Epicardial adipose tissue volume and coronary calcification among people living with diabetes: a cross-sectional study

Detecting severe coronary artery stenosis in T2DM patients with NAFLD using cardiac fat radiomics-based machine learning

To analyze radiomics features of cardiac adipose tissue in individuals with type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD), integrating relevant clinical indicators, and employing machine learning techniques to construct a precise model for detecting severe coronary artery stenosis. A retrospective analysis of 710 T2DM patients with NAFLD was conducted at First People's Hospital of Wenling. The study population was randomly divided into a training set (n = 497) and a validation set (n = 213). Radiomics features from cardiac fat CT images, including epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT), were extracted for all patients. The semi-automated segmentation and extraction of shape, first-order statistics, texture, and wavelet were performed using specialized software. Simultaneously, clinical characteristics were collected. Following feature selection, four machine learning algorithms were utilized to develop radiomics, clinical, and combined radiomics-clinical models. The detection performance of these models was subsequently evaluated in both the training and validation cohorts. Additionally, Shapley Additive exPlanations (SHAP) values were calculated to quantify the importance of features. A total of 10 radiomics features for EAT and PAT were extracted from CT images after feature selection. The clinical model obtained an area under the curve (AUC) of 0.747 with the support vector machine (SVM), while the radiomics model reached an AUC of 0.838 with the extreme gradient boosting (XGBoost) algorithm. In comparison, the radiomics-clinical model using XGBoost demonstrated superior detection capability, achieving an AUC of 0.883 in the training set and maintaining high performance in the validation set, with the highest F1 score, accuracy, and precision. SHAP analysis revealed the importance of radiomics features from EAT and PAT, as well as clinical factors such as diabetes duration, global longitudinal strain (GLS), and low-density lipoprotein cholesterol (LDL-C), in detecting severe coronary artery stenosis. This study confirms that the integrated application of cardiac fat radiomics features and clinical data using machine learning models, particularly the XGBoost algorithm, facilitates the detection of severe coronary artery stenosis in T2DM patients with NAFLD. SHAP analysis further elucidates the contribution of key variables in the model, providing crucial foundations for personalized treatment decision-making.

Effect of smoking behaviour and related blood DNA methylation on visceral adipose tissues

BACKGROUND

Recent studies have found that tobacco smoking is associated with fat distribution, yet limited research has focused on its relationship with visceral adipose tissues (VATs). Furthermore, the cellular and molecular mechanisms underlying the interactions among smoking, epigenetic modifications, and VATs remain unknown.

METHOD

We performed univariable Mendelian randomization (MR) analysis to elucidate the causal relationship between smoking behaviours and VATs, including epicardial and pericardial adipose tissue (EPAT), liver fat (LF), and pancreas fat (PF). This approach could minimize the impact of confounders and reverse causality through utilizing genetic variants to proxy the smoking behaviours. Mediation MR analysis were conducted to detect potential mediators. Additionally, summary-data-based MR (SMR) and colocalization analysis were performed to explore the association between smoking-related DNA methylation and VATs.

RESULTS

We identified a convincing association between smoking initiation and increased EPAT (beta: 0.15, 95% CI: 0.06, 0.23, p = 7.01 × 10-4) and LF area (beta: 0.15, 95% CI = 0.05, 0.24, p = 2.85 × 10-3), respectively. Further mediation analysis suggested type 2 diabetes mellitus (T2DM) as a potential mediator within these co-relationships. When further exploring the associations between the smoking related DNA methylation and VATs, we identified that WT1 methylation at cg05222924 was significantly linked to a lower EPAT area (beta: -0.12, 95% CI: -0.16, -0.06, PFDR = 2.24 × 10-3), while GPX1 methylation at cg18642234 facilitated the deposition of EPAT (beta: 0.15, 95% CI: 0.10, 0.20, PFDR = 1.66 × 10-4).

CONCLUSION

Our study uncovered a significant causal effect between smoking and VATs, with T2DM identified as a potential mediator. Further investigation into DNA methylation yielded novel insights into the pathogenic role of smoking on EPAT.

Echocardiographic assessment of epicardial adipose tissue thickness as independent predictor in coronary artery disease

This study aimed to assess the utility of echocardiography-measured epicardial adipose tissue (EAT) thickness (EATT) as an independent predictor for coronary artery disease (CAD), examining its correlation with oxidative stress levels in epicardial tissue and the complexity of the disease in patients undergoing open-heart surgery. This study included a total of 25 patients referred for cardiac surgery with 14 in the CAD group and 11 in the non-CAD group. Epicardial fat was sampled from patients subjected to open-heart surgery. EATT was higher in the CAD group compared to the non-CAD group (8.15 ± 2.09 mm vs. 5.12 ± 1.8 mm, p = 0.001). The epicardial reactive oxygen species level was higher in the CAD group compared to the non-CAD group (21.4 ± 2.47 nmol H2O2/g tisssue/h vs. 15.7 ± 1.55 nmol H2O2/g tisssue/h, p < 0.001). EATT greater than 6.05 mm was associated with CAD, with a sensitivity of 86% and specificity of 73%. Echocardiographically measured EATT is a significant, independent predictor of CAD. Its relationship with increased EAT oxidative stress levels suggests a potential mechanistic link between EATT and CAD pathogenesis. These findings highlight the importance of EATT as a diagnostic tool in assessing the complexity of CAD in patients undergoing cardiac surgery.

Fully automated epicardial adipose tissue volume quantification with deep learning and relationship with CAC score and micro/macrovascular complications in people living with type 2 diabetes: the multicenter EPIDIAB study

BACKGROUND

The aim of this study (EPIDIAB) was to assess the relationship between epicardial adipose tissue (EAT) and the micro and macrovascular complications (MVC) of type 2 diabetes (T2D).

METHODS

EPIDIAB is a post hoc analysis from the AngioSafe T2D study, which is a multicentric study aimed at determining the safety of antihyperglycemic drugs on retina and including patients with T2D screened for diabetic retinopathy (DR) (n = 7200) and deeply phenotyped for MVC. Patients included who had undergone cardiac CT for CAC (Coronary Artery Calcium) scoring after inclusion (n = 1253) were tested with a validated deep learning segmentation pipeline for EAT volume quantification.

RESULTS

Median age of the study population was 61 [54;67], with a majority of men (57%) a median duration of the disease 11 years [5;18] and a mean HbA1c of7.8 ± 1.4%. EAT was significantly associated with all traditional CV risk factors. EAT volume significantly increased with chronic kidney disease (CKD vs no CKD: 87.8 [63.5;118.6] vs 82.7 mL [58.8;110.8], p = 0.008), coronary artery disease (CAD vs no CAD: 112.2 [82.7;133.3] vs 83.8 mL [59.4;112.1], p = 0.0004, peripheral arterial disease (PAD vs no PAD: 107 [76.2;141] vs 84.6 mL[59.2; 114], p = 0.0005 and elevated CAC score (> 100 vs  < 100 AU: 96.8 mL [69.1;130] vs 77.9 mL [53.8;107.7], p < 0.0001). By contrast, EAT volume was neither associated with DR, nor with peripheral neuropathy. We further evidenced a subgroup of patients with high EAT volume and a null CAC score. Interestingly, this group were more likely to be composed of young women with a high BMI, a lower duration of T2D, a lower prevalence of microvascular complications, and a higher inflammatory profile.

CONCLUSIONS

Fully-automated EAT volume quantification could provide useful information about the risk of both renal and macrovascular complications in T2D patients.

Epicardial adipose tissue defined by initial polytrauma CT of mechanically ventilated trauma patients: retrospective single-center cohort study to predict short-term outcomes

PURPOSE

Epicardial adipose tissue (EAT) detected by computed tomography (CT) is associated with morbidity and mortality in patients with COVID-19 and other critical care patient cohorts, whereas their prognostic relevance in trauma patients remains unclear. The present study explored associations with four potential short-term outcomes in trauma patients.

METHODS

All consecutive trauma patients requiring emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period (2008-2019) were reanalyzed for this study. EAT was measured semiquantitatively in initial CT and analyzed regarding associations with 24-hour and 30-day mortality using Cox proportional hazard models. In survivors, associations of EAT with intensive care unit length of stay (ICU LOS) and mechanical ventilation duration were analyzed using linear regression analyses.

RESULTS

Four hundred fifty-five patients (74.7% male) with a median age of 49 years, and a median injury severity score (ISS) of 26 points were analyzed. In univariable analysis, EAT index was significantly associated with 24-hour and 30-day mortality (p = 0.007, and p = 0.013, respectively). After adjustment for significant predictors age, body mass index, and ISS, no significant associations were confirmed (p = 0.622, and p = 0.903, respectively). In a subanalysis of 353 survivors, EAT index was significantly associated with ICU LOS and mechanical ventilation duration in univariable analyses (p = 0.031, and p = 0.014, respectively), but not in multivariable analyses (p = 0.81 and p = 0.46, respectively).

CONCLUSION

EAT index was associated with short-term outcomes in severely injured trauma patients, which not remained significant in multivariable analysis, suggesting that its prognostic capability is limited.

Epicardial adipose tissue as a prognostic marker in acute pulmonary embolism

BACKGROUND

Epicardial adipose tissue (EAT) has been established as a quantitative imaging biomarker associated with disease severity in coronary heart disease. Our aim was to use this prognostic marker derived from computed tomography pulmonary angiography (CTPA) for the prediction of mortality and prognosis in patients with acute pulmonary embolism.

METHODS

The clinical database was retrospectively screened for patients with acute pulmonary embolism between 2015 and 2021. Overall, 513 patients (216 female, 42.1%) were included in the analysis. The study end-point was 30-day mortality. Epicardial adipose tissue was measured on the diagnostic CTPA in a semiquantitative manner. The volume and density of EAT were measured for every patient.

RESULTS

Overall, 60 patients (10.4%) died within the 30-day observation period. The mean EAT volume was 128.3 ± 65.0 cm3 in survivors and 154.6 ± 84.5 cm3 in nonsurvivors (p = 0.02). The density of EAT was -79.4 ± 8.3 HU in survivors and -76.0 ± 8.4 HU in nonsurvivors (p = 0.86), and EAT density was associated with 30-day mortality (odds ratio [OR] = 1.07; 95% confidence interval [CI]: 1.03; 1.1, p < 0.001) but did not remain statistically significant in multivariable analysis. No association was identified between EAT volume and 30-day mortality (OR = 1.0; 95% CI: 1.0; 1.0, p = 0.48).

CONCLUSION

There might be an association between EAT density and mortality in patients with acute pulmonary embolism. Further studies are needed to elucidate the prognostic relevance of EAT parameters in patients with acute pulmonary embolism.

[Arterial mediacalcinosis in patients with diabetes mellitus: etiopathogenetic and histopathological aspects]

In a review of the generalized results of foreign and domestic studies on the development mechanism and pathogenesis of vascular calcification. The etiopathogenetic, pathophysiological and histomorphological features of mediacalcinosis, which reveal changes in the vascular bed in patients with DM, are considered. The role of risk factors for diseases, such as increased glycemia, changes in insulin levels, impaired lipid metabolism, obesity, arterial hypertension, CKD and aging, is indicated. The role of procalcifying and anticalcifying factors in colonic vascular remodeling is discussed. Identification of informative molecular markers and factors of CS will allow in the future to develop effective strategies for drug management of the risk of their progression and individual prevention programs to improve the quality and life expectancy in patients with cardiovascular diseases.

Epicardial adipose tissue as an independent predictor of long-term outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

BACKGROUND

Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR.

METHODS

A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74 cm3 of EAT into groups with low EAT and high EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses.

RESULTS

A total number of 341 of 416 patients (median age 80.9 years, 45% female) were included in the final analysis. Patients with high EAT volumes had similar short-term outcome (p = 0.794) but significantly worse long-term prognosis (p = 0.023) compared to patients with low EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59; p = 0.031) independently from concomitant cardiovascular risk factors, general type of AS, and functional echocardiography parameters of AS severity (HR1.69; p = 0.013).

CONCLUSION

Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS.

TRIAL REGISTRATION

DRKS, DRKS00024479.

Analysis of Epicardial Adipose Tissue Texture in Relation to Coronary Artery Calcification in PCCT: The EAT Signature!

(1) Background: Epicardial adipose tissue influences cardiac biology in physiological and pathological terms. As it is suspected to be linked to coronary artery calcification, identifying improved methods of diagnostics for these patients is important. The use of radiomics and the new Photon-Counting computed tomography (PCCT) may offer a feasible step toward improved diagnostics in these patients. (2) Methods: In this retrospective single-centre study epicardial adipose tissue was segmented manually on axial unenhanced images. Patients were divided into three groups, depending on the severity of coronary artery calcification. Features were extracted using pyradiomics. Mean and standard deviation were calculated with the Pearson correlation coefficient for feature correlation. Random Forest classification was applied for feature selection and ANOVA was performed for group comparison. (3) Results: A total of 53 patients (32 male, 21 female, mean age 57, range from 21 to 80 years) were enrolled in this study and scanned on the novel PCCT. "Original_glrlm_LongRunEmphasis", "original_glrlm_RunVariance", "original_glszm_HighGrayLevelZoneEmphasis", and "original_glszm_SizeZoneNonUniformity" were found to show significant differences between patients with coronary artery calcification (Agatston score 1-99/≥100) and those without. (4) Conclusions: Four texture features of epicardial adipose tissue are associated with coronary artery calcification and may reflect inflammatory reactions of epicardial adipose tissue, offering a potential imaging biomarker for atherosclerosis detection.

Epicardial Adipose Tissue as a Prognostic Marker in COVID-19

BACKGROUND/AIM

Epicardial adipose tissue (EAT) has been established as a quantitative imaging biomarker associated with the prognosis of several diseases, especially cardiovascular diseases. The cardiac injury by coronavirus disease 2019 (COVID-19) might be linked to the EAT. This study aimed to use this prognostic marker derived from computed tomography (CT) images to predict 30-day mortality in patients with COVID-19.

PATIENTS AND METHODS

Consecutive patients with COVID-19 were retrospectively screened between 2020 and 2022. Overall, 237 patients (78 female, 32.9%) were included in the present study. The study end-point was the 30-day mortality. EAT was measured using the diagnostic CT in a semiquantitative manner. EAT volume and density were measured for each patient.

RESULTS

Overall, 70 patients (29.5%) died within the 30-day observation period and 143 patients (60.3%) were admitted to the intensive care unit (ICU). The mean EAT volume was 140.9±89.1 cm3 in survivors and 132.9±77.7 cm3 in non-survivors, p=0.66. The mean EAT density was -71.9±8.1 Hounsfield units (HU) in survivors, and -67.3±8.4 HU in non-survivors, p=0.0001. EAT density was associated with 30-day mortality (p<0.0001) and ICU admission (p<0.0001). EAT volume was not associated with mortality and/or ICU admission.

CONCLUSION

EAT density was associated with 30-day mortality and ICU admission in patients with COVID-19.

Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes

Vascular inflammation is recognized as the primary trigger of acute coronary syndrome (ACS). However, current noninvasive methods are not capable of accurately detecting coronary inflammation. Epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT), in addition to their role as an energy reserve system, have been found to contribute to the development and progression of coronary artery calcification, inflammation, and plaque vulnerability. They also participate in the vascular response during ischemia, sympathetic stimuli, and arrhythmia. As a result, the evaluation of EAT and PCAT using imaging techniques such as computed tomography (CT), cardiac magnetic resonance (CMR), and nuclear imaging has gained significant attention. PCAT-CT attenuation, which measures the average CT attenuation in Hounsfield units (HU) of the adipose tissue, reflects adipocyte differentiation/size and leukocyte infiltration. It is emerging as a marker of tissue inflammation and has shown prognostic value in coronary artery disease (CAD), being associated with plaque development, vulnerability, and rupture. In patients with acute myocardial infarction (AMI), an inflammatory pericoronary microenvironment promoted by dysfunctional EAT/PCAT has been demonstrated, and more recently, it has been associated with plaque rupture in non-ST-segment elevation myocardial infarction (NSTEMI). Endothelial dysfunction, known for its detrimental effects on coronary vessels and its association with plaque progression, is bidirectionally linked to PCAT. PCAT modulates the secretory profile of endothelial cells in response to inflammation and also plays a crucial role in regulating vascular tone in the coronary district. Consequently, dysregulated PCAT has been hypothesized to contribute to type 2 myocardial infarction with non-obstructive coronary arteries (MINOCA) and coronary vasculitis. Recently, quantitative measures of EAT derived from coronary CT angiography (CCTA) have been included in artificial intelligence (AI) models for cardiovascular risk stratification. These models have shown incremental utility in predicting major adverse cardiovascular events (MACEs) compared to plaque characteristics alone. Therefore, the analysis of PCAT and EAT, particularly through PCAT-CT attenuation, appears to be a safe, valuable, and sufficiently specific noninvasive method for accurately identifying coronary inflammation and subsequent high-risk plaque. These findings are supported by biopsy and in vivo evidence. Although speculative, these pieces of evidence open the door for a fascinating new strategy in cardiovascular risk stratification. The incorporation of PCAT and EAT analysis, mainly through PCAT-CT attenuation, could potentially lead to improved risk stratification and guide early targeted primary prevention and intensive secondary prevention in patients at higher risk of cardiac events.

Vascular calcification: from the perspective of crosstalk

Vascular calcification (VC) is highly correlated with cardiovascular disease morbidity and mortality, but anti-VC treatment remains an area to be tackled due to the ill-defined molecular mechanisms. Regardless of the type of VC, it does not depend on a single cell but involves multi-cells/organs to form a complex cellular communication network through the vascular microenvironment to participate in the occurrence and development of VC. Therefore, focusing only on the direct effect of pathological factors on vascular smooth muscle cells (VSMCs) tends to overlook the combined effect of other cells and VSMCs, including VSMCs-VSMCs, ECs-VMSCs, Macrophages-VSMCs, etc. Extracellular vesicles (EVs) are a collective term for tiny vesicles with a membrane structure that are actively secreted by cells, and almost all cells secrete EVs. EVs docked on the surface of receptor cells can directly mediate signal transduction or transfer their contents into the cell to elicit a functional response from the receptor cells. They have been proven to participate in the VC process and have also shown attractive therapeutic prospects. Based on the advantages of EVs and the ability to be detected in body fluids, they may become a novel therapeutic agent, drug delivery vehicle, diagnostic and prognostic biomarker, and potential therapeutic target in the future. This review focuses on the new insight into VC molecular mechanisms from the perspective of crosstalk, summarizes how multi-cells/organs interactions communicate via EVs to regulate VC and the emerging potential of EVs as therapeutic methods in VC. We also summarize preclinical experiments on crosstalk-based and the current state of clinical studies on VC-related measures.

Distribution and determinants of coronary artery calcium score in asymptomatic patients with Type-2 diabetes: The French-CAC100 score

BACKGROUND

Coronary artery calcium score (CACS) refines the cardiovascular disease (CVD) risk prediction in patients with Type-2 diabetes (T2D). We aimed to identify the determinants for high CACS in CVD-free patients with T2D.

METHODS

We studied 796 patients with T2D with CACS measured in three centers: two in continental France and a third in the Reunion Island. To predict a CACS ≥ 100, we derived a risk score in patients in continental France, and validated it in those in the Reunion Island.

RESULTS

The distributions of CACS distributions were similar among patients in continental France and Reunion Island. The French-CAC100 score included 5 parameters (age, sex, diabetes duration, non-CV end-organ damage and presence of ≥ 2 other CVD risk factors), ranging from 0 to 22 points. Similar areas under the curves were found for the risk score in both settings (0.80 vs. 0.73, p = 0.10). A French-CAC100 score < 10 excluded the odds for CACS ≥ 100 and CACS ≥ 400 with negative predictive values of 90% and 97% respectively, avoiding 58% of CT-scans.

CONCLUSION

Regardless of the geographic area, patients with T2D share similar risk factors for high CACS. The French-CAC100 score allows the identification of those at higher risk of elevated CACS.

Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study

BACKGROUND

Coronary artery calcium (CAC) improves cardiovascular event prediction. Visceral adipose tissue (VAT) is a cardiometabolic risk factor that may directly or through its related comorbidities determine the obesity-related risk. A clinical VAT estimator could allow an efficient evaluation of obesity-related risk. We aimed to analyze the effect of VAT and its related cardiometabolic risk factors on CAC progression.

METHODS

CAC was quantified at baseline and after 5 years by computed tomography (CT), determining its progression. VAT and pericardial fat were measured by CT and estimated by a clinical surrogate (METS-VF). Considered cardiometabolic risk factors were: peripheral insulin resistance (IR), HOMA-IR, adipose tissue IR (ADIPO-IR), and adiponectin. Factors independently associated to CAC progression were analyzed by adjusted Cox proportional hazard models, including statin use and ASCVD risk score as covariates. We performed interaction and mediation models to propose possible pathways for CAC progression.

RESULTS

The study included 862 adults (53 ± 9 years, 53% women), incidence CAC progression rate: 30.2 (95% CI 25.3-35.8)/1000 person-years. VAT (HR: 1.004, 95% CI 1.001-1.007, p < 0.01) and METS-VF (HR: 1.001, 95% CI 1.0-1.001, p < 0.05) independently predicted CAC progression. VAT-associated CAC progression risk was evident among low-risk ASCVD subjects, and attenuated among medium-high-risk subjects, suggesting that traditional risk factors overcome adiposity in the latter. VAT mediates 51.8% (95% CI 44.5-58.8%) of the effect attributable to IR together with adipose tissue dysfunction on CAC progression.

CONCLUSIONS

This study supports the hypothesis that VAT is a mediator of the risk conferred by subcutaneous adipose tissue dysfunction. METS-VF is an efficient clinical surrogate that could facilitate the identification of at-risk adiposity subjects in daily clinical practice.

Diagnosis of coronary artery disease in patients with type 2 diabetes mellitus based on computed tomography and pericoronary adipose tissue radiomics: a retrospective cross-sectional study

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) are highly susceptible to cardiovascular disease, and coronary artery disease (CAD) is their leading cause of death. We aimed to assess whether computed tomography (CT) based imaging parameters and radiomic features of pericoronary adipose tissue (PCAT) can improve the diagnostic efficacy of whether patients with T2DM have developed CAD.

METHODS

We retrospectively recruited 229 patients with T2DM but no CAD history (146 were diagnosed with CAD at this visit and 83 were not). We collected clinical information and extracted imaging manifestations from CT images and 93 radiomic features of PCAT from all patients. All patients were randomly divided into training and test groups at a ratio of 7:3. Four models were constructed, encapsulating clinical factors (Model 1), clinical factors and imaging indices (Model 2), clinical factors and Radscore (Model 3), and all together (Model 4), to identify patients with CAD. Receiver operating characteristic curves and decision curve analysis were plotted to evaluate the model performance and pairwise model comparisons were performed via the DeLong test to demonstrate the additive value of different factors.

RESULTS

In the test set, the areas under the curve (AUCs) of Model 2 and Model 4 were 0.930 and 0.929, respectively, with higher recognition effectiveness compared to the other two models (each p < 0.001). Of these models, Model 2 had higher diagnostic efficacy for CAD than Model 1 (p < 0.001, 95% CI [0.129-0.350]). However, Model 4 did not improve the effectiveness of the identification of CAD compared to Model 2 (p = 0.776); similarly, the AUC did not significantly differ between Model 3 (AUC = 0.693) and Model 1 (AUC = 0.691, p = 0.382). Overall, Model 2 was rated better for the diagnosis of CAD in patients with T2DM.

CONCLUSIONS

A comprehensive diagnostic model combining patient clinical risk factors with CT-based imaging parameters has superior efficacy in diagnosing the occurrence of CAD in patients with T2DM.

Adverse association of epicardial adipose tissue accumulation with cardiac function and atrioventricular coupling in postmenopausal women assessed by cardiac magnetic resonance imaging

Background

This study aims to investigate the association of epicardial adipose tissue (EAT) accumulation with cardiac function and atrioventricular coupling in a cohort of postmenopausal women assessed by cardiac magnetic resonance imaging (CMR).

Materials and methods

Overall, 283 postmenopausal women (mean age 61.5 ± 9.1 years) who underwent CMR examination were enrolled. Participants were classified into four groups by the quartile of EAT volume. EAT volume was quantified on short-axis cine stacks covering the entire epicardium. CMR-derived cardiac structure and function, including left atrial (LA)- volume, emptying fraction, deformation, and left ventricular (LV)- mass, volume, ejection fraction, and deformation, were compared among the four groups of graded EAT volume.

Results

Left ventricular mass (LVM) and LV remodeling index were both increased in the group with the highest EAT volume, compared to those in the lowest quartile (p = 0.016 and p = 0.003). The LV global longitudinal strain (LV-GLS), circumferential strain (LV-GCS), and LA- reservoir strain (LA-RS), conduit strain (LA-CS), and booster strain (LA-BS), were all progressively decreased from the lowest quartile of EAT volume to the highest (all p &lt; 0.05). Multivariable linear regression analyses showed that EAT was independently associated with LV-GLS, LA-RS, LA-CS, and LA-BS after adjusting for body mass index and other clinical factors.

Conclusion

Epicardial adipose tissue accumulation is independently associated with subclinical LV and LA function in postmenopausal women. These associations support the role of EAT in mediating deleterious effects on cardiac structure and function.

The Importance of the Assessment of Epicardial Adipose Tissue in Scientific Research

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.

Impact of Sex and Menopausal Status on the Association Between Epicardial Adipose Tissue and Diastolic Function in Patients with Type 2 Diabetes Mellitus

OBJECTIVE

To evaluate the impact of sex and menopausal status on the association between the epicardial adipose tissue (EAT) volume and diastolic function in patients with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

A total of 542 consecutive patients with T2DM were retrospectively included in this study. All patients underwent cardiac computed tomographic as well as echocardiography. To assess the independent association of EAT and diastolic function parameters, we performed a multivariate linear regression analysis.

RESULTS

The median EAT volume was 113.11 cm³ (interquartile range (IQR): 88.38, 148.03), and EAT volume was higher in men than in women (p < 0.05). We also discovered that EAT volume was significantly associated with diastolic function in both sexes after adjusting for risk factors (p < 0.05). Concerning menopausal status, EAT volume was higher in postmenopausal women than premenopausal women and was independently associated with the diastolic function only in postmenopausal women.

CONCLUSION

In patients with T2DM, EAT is independently associated with diastolic function in the male population and a portion of the female population. In contrast to premenopausal women, EAT volume is only significantly correlated with diastolic function in postmenopausal women.

The Role and Implications of Epicardial Fat in Coronary Atherosclerotic Disease

The current minireview aims to assess the implications of epicardial fat secretory function in the development of coronary artery disease. The epicardial adipose tissue (EAT) is a visceral fat depot that has been described as a cardiovascular risk factor. In addition to its mechanical protection role and physiological secretory function, it seems that various secretion products of the epicardial fat are responsible for metabolic disturbances at the level of the cardiac muscle when in association with pre-existing pathological conditions, such as metabolic syndrome. There is a pathological reduction in sarcomere shortening, abnormal cytosolic Ca²⁺ fluxes, reduced expression of sarcoplasmic endoplasmic reticulum ATPase 2a and decreased insulin-mediated Akt-Ser473-phosphorylation in association with abnormal levels of epicardial fat tissue. Activin A, angiopoietin-2, and CD14-positive monocytes selectively accumulate in the diseased myocardium, resulting in reduced cardiomyocyte contractile function. At the same time, it is believed that these alterations in secretory products directly decrease the myocyte function via molecular changes, thus contributing to the development of coronary disease when certain comorbidities are associated.

Ethnicity should be included as a risk factor for coronary artery calcium score

Coronary artery calcium score (CACs) is a measurement of calcification in coronary arteries using a computed tomography scan. It has a predictive role for future myocardial infarction thus it aids in cardiovascular risk assessment and physician decision making. Multiple risk factors have been attributed to coronary artery calcification including age, male gender and ethnicity. Herein, we report our concerns regarding neglecting ethnicity within participants demographics and data analysis, which may affect the findings of the study.

Effect of glucagon-like peptide-1 (GLP-1) analogues on epicardial adipose tissue: A meta-analysis

BACKGROUND AND AIMS

Glucagon-like peptide-1 (GLP-1) analogues reduce body fat and cardiovascular events in patients with type 2 diabetes. Accumulation of epicardial adipose tissue (EAT) is associated with increased cardio-metabolic risks and coronary events in type 2 diabetes.

METHODS

A systematic review and meta-analysis were performed from Glucagon-like peptide-1 analogues therapy on type 2 diabetes patients, reporting data from changes in EAT, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases.

RESULTS

It has been found a limited number of studies, a total of 4 studies (n = 160 patients with GLP-1 analogues therapy) were included in the final analysis. Pooled analysis revealed that GLP-1 analogues reduce EAT (MD: 1.83 mm [-2.50; -1.10]; P < 0.01). Compared with the patients before the treatment, the patients after the treatment had a smaller HbA1c (MD -1.10%[-1.80; -0.30]; p = 0.0143) and body mass index was reduced (MD -2.20 kg/m²[-3.70; -0.60]; p = 0.0058), GLP-1 therapy reduced low-density lipoprotein levels (MD-13.53 mg/dL [-21.74; -5.31]; p = 0.001) and reduced triglycerides levels significantly (MD -18.32 -28.20 mg/dL; -8.50); p = 0.0003).

CONCLUSIONS

This meta-analysis suggests that the amount of EAT is significantly reduced in T2D patients with Glucagon-like peptide-1 analogues.

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

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

Subclinical cardiovascular disease and utility of coronary artery calcium score

ASCVD are the leading causes of mortality and morbidity among Globe. Evaluation of patients' comprehensive and personalized risk provides risk management strategies and preventive interventions to achieve gain for patients. Framingham Risk Score (FRS) and Systemic Coronary Risk Evaluation Score (SCORE) are two well studied risk scoring models, however, can miss some (20-35%) of future cardiovascular events. To obtain more accurate risk assessment recalibrating risk models through utilizing novel risk markers have been studied in last 3 decades and both ESC and AHA recommends assessing Family History, hs-CRP, CACS, ABI, and CIMT. Subclinical Cardiovascular Disease (SCVD) has been conceptually developed for investigating gradually progressing asymptomatic development of atherosclerosis and among these novel risk markers it has been well established by literature that CACS having highest improvement in risk assessment. This review study mainly selectively discussing studies with CACS measurement. A CACS = 0 can down-stratify risk of patients otherwise treated or treatment eligible before test and can reduce unnecessary interventions and cost, whereas CACS ≥ 100 is equivalent to statin treatment threshold of ≥ 7.5% risk level otherwise statin ineligible before test. Since inflammation, insulin resistance, oxidative stress, dyslipidemia and ongoing endothelial damage due to hypertension could lead to CAC, ASCVD linked with comorbidities. Recent cohort studies have shown a CACS 100-300 as a sign of increased cancer risk. Physical activity, dietary factors, cigarette use, alcohol consumption, metabolic health, family history of CHD, aging, exposures of neighborhood environment and non-cardiovascular comorbidities can determine CACs changes.

Epicardial adipose tissue volume and myocardial ischemia in asymptomatic people living with diabetes: a cross-sectional study

Background

Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. This study aimed to evaluate whether EAT volume was associated with stress-induced myocardial ischemia in asymptomatic people living with diabetes—independently of confounding factors—and whether it could predict this condition.

Methods

We included asymptomatic patients with diabetes and no coronary history, who had undergone both a stress a myocardial scintigraphy to diagnose myocardial ischemia, and a computed tomography to measure their coronary artery calcium (CAC) score. EAT volume was retrospectively measured from computed tomography imaging. Determinants of EAT volume and asymptomatic myocardial ischemia were evaluated.

Results

The study population comprised 274 individuals, including 153 men. Mean (± standard deviation) age was 62 ± 9 years, and 243, 23 and 8 had type 2, type 1, or another type of diabetes, respectively. Mean body mass index was 30 ± 6 kg/m², and mean EAT volume 96 ± 36 cm³. Myocardial ischemia was detected in 32 patients (11.7%). EAT volume was positively correlated with age, body mass index and triglyceridemia, but negatively correlated with HbA1c, HDL- and LDL-cholesterol levels. Furthermore, EAT volume was lower in people with retinopathy, but higher in men, in current smokers, in patients with nephropathy, those with a CAC score > 100 Agatston units, and finally in individuals with myocardial ischemia (110 ± 37 cm³ vs 94 ± 37 cm³ in those without myocardial ischemia, p < 0.05). The association between EAT volume and myocardial ischemia remained significant after adjustment for gender, diabetes duration, peripheral macrovascular disease and CAC score. We also found that area under the ROC curve analysis showed that EAT volume (AROC: 0.771 [95% confidence interval 0.683–0.858]) did not provide improved discrimination of myocardial ischemia over the following classic factors: gender, diabetes duration, peripheral macrovascular disease, retinopathy, nephropathy, smoking, atherogenic dyslipidemia, and CAC score (AROC 0.773 [0.683–0.862]).

Conclusions

EAT may play a role in coronary atherosclerosis and coronary circulation in patients with diabetes. However, considering EAT volume is not a better marker for discriminating the risk of asymptomatic myocardial ischemia than classic clinical data.

Glycaemic Control in Diabetes

Reduction of glucose is the hallmark of diabetes therapy proven to reduce micro- and macro-vascular risk in patients with type 1 diabetes. However glucose-lowering efficacy trials in type 2 diabetes didn't show major cardiovascular benefit. Then, a paradigm change in the treatment of patients with type 2 diabetes has emerged due to the introduction of new blood glucose-lowering agents. Cardiovascular endpoint studies have proven HbA1c-independent cardioprotective effects for GLP-1 receptor agonists and SGLT-2 inhibitors. Furthermore, SGLT-2 inhibitors reduce the risk for heart failure and chronic kidney disease. Mechanisms for these blood glucose independent drug target-related effects are still an enigma. Recent research has shown that GLP-1 receptor agonists might have anti-inflammatory and plaque stabilising effects whereas SGLT-2 inhibitors primarily reduce pre- and after-load of the heart and increase work load efficiency of the heart. In addition, reduction of intraglomerular pressure, improved energy supply chains and water regulation appear to be major mechanisms for renoprotection by SGLT-2 inhibitors. These studies and observations have led to recent changes in clinical recommendations and treatment guidelines for type 2 diabetes. In patients with high or very high cardio-renal risk, SGLT-2 inhibitors or GLP-1 receptor agonists have a preferred recommendation independent of baseline HbA1c levels due to cardioprotection. In patients with chronic heart failure, chronic kidney disease or at respective risks SGLT-2 inhibitors are the preferred choice. Therefore, the treatment paradigm of glucose control in diabetes has changed towards using diabetes drugs with evidence-based organ protection improving clinical prognosis.

Epicardial adipose tissue and severe Coronavirus Disease 19

BACKGROUND

Both visceral adipose tissue and epicardial adipose tissue (EAT) have pro-inflammatory properties. The former is associated with Coronavirus Disease 19 (COVID-19) severity. We aimed to investigate whether an association also exists for EAT.

MATERIAL AND METHODS

We retrospectively measured EAT volume using computed tomography (CT) scans (semi-automatic software) of inpatients with COVID-19 and analyzed the correlation between EAT volume and anthropometric characteristics and comorbidities. We then analyzed the clinicobiological and radiological parameters associated with severe COVID-19 (O2 [Formula: see text] 6 l/min), intensive care unit (ICU) admission or death, and 25% or more CT lung involvement, which are three key indicators of COVID-19 severity.

RESULTS

We included 100 consecutive patients; 63% were men, mean age was 61.8 ± 16.2 years, 47% were obese, 54% had hypertension, 42% diabetes, and 17.2% a cardiovascular event history. Severe COVID-19 (n = 35, 35%) was associated with EAT volume (132 ± 62 vs 104 ± 40 cm³, p = 0.02), age, ferritinemia, and 25% or more CT lung involvement. ICU admission or death (n = 14, 14%) was associated with EAT volume (153 ± 67 vs 108 ± 45 cm³, p = 0.015), hypertension and 25% or more CT lung involvement. The association between EAT volume and severe COVID-19 remained after adjustment for sex, BMI, ferritinemia and lung involvement, but not after adjustment for age. Instead, the association between EAT volume and ICU admission or death remained after adjustment for all five of these parameters.

CONCLUSIONS

Our results suggest that measuring EAT volume on chest CT scans at hospital admission in patients diagnosed with COVID-19 might help to assess the risk of disease aggravation.