Association of Epicardial Adipose Tissue Thickness with Left Atrial Size and Atrial Fibrillation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with detrimental consequences. Epicardial fat is consistently associated with the presence, severity, and recurrence of AF. Aim: The aim of the work was to investigate the association of epicardial adipose tissue thickness with left atrial size in patients with atrial fibrillation. Patients and Methods: This study was conducted on 25 atrial fibrillation (AF) patients and 25 subjects with normal sinus rhythm as a control group matched in body weight. All patients underwent transthoracic echocardiogram. EAT (epicardial adipose tissue) thickness was measured on the right ventricular free wall of the two- dimensional parasternal long-axis view at end systole. Results: The results showed that there was a significant difference between the two groups in waist circumference, EAT (epicardial adipose tissue) thickness, left atrium diameter, LA volume. Receiver operating characteristics (ROC) analysis showed that an EAT thickness of > 0.30 cm maximizes the sensitivity and specificity to predict the development of AF. Conclusion: Increases epicardial adipose tissue is associated with the occurrence of atrial fibrillation.

CORRELATION BETWEEN EPICARDIAL ADIPOSE TISSUE AND STRUCTURAL AND FUNCTIONAL PARAMETERS OF POST-INFARCTION MYOCARDIUM IN PATIENTS WITH CORONARY STENTING

Available literature contains limited data on the correlation between epicardial adipose tissue and post-infarction myocardial remodeling with regard to diagnosis and prognosis. Objective. The aim of the paper is to study the correlation between epicardial adipose tissue thickness and structural and functional heart parameters in patients with myocardial infarction and percutaneous coronary intervention. Materials and Methods. The study involved 94 patients with myocardial infarction and subsequent ad-hoc percutaneous coronary intervention. All the patients underwent stress echocardiography 6 weeks after coronary stenting. Student’s t-test, Mann–Whitney U-test, and sign test were used for statistical data processing. Results. The authors revealed significant differences in the parameters of the ejection fraction and the shortening fraction while assessing the systolic function of the left ventricle (LV). Patients whose epicardial adipose tissue thickness (EATT) was more than 3.5 mm demonstrated lower parameters. Assessment of the correlation between diastolic function and EATT showed that patients with EATT (>3.5 mm) had a longer time of LV isovolumetric relaxation (p<0.05). Myocardium response to the stress test showed a statistically significant increase in the LV end-diastolic dimension in patients with EATT>3.5 mm compared with those with EATT<3.5 mm (55.9±4.2 vs 53.0±3.2 mm, p=0.01). After physical activity patients with EATT>3.5 mm demonstrated an increase in the end-diastolic LV dimension from 53.8 to 55.9 mm (p<0.05). Conclusion. Epicardial adipose tissue thickness (>3.5 mm) in patients with percutaneous coronary intervention is associated with higher values of LV end-diastolic dimension, indexed left atrial volume and LV myocardial mass associated with lower values of LV ejection fraction and shortening fraction. Epicardial adipose tissue (>3.5 mm) in patients with post-infarction myocardial remodeling is associated with post-load increase in the LV end-diastolic dimension. Keywords: epicardial adipose tissue, post-infarction remodeling, myocardial dysfunction, stress testing. В доступной литературе имеются ограниченные данные о связи эпикардиального ожирения с постинфарктным ремоделированием миокарда с позиций диагностики и прогноза. Цель. Изучение связи толщины эпикардиального жира (ТЭЖ) со структурно-функциональными параметрами сердца у пациентов с инфарктом миокарда, подвергнутых чрескожному коронарному вмешательству. Материалы и методы. В исследовании приняли участие 94 пациента с инфарктом миокарда и последующим стентированием коронарных артерий ad hoc, которым через 6 нед. после чрескожного коронарного вмешательства проводилась стресс-эхоКГ. Статистическая обработка данных осуществлялась с помощь t-критерия Стьюдента, U-критерия Манна–Уитни, критерия знаков. Результаты. При оценке систолической функции левого желудочка (ЛЖ) выявлены достоверные различия параметров фракции выброса и фракции укорочения, которые характеризовались более низкими значениями у пациентов с ТЭЖ более 3,5 мм. Оценка связи диастолической функции с ТЭЖ показала, что пациенты с ТЭЖ более 3,5 мм имеют более длительное время изоволюметрического расслабления ЛЖ (p<0,05). Реакция миокарда на стресс-тест продемонстрировала статистически значимое увеличение конечно-диастолического размера ЛЖ у пациентов с ТЭЖ более 3,5 мм по сравнению с пациентами с ТЭЖ менее 3,5 мм (55,9±4,2 vs 53,0±3,2 мм, p=0,01). К особенностям изменения линейно-объемных параметров сердца после физической нагрузки можно отнести увеличение конечно-диастолического размера ЛЖ у пациентов с ТЭЖ более 3,5 мм с 53,8 до 55,9 мм (p<0,05). Выводы. Толщина эпикардиального жира более 3,5 мм у пациентов, стентированных по поводу острого инфаркта миокарда, ассоциирована с более высокими значениями конечно-диастолического размера ЛЖ, индексированного объема левого предсердия и массы миокарда ЛЖ на фоне более низких значений фракции выброса и фракции укорочения ЛЖ. Наличие эпикардиального жира более 3,5 мм у пациентов с постинфарктным ремоделированием миокарда сопровождается постнагрузочным увеличением конечно-диастолического размера ЛЖ. Ключевые слова: эпикардиальный жир, постинфарктное ремоделирование, дисфункция миокарда, нагрузочное тестирование.

Association of Epicardial Adipose Tissue Thickness by Echocardiography With Coronary Artery Disease

Background: Epicardial adipose tissue (EAT) mimics visceral fat which is associated with metabolic derangements and coronary artery disease (CAD). EAT volume (EAT-V) measured by CT scan had shown good correlation with CAD. QRISK3 score is a validated risk predictor of future cardiovascular events but has limitations. We assessed whether EAT thickness (EAT-T) measured by echocardiography, a simple and widely available tool, correlated with EAT-V, and whether EAT-T is a predictor of CAD independently of QRISK3 scores. Methods: We enrolled 97 patients who underwent CTA for evaluation of chest pain. EAT-T was measured by 2D-echocardiography in parasternal long axis (PLAX) and parasternal short axis (PSAX) views. We evaluated association of EAT-T with EAT-V and CAD (≥50% stenosis on CTA); and independent predictive value of EAT-T for CAD after adjusting for QRISK 3 scores. Results: EAT-T was significantly more in patients with CAD (PLAX: 4.82 ± 1.31 mm vs. 4.06 ± 1.25 mm, p=0.005). EAT-T correlated strongly with EAT-V (r=0.75, p<0.001). On receiver operating characteristic curve analysis, EAT-T (PLAX) ≥3.9 mm (area-under-curve: 0.68; 95% CI: 0.58-0.79, sensitivity 84%, specificity 55%) predicted the presence of CAD. On multivariate analysis after adjusting for QRISK 3 scores, EAT-T showed significant association with CAD with highest odds ratio for indexed EAT-T (EAT-T/body surface area) (PLAX) ≥2.2 mm/m2 (OR 5.40; 95% CI: 2.17-13.55.; p<0.001). Conclusion: EAT-T is a predictor of CAD independent of QRISK3 scores. An increased EAT-T detected CAD with >80% sensitivity. These findings need to be validated in larger prospective cohort studies.