Association of epicardial fat thickness with clinical and polysomnographic parameters in non-obese obstructive sleep apnoea patients

Cardio-Lipotoxicity of Epicardial Adipose Tissue

Epicardial adipose tissue is a unique visceral adipose tissue depot that plays a crucial role in myocardial metabolism. Epicardial adipose tissue is a major source of energy and free fatty acids for the adjacent myocardium. However, under pathological conditions, epicardial fat can affect the heart through the excessive and abnormal influx of lipids. The cardio-lipotoxicity of the epicardial adipose tissue is complex and involves different pathways, such as increased inflammation, the infiltration of lipid intermediates such as diacylglycerol and ceramides, mitochondrial dysfunction, and oxidative stress, ultimately leading to cardiomyocyte dysfunction and coronary artery ischemia. These changes can contribute to the pathogenesis of various cardio-metabolic diseases including atrial fibrillation, coronary artery disease, heart failure, and obstructive sleep apnea. Hence, the role of the cardio-lipotoxicity of epicardial fat and its clinical implications are discussed in this review.

Increased Levels of VCAM-1 in Patients with High Cardiovascular Risk and Obstructive Sleep Apnea Syndrome

(1) Background: Although obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity, the link between OSA and cardiovascular disease (CVD) is not completely elucidated. Thus, we aim to assess cardiovascular risk (CVR) using SCORE 2 and SCORE 2 for older persons (SCORE 2OP), and to evaluate the association between the endothelial biomarkers VCAM-1, ICAM-1, epicardial fat, and sleep study parameters in order to improve current clinical practices and better understand the short-and long-term CVRs in OSA patients. (2) Methods: 80 OSA patients and 37 healthy volunteers were enrolled in the study. SCORE2 and SCORE 2 OP regional risk charts (validated algorithms to predict the 10-year risk of first-onset CVD) were used for the analysis of CVR. Two-dimensional echocardiography was performed on all patients and epicardial fat thickness was measured. VCAM-1 and ICAM-1 serum levels were assessed in all patients. (3) Results: OSA patients were classified as being at high CVR, regardless of the type of score achieved. Increased EFT was observed in the OSA group. VCAM-1 was associated with a high CVR in OSA patients, but no significant correlation was observed between adhesion molecules and epicardial fat thickness. (4) Conclusions: OSA patients have a high CVR according to the SCORE 2 and SCORE 2OP risk scores. VCAM-1 may be associated with a high CVR in OSA patients. Extending conventional risk stratification scores by adding other potential biomarkers improves the risk stratification and guide treatment eligibility for CVD prevention in the OSA population.

Different clinical parameters inform epicardial fat thickness in pre- and post-menopausal women with obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a sleep-related disorder with breathing difficulties. Previous studies revealed that epicardial fat thickness (EFT) correlates with OSA severity. Interestingly, female patients display a stronger EFT-OSA correlation than males. The purpose of this study is to investigate the relationship between EFT and different clinical characteristics in pre- and post-menopausal women diagnosed with OSA.

METHODS

Patients diagnosed with OSA were divided into pre/early peri-menopausal (Group 1) and post/late peri-menopausal (Group 2) according to the menopause status. EFT was obtained from parasternal long-axis echocardiographic images. We also collected general clinical characteristics of patients involved in this study, and performed spearman correlation analysis to explore the correlations between EFT and the general clinical characteristics. We further applied Multiple stepwise linear regression analysis to explore the predictors for EFT in both groups.

RESULTS

A total number of 23 and 59 patients were enrolled in Group 1 and Group 2 respectively. EFT in Group 2 was significantly higher than that of Group 1. In both groups, EFT was positively correlated with apnea-hypopnea index (AHI), percentage of total sleep time when blood oxygen saturation was less than 90% (T90), oxygen desaturation index (ODI) and glucose; while EFT was negatively correlated with mean and lowest SaO₂ (oxygen saturation) levels. However, EFT was positively correlated with total cholesterol (TC) only in Group 1 and body mass index (BMI) only in Group2, respectively. Multiple stepwise linear regression analysis showed that AHI was independently associated with EFT in Group 1. However, both AHI and BMI were independent predictors of EFT in Group 2.

CONCLUSION

EFT was notably correlated with menopausal status in women with OSA. AHI was the independent predictor of EFT in women with OSA. BMI was the independent predictor of EFT in post/late peri-menopausal women with OSA.

Metabolic Syndrome and Abnormal Peri-Organ or Intra-Organ Fat (APIFat) Deposition in Chronic Obstructive Pulmonary Disease: An Overview

Chronic obstructive pulmonary disease (COPD) is a common disorder with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Systemic inflammation is involved in the pathogenesis of COPD and can also predispose to metabolic disorders (e.g., metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD)). Such comorbidities can negatively affect COPD outcomes, cardiovascular risk, and quality of life. Apart from NAFLD, abnormal peri-organ or intra-organ fat (APIFat) could be considered as markers for cardiometabolic diseases and even for COPD. The present narrative review considers the associations of COPD with MetS, NAFLD, and other APIFat, including epicardial, perirenal, peripancreatic, and intramuscular adipose tissue. Further research is needed to define these relationships and identify any potential clinical implications.

Epicardial Adipose Tissue in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

Objective: Epicardial adipose tissue (EAT) is a potential risk factor for obstructive sleep apnea (OSA). We performed a meta-analysis to assess the association of EAT with OSA.Methods: The PubMed, EMBASE, Web of Science, Cochrane Library, and Wanfang databases were searched by two independent investigators for all observational studies assessing the association of EAT with OSA. Then we assessed the association of EAT thickness (EAT-t) and EAT volume (EAT-v) with OSA by a meta-analysis.Results: Ten studies were included in the final analysis. Compared with that in controls, EAT-t in OSA patients was significantly increased (standardized mean difference 0.88, 95% confidence interval 0.72‐1.05, P=0.000). Furthermore, EAT-t was greater in OSA patients than in controls with similar BMIs. However, we did not find significant differences in EAT-v between OSA patients and controls (standardized mean difference 2.46, 95% confidence interval −0.36 to 5.29, P=0.088). EAT-t in the mild, moderate, and severe OSA subgroups was greater than in the controls. In addition, there were significant differences in EAT-t among the mild, moderate, and severe OSA subgroups.Conclusions: EAT-t was greater in patients with OSA than in controls, and EAT-t was also associated with the severity of OSA. These findings may provide a new clue for the pathogenesis and treatment of OSA.

Cardiometabolic-Based Chronic Disease, Adiposity and Dysglycemia Drivers: JACC State-of-the-Art Review

A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.

Cardiometabolic-Based Chronic Disease, Adiposity and Dysglycemia Drivers: JACC State-of-the-Art Review

A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.

Association of epicardial adipose tissues with obstructive sleep apnea and its severity: A meta-analysis study

BACKGROUND AND AIMS

Obstructive sleep apnea (OSA) is a global disease that is a manifestation of metabolic syndrome. Epicardial adipose tissue (EAT), a special type of visceral adipose tissue, has been proposed to be an independent predictor of visceral adiposity. Both OSA and EAT have a close association with diabetes and coronary artery disease. Whether EAT thickness is associated with OSA is controversial.

METHODS AND RESULTS

Several databases were searched from their inception to October 13, 2019. We estimated the summarized weighted mean difference (WMD) with 95% confidence intervals (CIs) for EAT thickness in the OSA and non-OSA groups. Then, we conducted a meta-analysis to evaluate the association between EAT thickness and OSA. The relationship between EAT thickness and OSA severity was also assessed. Nine studies with a total of 1178 participants were included. Globally, patients with OSA had a higher EAT thickness than patients without OSA (WMD = 0.95, 95% CI: 0.73-1.16, P < 0.001). Compared to the non-OSA patients, those with mild, moderate, and severe OSA had a progressively higher EAT thickness (WMD = 0.62, 95% CI: 0.41-0.83; WMD = 0.83, 95% CI: 0.50-1.15; and WMD = 1.06, 95% CI: 0.70-1.43, respectively; all P < 0.001).

CONCLUSION

EAT thickness was shown to be higher in patients with OSA than in patients with non-OSA measured by echocardiography. The increase in the EAT thickness was associated with OSA severity.