COVID-19 patients with obesity, especially cardiovascular events, emphasizing the harmful role of excess ectopic adipose tissue, particularly EAT.
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Affiliation(s)
- Adèle Lasbleiz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Bénédicte Gaborit
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Astrid Soghomonian
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Axel Bartoli
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Medical Imaging, Hôpital Universitaire Timone APHM, Marseille, France
| | - Patricia Ancel
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Alexis Jacquier
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Medical Imaging, Hôpital Universitaire Timone APHM, Marseille, France
| | - Anne Dutour
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
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36
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Mohamed A. Predicting mortality and no-reflow in STEMI patients using epicardial adipose tissue. Clin Cardiol 2021; 44:1371-1376. [PMID: 34255859 PMCID: PMC8495074 DOI: 10.1002/clc.23692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acute myocardial infarction is a leading cause of morbidity and mortality worldwide. It occurs when irreversible myocardial cell damage or death occurs. ST‐segment elevation myocardial infarction (STEMI) is the most serious presentation of atherosclerotic coronary artery disease. STEMI results from the occlusion of a major coronary artery. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. It should be performed by an experienced team within the shortest time possible from the first medical contact. Hypothesis Increased mortality risk and no‐reflow in STEMI patients with epicardial adipose tissue thickness (EAT) more than 5 mm compared to STEMI patients with EAT less than 5 mm. Methods This study was conducted on 113 patients who presented to the cardiology department of Ain Shams university hospital with the first STEMI and underwent primary PCI. Medical treatment for STEMI was given to all subjects as per the guidelines. All patients underwent an echocardiographic evaluation of epicardial adipose tissue and left ventricular ejection fraction. Patients were divided into two groups using epicardial adipose tissue thickness of 5 mm as a cutoff point; this number was derived from the ROC curve. Group I: Included patients with EAT thickness less than 5 mm, including 44 patients (38.9%). Group II: Included patients with EAT thickness greater than 5 mm, including 69 patients (61.1%). Results The current study showed that epicardial fat thickness significantly correlated with the no‐reflow phenomenon in the cath lab and overall prognosis in patients with STEMI. Conclusion Increased EAT thickness may be an independent predictor of the no‐reflow phenomenon and mortality. Therefore, our study emphasizes that EAT thickness measured by echocardiography may provide additional and substantial information on the risk of no‐reflow and mortality in STEMI patients.
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Affiliation(s)
- Amr Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.,Department of Cardiology, Ain Shams University, Cairo, Egypt
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37
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Rao VN, Bush CG, Mongraw-Chaffin M, Hall ME, Clark D, Fudim M, Correa A, Hammill BG, O'Brien E, Min YI, Mentz RJ. Regional Adiposity and Risk of Heart Failure and Mortality: The Jackson Heart Study. J Am Heart Assoc 2021; 10:e020920. [PMID: 34238024 PMCID: PMC8483488 DOI: 10.1161/jaha.121.020920] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Visceral adipose tissue (VAT) is associated with incident heart failure (HF) and HF with preserved ejection fraction, yet it is unknown how pericardial and abdominal adiposity affect HF and mortality risks in Black individuals. We examined the associations of pericardial adipose tissue (PAT), VAT, and subcutaneous adipose tissue (SAT) with incident HF hospitalization and all-cause mortality in a large community cohort of Black participants. Methods and Results Among the 2882 Jackson Heart Study Exam 2 participants without prevalent HF who underwent body computed tomography, we used Cox proportional hazards models to examine associations between computed tomography-derived regional adiposity and incident HF hospitalization and all-cause mortality. Fully adjusted models included demographics and cardiovascular disease risk factors. Median follow-up was 10.6 years among participants with available VAT (n=2844), SAT (n=2843), and PAT (n=1386). Fully adjusted hazard ratios (95% CIs) of distinct computed tomography-derived adiposity measures (PAT per 10 cm3, VAT or SAT per 100 cm3) were as follows: for incident HF, PAT 1.08 (95% CI, 1.02-1.14) and VAT 1.04 (95% CI, 1.01-1.08); for HF with preserved ejection fraction, PAT 1.13 (95% CI, 1.04-1.21) and VAT 1.07 (95% CI, 1.01-1.13); for mortality, PAT 1.07 (95% CI, 1.03-1.12) and VAT 1.01 (95% CI, 0.98-1.04). SAT was not associated with either outcome. Conclusions High PAT and VAT, but not SAT, were associated with incident HF and HF with preserved ejection fraction, and only PAT was associated with mortality in the fully adjusted models in a longitudinal community cohort of Black participants. Future studies may help understand whether changes in regional adiposity improves HF, particularly HF with preserved ejection fraction, risk predictions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005485.
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Affiliation(s)
- Vishal N Rao
- Duke Clinical Research Institute Duke University School of Medicine Durham NC.,Division of Cardiology Department of Medicine Duke University School of Medicine Durham NC
| | - Christopher G Bush
- Duke Clinical Research Institute Duke University School of Medicine Durham NC.,Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology & Prevention Wake Forest University School of Medicine Winston-Salem NC
| | - Michael E Hall
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Donald Clark
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Marat Fudim
- Duke Clinical Research Institute Duke University School of Medicine Durham NC.,Division of Cardiology Department of Medicine Duke University School of Medicine Durham NC
| | - Adolfo Correa
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Bradley G Hammill
- Duke Clinical Research Institute Duke University School of Medicine Durham NC.,Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Emily O'Brien
- Duke Clinical Research Institute Duke University School of Medicine Durham NC.,Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Yuan-I Min
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Robert J Mentz
- Duke Clinical Research Institute Duke University School of Medicine Durham NC.,Division of Cardiology Department of Medicine Duke University School of Medicine Durham NC
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Yang W, Shi H, Huang X, Ma Y, Guan B, Sun S, Yu Y, Luo J, Tian F, Cao J. Ideal cardiovascular health metrics and epicardial adipose tissue volume in a Northern Chinese population: a cross-sectional study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:935. [PMID: 34350250 PMCID: PMC8263873 DOI: 10.21037/atm-21-1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/26/2021] [Indexed: 12/02/2022]
Abstract
Background Coronary artery disease, fatty liver disease, cardiac abnormalities, the metabolic syndrome, and insulin resistance may all occur in association with an increase of epicardial adipose tissue volume (EATV). Previous studies have shown that some cardiovascular-risk factors and healthy behaviors were related to a lower risk of EATV increase. The main purpose of this study was to determine whether ideal cardiovascular health (CVH) metrics were correlated with the prevalence of high EATV. Methods The study commenced across 2013 and 2014 and involved volunteers from the Jidong (East Hebei) district. A cohort of 2,482 participants aged 45 years or older were randomly selected, of which 49.9% were women and none were diagnosed as having cancer, stroke, or heart diseases such as atrial fibrillation, heart failure, or myocardial infarction. The study collected information concerning seven CVH metrics; namely body mass index, dietary intake, smoking, blood pressure, physical activity, total cholesterol, and fasting blood glucose, and evaluated EATV based on computed tomography. Finally, an analysis of the relationship between ideal CVH metrics and the prevalence of high EATV was made applying multiple logistic regression. Results On the basis that age, gender, and other potential confounding factors are adjusted, comparing the participants having an ideal CVH index of 2, 3, 4, 5 and 6–7 with those having a 0–1 metric, the adjusted odds ratios (95% confidence interval) of high EATV were as follows: 0.893 (0.468–1.705), 0.581 (0.316–1.069), 0.368 (0.202–0.670), 0.218 (0.119–0.400), and 0.161 (0.085–0.306) (P trend less than 0.0001). Similar negative correlations were also seen in other cases of different age groups and gender groups, where all P trends were less than 0.0001. Conclusions The number of ideal CVH metrics in the northern Chinese population is negatively correlated with the prevalence of high EATV, supporting the greater use of EATV as a useful parameter in clinical practice.
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Affiliation(s)
- Wenyi Yang
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Department of Geriatric Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Haiyan Shi
- Department of Geriatric Gastroenterology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xin Huang
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Department of Geriatric Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yufei Ma
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Department of Geriatric Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bo Guan
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Department of Geriatric Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Shasha Sun
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Department of Geriatric Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yan Yu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Department of Geriatric Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jiakun Luo
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Health Service Department of the Guard Bureau of the General Office of the Central Committee of the Communist Party of China, Beijing, China
| | - Fan Tian
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.,Fourth Department of Special Service, Strategic Support Force Medical Center, Beijing, China
| | - Jian Cao
- Department of Geriatric Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Slipczuk L, Castagna F, Schonberger A, Novogrodsky E, Sekerak R, Dey D, Jorde UP, Levsky JM, Garcia MJ. Coronary artery calcification and epicardial adipose tissue as independent predictors of mortality in COVID-19. Int J Cardiovasc Imaging 2021; 37:3093-3100. [PMID: 33978937 PMCID: PMC8113796 DOI: 10.1007/s10554-021-02276-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022]
Abstract
Recent epidemiological studies have demonstrated that common cardiovascular risk factors are strongly associated with adverse outcomes in COVID-19. Coronary artery calcium (CAC) and epicardial fat (EAT) have shown to outperform traditional risk factors in predicting cardiovascular events in the general population. We aim to determine if CAC and EAT determined by Computed Tomographic (CT) scanning can predict all-cause mortality in patients admitted with COVID-19 disease. We performed a retrospective, post-hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st, 2020 to May 2nd, 2020 who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the epicardial (EAT) and thoracic (TAT) fat volume and examined their relationship with inpatient mortality. A total of 493 patients were analyzed. There were 197 deaths (39.95%). Patients who died during the index admission had higher age (72, [64–80] vs 68, [57–76]; p < 0.001), CAC score (3, [0–6] vs 1, [0–4]; p < 0.001) and EAT (107, [70–152] vs 94, [64–129]; p = 0.023). On a competing risk analysis regression model, CAC ≥ 4 and EAT ≥ median (98 ml) were independent predictors of mortality with increased mortality of 63% (p = 0.003) and 43% (p = 0.032), respectively. As a composite, the group with a combination of CAC ≥ 4 and EAT ≥ 98 ml had the highest mortality. CAC and EAT measured from chest CT are strong independent predictors of inpatient mortality from COVID-19 in this high-risk cohort.
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Affiliation(s)
- Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA
| | | | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ulrich P Jorde
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey M Levsky
- Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
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40
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Muzurović EM, Vujošević S, Mikhailidis DP. Can We Decrease Epicardial and Pericardial Fat in Patients With Diabetes? J Cardiovasc Pharmacol Ther 2021; 26:415-436. [PMID: 33844605 DOI: 10.1177/10742484211006997] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diabetes mellitus (DM) is a chronic and complex metabolic disorder and also an important cause of cardiovascular (CV) disease (CVD). Patients with type 2 DM (T2DM) and obesity show a greater propensity for visceral fat deposition (and excessive fat deposits elsewhere) and the link between adiposity and CVD risk is greater for visceral than for subcutaneous (SC) adipose tissue (AT). There is growing evidence that epicardial AT (EAT) and pericardial AT (PAT) play a role in the development of DM-related atherosclerosis, atrial fibrillation (AF), myocardial dysfunction, and heart failure (HF). In this review, we will highlight the importance of PAT and EAT in patients with DM. We also consider therapeutic interventions that could have a beneficial effect in terms of reducing the amount of AT and thus CV risk. EAT is biologically active and a likely determinant of CV morbidity and mortality in patients with DM, given its anatomical characteristics and proinflammatory secretory pattern. Consequently, modification of EAT/PAT may become a therapeutic target to reduce the CV burden. In patients with DM, a low calorie diet, exercise, antidiabetics and statins may change the quantity of EAT, PAT or both, alter the secretory pattern of EAT, improve the metabolic profile, and reduce inflammation. However, well-designed studies are needed to clearly define CV benefits and a therapeutic approach to EAT/PAT in patients with DM.
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Affiliation(s)
- Emir M Muzurović
- Department of Internal Medicine, Endocrinology Section, 274294Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Snežana Vujošević
- Department of Internal Medicine, Endocrinology Section, 274294Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, 9687Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London, UK.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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41
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Cosson E, Nguyen MT, Rezgani I, Tatulashvili S, Sal M, Berkane N, Allard L, Brillet PY, Bihan H. Epicardial adipose tissue volume and coronary calcification among people living with diabetes: a cross-sectional study. Cardiovasc Diabetol 2021; 20:35. [PMID: 33546697 PMCID: PMC7863354 DOI: 10.1186/s12933-021-01225-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) has anatomic and functional proximity to the heart and is considered a novel diagnostic marker and therapeutic target in cardiometabolic diseases. The aim of this study was to evaluate whether EAT volume was associated with coronary artery calcification (CAC) in people living with diabetes, independently of confounding factors. METHODS We included all consecutive patients with diabetes whose EAT volume and CAC score were measured using computed tomography between January 1, 2019 and September 30, 2020 in the Department of Diabetology-Endocrinology-Nutrition at Avicenne Hospital, France. Determinants of EAT volume and a CAC score ≥ 100 Agatston units (AU) were evaluated. RESULTS The study population comprised 409 patients (218 men). Mean (± standard deviation) age was 57 ± 12 years, and 318, 56 and 35 had type 2 (T2D), type 1 (T1D), or another type of diabetes, respectively. Mean body mass index (BMI) was 29 ± 6 kg/m2, mean AET volume 93 ± 38 cm3. EAT volume was positively correlated with age, BMI, pack-year smoking history and triglyceridaemia, but negatively correlated with HDL-cholesterol level. Furthermore, it was lower in people with retinopathy, but higher in men, in Caucasian people, in patients on antihypertensive and lipid-lowering medication, in people with nephropathy, and finally in individuals with a CAC ≥ 100 AU (CAC < 100 vs CAC ≥ 100: 89 ± 35 vs 109 ± 41 cm3, respectively, p < 0.05). In addition to EAT volume, other determinants of CAC ≥ 100 AU (n = 89, 22%) were age, T2D, ethnicity, antihypertensive and lipid-lowering medication, cumulative tobacco consumption, retinopathy, macular edema and macrovascular disease. Multivariable analysis considering all these determinants as well as gender and BMI showed that EAT volume was independently associated with CAC ≥ 100 AU (per 10 cm3 increase: OR 1.11 [1.02-1.20]). CONCLUSIONS EAT volume was independently associated with CAC. As it may play a role in coronary atherosclerosis in patients with diabetes, reducing EAT volume through physical exercise, improved diet and pharmaceutical interventions may improve future cardiovascular risk outcomes in this population.
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Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France. .,Unité de Recherche Epidémiologique Nutritionnelle, UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, Bobigny, France.
| | - Minh Tuan Nguyen
- Department of Functional Explorations, AP-HP, Jean Verdier Hospital, Université Paris 13, Bondy, France
| | - Imen Rezgani
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Sopio Tatulashvili
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Meriem Sal
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Narimane Berkane
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Lucie Allard
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | | | - Hélène Bihan
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France.,Laboratoire Educations et Pratiques de Santé UR 3412, UFR Santé, Médecine, Biologie Humaine, Université Paris Sorbonne Paris Nord, 74, rue Marcel Cachin, 93017, Bobigny Cedex, France
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Venuraju SM, Lahiri A, Jeevarethinam A, Rakhit RD, Shah PK, Nilsson J. Association of Epicardial Fat Volume With the Extent of Coronary Atherosclerosis and Cardiovascular Adverse Events in Asymptomatic Patients With Diabetes. Angiology 2021; 72:442-450. [PMID: 33467865 DOI: 10.1177/0003319720984607] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epicardial adipose tissue has a paracrine effect, enhancing coronary artery atherosclerotic plaque development. This study evaluated epicardial fat volume (EFV), adipokines, coronary atherosclerosis, and adverse cardiovascular events in a cohort of asymptomatic patients with type 2 diabetes mellitus (T2DM). Epicardial fat volume was calculated using data from computed tomography coronary angiograms. Adipokines and inflammatory cytokines were also assayed and correlated with EFV. Epicardial fat volume was also assessed as a predictor of coronary artery calcium (CAC) score, number of coronary artery plaques, and significant plaque (>50% luminal stenosis). Data from the EFV analysis were available for 221 (85.7%) participants. Median EFV was 97.4 cm3, mean body mass index was 28.1 kg/m2, and mean duration of T2DM was 13 years. Statistically significant, but weak, correlations were observed between several adipokines, inflammatory cytokines, and EFV. Epicardial fat volume was a significant univariate (P = .01), but not multivariate, predictor of the number of coronary plaques, but not of CAC score or significant plaque. After a mean follow-up of 22.8 months, 12 adverse cardiovascular events were reported, exclusively in participants with EFV >97.4 cm3. Epicardial fat volume has limited utility as a marker of coronary artery plaque in patients with T2DM and is weakly correlated with adipokine expression.
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Affiliation(s)
- Shreenidhi M Venuraju
- Institute of Cardiovascular Science, 4919University College London, United Kingdom
- 40531British Cardiac Research Trust, London, United Kingdom
- Bedford Hospital, Bedford, United Kingdom
| | - Avijit Lahiri
- 40531British Cardiac Research Trust, London, United Kingdom
- Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom
- Imperial College School of Medicine, Imperial College London, United Kingdom
- Healthcare Science, Middlesex University, London, United Kingdom
| | - Anand Jeevarethinam
- Institute of Cardiovascular Science, 4919University College London, United Kingdom
- 40531British Cardiac Research Trust, London, United Kingdom
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Roby D Rakhit
- Institute of Cardiovascular Science, 4919University College London, United Kingdom
- Department of Cardiology, Royal Free Hospital, London, United Kingdom
| | | | - Jan Nilsson
- Experimental Cardiovascular Research Unit, Department of Clinical Sciences, Lund University, Sweden
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43
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Ni X, Jiao L, Zhang Y, Xu J, Zhang Y, Zhang X, Du Y, Sun Z, Wang S. Correlation Between the Distribution of Abdominal, Pericardial and Subcutaneous Fat and Muscle and Age and Gender in a Middle-Aged and Elderly Population. Diabetes Metab Syndr Obes 2021; 14:2201-2208. [PMID: 34045873 PMCID: PMC8144844 DOI: 10.2147/dmso.s299171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/08/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The present study aimed to explore the relationships between the distribution of abdominal fat and muscle and age and gender in a middle-aged and elderly population. METHODS The levels of abdominal (visceral and subcutaneous) fat, pericardial fat, and psoas major muscle were measured in subjects who had physical examinations at the Health and Medical Department of Peking Union Medical College Hospital from July 2019 to June 2020. The relationship between fat in different areas (ie, different types of fat) and the relationship between different types of fat and the psoas major muscle were investigated in the context of different genders and ages. RESULTS The distribution of fat and muscle differed between males and females of the middle-aged and elderly study sample. Volumes of pericardial fat, total abdominal fat, and visceral fat were significantly lower in females than in males, and the area of the psoas major muscle was also significantly lower in females than in males. Levels of subcutaneous fat and total abdominal fat showed no significant correlation with age. The level of muscle showed a significant negative correlation with age. CONCLUSION 1) Within the middle-aged and elderly sample, male subjects had higher levels than females of all types of fat except for abdominal subcutaneous fat, and had higher levels of psoas muscle than females. 2) Pericardial fat increased with age, whereas levels of abdominal fat did not change significantly with age. 3) The area of psoas major muscle appears to be positively correlated with volumes of all types of fat: subjects with more fat tended to have higher levels of psoas major muscle.
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Affiliation(s)
- Xuefeng Ni
- Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
| | - Li Jiao
- Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
- Correspondence: Li Jiao Department of Healthcare, Peking Union Medical College Hospital, No. 1 of Shuaifuyuan Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86 10 69157229 Email
| | - Ye Zhang
- Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
| | - Jin Xu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
| | - Yunqing Zhang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
| | - Xiaona Zhang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
| | - Yao Du
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
| | - Zhaoyong Sun
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
| | - Shitian Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
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Hunt SC, Davidson LE, Adams TD, Ranson L, McKinlay RD, Simper SC, Litwin SE. Associations of Visceral, Subcutaneous, Epicardial, and Liver Fat with Metabolic Disorders up to 14 Years After Weight Loss Surgery. Metab Syndr Relat Disord 2020; 19:83-92. [PMID: 33136533 DOI: 10.1089/met.2020.0008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Bariatric surgery leads to long-term remission and reduced incidence of diabetes, hypertension, and dyslipidemia. Short-term studies suggest reduction in specific fat depots may be more predictive of health improvement than reduced body mass index (BMI). Visceral, subcutaneous, epicardial, and liver fat, measured 11 years after bariatric surgery, were associated with long-term remission and incidence of diabetes, dyslipidemia, and hypertension. Methods: Fat depots an average of 11 (maximum 14) years after surgery were quantified by noncontrast computed tomography in subjects who did (N = 261; 86% gastric bypass) or did not (N = 243) have bariatric surgery. Multiple regression related fat depots to disease endpoints with and without adjustment for change in BMI and surgical status. Results: Visceral fat was 42% lower, subcutaneous fat 20% lower, epicardial fat 30% lower, and liver-to-spleen density ratio 9% higher at follow-up in the bariatric surgery group compared with the nonsurgery group (all P < 0.01). Higher visceral fat at follow-up exam was significantly associated with reduced remission and increased incidence of diabetes, hypertension, and dyslipidemia. Subcutaneous fat was not associated with disease. The liver-to-spleen ratio was associated with the remission and incidence of hypertriglyceridemia and not with other fat depots. Epicardial fat was related to incidence of elevated low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol. Conclusions: Whether or not a patient shows greater long-term diabetes, dyslipidemia, or hypertension remission or incidence after bariatric surgery appears dependent on the amount of fat within specific fat depots measured at follow-up. Furthermore, associations of the three disease endpoints with different fat depots suggest varied fat depot pathology.
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Affiliation(s)
- Steven C Hunt
- Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lance E Davidson
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.,Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Ted D Adams
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.,Intermountain Live Well Center, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Lauren Ranson
- Division of Cardiology, Department of Internal Medicine, Georgia Regents University, Augusta, Georgia, USA
| | | | - Steven C Simper
- Rocky Mountain Associated Physicians, Salt Lake City, Utah, USA
| | - Sheldon E Litwin
- Department of Cardiology, The Medical University of South Carolina, Charleston, South Carolina, USA.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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45
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Lee R, Seok JW. An Update on [ 18F]Fluoride PET Imaging for Atherosclerotic Disease. J Lipid Atheroscler 2020; 9:349-361. [PMID: 33024730 PMCID: PMC7521973 DOI: 10.12997/jla.2020.9.3.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Atherosclerosis is the leading cause of life-threatening morbidity and mortality, as the rupture of atherosclerotic plaques leads to critical atherothrombotic events such as myocardial infarction and ischemic stroke, which are the 2 most common causes of death worldwide. Vascular calcification is a complicated pathological process involved in atherosclerosis, and microcalcifications are presumed to increase the likelihood of plaque rupture. Despite many efforts to develop novel non-invasive diagnostic modalities, diagnostic techniques are still limited, especially before symptomatic presentation. From this point of view, vulnerable plaques are a direct target of atherosclerosis imaging. Anatomic imaging modalities have the limitation of only visualizing macroscopic structural changes, which occurs in later stages of disease, while molecular imaging modalities are able to detect microscopic processes and microcalcifications, which occur early in the disease process. Na[18F]-fluoride positron emission tomography/computed tomography could allow the early detection of plaque instability, which is deemed to be a primary goal in the prevention of cardiac or brain ischemic events, by quantifying the microcalcifications within vulnerable plaques and evaluating the atherosclerotic disease burden.
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Affiliation(s)
- Reeree Lee
- Department of Nuclear Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Ju Won Seok
- Department of Nuclear Medicine, Chung-Ang University Hospital, Seoul, Korea
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46
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Demir K, Avcı A, Ergulu Esmen S, Tuncez A, Yalcın MU, Yılmaz A, Yılmaz S, Altunkeser BB. Assessment of arterial stiffness and epicardial adipose tissue thickness in predicting the subclinical atherosclerosis in patients with ankylosing spondylitis. Clin Exp Hypertens 2020; 43:169-174. [PMID: 33028113 DOI: 10.1080/10641963.2020.1833025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Atherosclerosis is a chronic, progressive, inflammatory disease. Recognition of subclinical atherosclerotic vascular changes before clinical manifestation in an asymptomatic population is important for risk stratification and optimal management, which finally leads to the prevention of cardiovascular disease. We aimed to determine the risk of premature subclinical atherosclerosis by evaluating epicardial adipose tissue thickness (EATT) and arterial stiffness parameters in patients with ankylosing spondylitis (AS). METHODS We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS compared to 60 controls matched for age and sex. Patients with traditional cardiovascular risk factors were excluded. Arterial stiffness parameters and EATT (examined via echocardiography) values of all patients and control groups were measured. RESULTS There was no difference between basal characteristic and echocardiographic parameters in patients with AS and in the control group. EATT and pulse wave velocity (PWV) were higher in the AS patients compared to the control group. EATT was 5.74 ± 1.22 mm and 4.91 ± 1.21 mm (p < .001) and PWV was 9.90 ± 0.98 m/s and 6.46 ± 0.83 m/s (p = .009) in the AS and control groups, respectively. Also, PWV was significantly correlated with EATT, age, and central blood pressure in patients with AS. CONCLUSIONS EATT and PWV, markers of atherosclerosis and cardiovascular disease, were significantly higher in patients with AS than the control group. In addition, in this study, it has been shown that there is a significant relationship between PWV and EATT in patients with AS.
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Affiliation(s)
- Kenan Demir
- Faculty of Medicine Cardiology Department, Selcuk University , Konya, Turkey
| | - Ahmet Avcı
- Faculty of Medicine Cardiology Department, Zonguldak Bülent Ecevit University , Zonguldak, Turkey
| | - Serpil Ergulu Esmen
- Department of Rheumatology, Konya Education Research Hospital , Konya, Turkey
| | - Abdullah Tuncez
- Faculty of Medicine Cardiology Department, Selcuk University , Konya, Turkey
| | | | - Ahmet Yılmaz
- , Department of Cardiology, Karaman State Hospital , Karaman, Turkey
| | - Sema Yılmaz
- Faculty of Medicine Rheumatology Department, Selcuk University , Konya, Turkey
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Hemke R, Buckless C, Torriani M. Quantitative Imaging of Body Composition. Semin Musculoskelet Radiol 2020; 24:375-385. [PMID: 32992366 DOI: 10.1055/s-0040-1708824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Body composition refers to the amount and distribution of lean tissue, adipose tissue, and bone in the human body. Lean tissue primarily consists of skeletal muscle; adipose tissue comprises mostly abdominal visceral adipose tissue and abdominal and nonabdominal subcutaneous adipose tissue. Hepatocellular and myocellular lipids are also fat pools with important metabolic implications. Importantly, body composition reflects generalized processes such as increased adiposity in obesity and age-related loss of muscle mass known as sarcopenia.In recent years, body composition has been extensively studied quantitatively to predict overall health. Multiple imaging methods have allowed precise estimates of tissue types and provided insights showing the relationship of body composition to varied pathologic conditions. In this review article, we discuss different imaging methods used to quantify body composition and describe important anatomical locations where target tissues can be measured.
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Affiliation(s)
- Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Colleen Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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48
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Rao VN, Fudim M, Mentz RJ, Michos ED, Felker GM. Regional adiposity and heart failure with preserved ejection fraction. Eur J Heart Fail 2020; 22:1540-1550. [PMID: 32619081 PMCID: PMC9991865 DOI: 10.1002/ejhf.1956] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
The role of obesity in the pathogenesis of heart failure (HF), and in particular HF with preserved ejection fraction (HFpEF), has drawn significant attention in recent years. The prevalence of both obesity and HFpEF has increased worldwide over the past decades and when present concomitantly suggests an obese-HFpEF phenotype. Anthropometrics, including body mass index, waist circumference, and waist-to-hip ratio, are associated with incident HFpEF. However, the cardiovascular effects of obesity may actually be driven by the distribution of fat, which can accumulate in the epicardial, visceral, and subcutaneous compartments. Regional fat can be quantified using non-invasive imaging techniques, including computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry. Regional variations in fat accumulation are associated with different HFpEF risk profiles, whereby higher epicardial and visceral fat have a much stronger association with HFpEF risk compared with elevated subcutaneous fat. Thus, regional adiposity may serve a pivotal role in the pathophysiology of HFpEF contributing to decreased cardiopulmonary fitness, impaired left ventricular compliance, upregulation of local and systemic inflammation, promotion of neurohormonal dysregulation, and increased intra-abdominal pressure and vascular congestion. Strategies to reduce total and regional adiposity have shown promise, including intensive exercise, dieting, and bariatric surgery programmes, but few studies have focused on HFpEF-related outcomes among obese. Further understanding the role these variable fat depots play in the progression of HFpEF and HFpEF-related hospitalizations may provide therapeutic targets in treating the obese-HFpEF phenotype.
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Affiliation(s)
- Vishal N Rao
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
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49
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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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50
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Kasper P, Martin A, Lang S, Kütting F, Goeser T, Demir M, Steffen HM. NAFLD and cardiovascular diseases: a clinical review. Clin Res Cardiol 2020; 110:921-937. [PMID: 32696080 PMCID: PMC8238775 DOI: 10.1007/s00392-020-01709-7] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Philipp Kasper
- Department of Gastroenterology and Hepatology, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anna Martin
- Department of Gastroenterology and Hepatology, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sonja Lang
- Department of Medicine, University of California, La Jolla, San Diego, USA
| | - Fabian Kütting
- Department of Gastroenterology and Hepatology, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Tobias Goeser
- Department of Gastroenterology and Hepatology, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Münevver Demir
- Department of Hepatology and Gastroenterology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany
| | - Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. .,Hypertension Center, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany.
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