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Salam B, Nowak S, Theis M, Böhner A, Vollbrecht TM, Voigt MB, Endler C, Dell T, Isaak A, Pieper CC, Kuetting D, Sprinkart AM, Luetkens JA. Associations between cardiac adipose tissue and abdominal visceral fat and muscle based on computed tomography area and density. Sci Rep 2025; 15:20192. [PMID: 40542059 DOI: 10.1038/s41598-025-06167-7] [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: 01/31/2025] [Accepted: 06/06/2025] [Indexed: 06/22/2025] Open
Abstract
Computed Tomography (CT)-derived body composition parameters of cardiac adipose tissue (CAT), as well as abdominal adipose and muscle tissue are surrogates for the patient's clinical condition and have prognostic implications. However, associations between the compositions of these diverse tissue compartments remain poorly investigated. This study aimed to investigate the associations between CT-derived parameters of CAT and abdominal adipose and muscle tissues. Retrospective analysis of CT scans from 842 patients was conducted, with measurements of CAT taken at the aortic valve level and abdominal tissues assessed at the L3/L4 intervertebral disc space. Area and density were calculated for each tissue compartment using single-slice images. Strong positive correlations were found between CAT area and visceral adipose tissue (VAT) area (R = .755, P < .001), as well as moderate correlations between CAT density and VAT density (R = .521, P < .001). Additionally, skeletal muscle (SM) area exhibited modest positive correlations with VAT area (R = .370, P < .001), CAT area (R = .300, P < .001), and SM density (R = .356, P < .001). No significant differences were observed between genders in the correlation strengths of these associations. These findings indicate a systematic pattern of body composition alterations, advocating for the inclusion of comprehensive body composition analysis in future studies and emphasizing the need for a deeper understanding of the underlying systemic processes influencing body composition.
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Affiliation(s)
- Babak Salam
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Sebastian Nowak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Maike Theis
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Alexander Böhner
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas M Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Marilia B Voigt
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Tatjana Dell
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
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S J, P M. Automated detection of epicardial adipose tissue in cardiac CT using ensemble machine learning for improved diagnosis. MethodsX 2025; 14:103410. [PMID: 40567944 PMCID: PMC12192617 DOI: 10.1016/j.mex.2025.103410] [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: 03/27/2025] [Accepted: 05/30/2025] [Indexed: 06/28/2025] Open
Abstract
Cardiovascular diseases remain a major global health concern, with epicardial adipose tissue (EAT) serving as a critical indicator for assessing cardiovascular risk. Performing manual delineation of epicardial adipose tissue (EAT) on cardiac CT scans is a labour-intensive process and can be susceptible to inaccuracies. This study presents an automated machine learning-based approach to improve the accuracy and efficiency of EAT segmentation. A dataset of 878 cardiac CT images from 20 patients is used. Pre-processing involved contrast enhancement and feature extraction using the Grey-Level Co-occurrence Matrix (GLCM). An ensemble machine learning model combining Support Vector Machine (SVM) and Artificial Neural Network (ANN) is developed for segmentation. The model's performance was evaluated using accuracy, precision, recall, Dice score, and classification time. The key highlights of the proposed method are:•Automated EAT segmentation using a hybrid ensemble approach (SVM + ANN).•Feature extraction with GLCM enhances segmentation accuracy.•Improved performance over traditional methods, reducing processing time and increasing precision.This method offers a promising solution for automated EAT detection, enabling efficient cardiovascular risk assessment.
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Affiliation(s)
- Jasmine S
- Department of Electronics and Communication Engineering, P.S.R Engineering College, Sivakasi, Tamilnadu, India, 626140
| | - Marichamy P
- Department of Electronics and Communication Engineering, P.S.R Engineering College, Sivakasi, Tamilnadu, India, 626140
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Pop ASK, Dănilă MD, Giuchici S, Buriman DG, Lolescu BM, Sturza A, Muntean DM, Lascu A. Epicardial adipose tissue as target of the incretin-based therapies in cardio-metabolic pathologies: a narrative review. Can J Physiol Pharmacol 2025; 103:182-192. [PMID: 40048723 DOI: 10.1139/cjpp-2024-0384] [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] [Indexed: 04/04/2025]
Abstract
The epicardial adipose tissue (EAT) serves in physiological conditions as a mechanical and thermal myocardial protective layer, as well as a readily available lipid-storage unit. In pathological conditions, EAT expansion becomes deleterious and is currently recognized as an independent risk factor for the progression of cardiovascular diseases. The EAT phenotypic shift from protective to pro-inflammatory/pro-oxidant is facilitated by the presence of metabolic diseases (obesity, metabolic syndrome, and diabetes), which further increase its expansion and dysregulation, favor the occurrence of complications (mainly atrial fibrillation), and promote progression towards heart failure. Glucagon-like peptide-1 (GLP-1) receptor agonists are novel antidiabetic medications belonging to the incretin class that have demonstrated efficacy beyond glycemic control, in terms of weight reduction and cardiorenal protection in patients with type 2 diabetes mellitus. The GLP-1 receptors and glucose-dependent insulinotropic polypeptide (GIP) receptors are expressed in the human EAT and are targeted by an increasing number of pharmacological agonists, with pleiotropic protective effects on EAT structure and function. Herein we review the literature characterizing the benefits of GLP-1 and GIP receptors activation by single and dual agonists with particular emphasis on their effects on EAT and highlight the role of incretin-based therapy for the management of cardiometabolic pathologies.
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Affiliation(s)
- Andrea S K Pop
- Doctoral School Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
| | - Maria D Dănilă
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Department of Functional Sciences - Chair of Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
| | - Silvia Giuchici
- Doctoral School Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Department of Functional Sciences - Chair of Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
| | - Darius G Buriman
- Doctoral School Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Department of Functional Sciences - Chair of Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
| | - Bogdan M Lolescu
- Doctoral School Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
| | - Adrian Sturza
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Department of Functional Sciences - Chair of Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
| | - Danina M Muntean
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Department of Functional Sciences - Chair of Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
| | - Ana Lascu
- Centre for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Department of Functional Sciences - Chair of Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Timișoara, Romania
- Institute of Cardiovascular Diseases, Timișoara, Romania
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Lacaita PG, Senoner T, Bilgeri V, Rauch S, Barbieri F, Kindl B, Plank F, Dichtl W, Deeg J, Widmann G, Feuchtner GM. The interaction of lipomatous hypertrophy of the interatrial septum with pericardial adipose tissue biomarkers by computed tomography. Eur Radiol 2025; 35:2189-2199. [PMID: 39237769 PMCID: PMC11914247 DOI: 10.1007/s00330-024-11061-3] [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: 04/16/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE Novel pericardial adipose tissue imaging biomarkers are currently under investigation for cardiovascular risk stratification. However, a specific compartment of the epicardial adipose tissue (EAT), lipomatous hypertrophy of the interatrial septum (LHIS), is included in the pericardial fat volume (PCFV) quantification software. Our aim was to evaluate LHIS by computed tomography angiography (CTA), to elaborate differences to other pericardial adipose tissue components (EAT) and paracardial adipose tissue (PAT), and to compare CT with [18F]FDG-PET. MATERIALS AND METHODS Of 6983 patients screened who underwent coronary CTA for clinical indications, 190 patients with LHIS were finally included (age 62.8 years ± 9.6, 31.6% females, BMI 28.5 kg/cm2 ± 4.7) in our retrospective cohort study. CT images were quantified for LHIS, EAT, and PAT density (HU), and total PCFV, with and without LHIS, was calculated. CT was compared with [18F]FDG-PET if available. RESULTS CT-density of LHIS was higher (- 22.4 HU ± 22.8) than all other pericardial adipose tissue components: EAT right and left (97.4 HU ± 13 and - 95.1 HU ± 13) PAT right and left (- 107.5 HU ± 13.4 and - 106.3 HU ± 14.5) and PCFV density -83.3 HU ± 5.6 (p < 0.001). There was a mild association between LHIS and PAT right (Beta 0.338, p = 0.006, 95% CI: 0.098-577) and PAT left (Beta 0.249, p = 0.030; 95% CI: 0.024-0.474) but not EAT right (p = 0.325) and left (p = 0.351), and not with total PCFV density (p = 0.164). The segmented LHIS volume comprised 3.01% of the total PCFV, and 4.3% (range, 2.16-11.7%) in those with LHIS > 9 mm. [18F]FDG-PET: LHIS was tracer uptake positive in 83.3% (37.5%: mild and 45.8%: minimal) of 24 patients. CONCLUSIONS LHIS is a distinct compartment of PCFV with higher density suggesting brown fat and has no consistent association with EAT, but rather with PAT. CLINICAL RELEVANCE STATEMENT LHIS should be recognized as a distinct compartment of the EAT, when using EAT for cardiovascular risk stratification. KEY POINTS LHIS is currently included in EAT quantification software. LHIS density is relatively high, it is not associated with EAT, and has a high [18F]FDG-PET positive rate suggesting brown fat. LHIS is a distinct compartment of the EAT, and it may act differently as an imaging biomarker for cardiovascular risk stratification.
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Affiliation(s)
- Pietro G Lacaita
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Senoner
- Department of Anaesthesiology and Intensive Care, Medical University Innsbruck, Innsbruck, Austria
| | - Valentin Bilgeri
- Department of Internal Medicine, Cardiology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Rauch
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Barbieri
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Benedikt Kindl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Plank
- Department of Internal Medicine, Tyrol Clinicum Hall, Hall, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine, Cardiology, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gudrun M Feuchtner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
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Lesjak V, Hebar T, Pirnat M. Prevalence of diffuse idiopathic skeletal hyperostosis and association with coronary artery calcifications in Slovenia. Radiol Oncol 2025; 59:54-62. [PMID: 40014782 PMCID: PMC11867563 DOI: 10.2478/raon-2025-0008] [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: 08/04/2024] [Accepted: 11/19/2024] [Indexed: 03/01/2025] Open
Abstract
BACKGROUND The aim of this study was to analyze the epidemiological aspects of diffuse idiopathic skeletal hyperostosis (DISH) patients in Slovenia, to evaluate the relationship between coronary CT angiography (CCTA)-derived epicardial adipose tissue (EAT) density and coronary artery calcifications (CAC) in patients with and without DISH, and study influencing factors of these parameters. PATIENTS AND METHODS The research comprised patients referred for CCTA due to a clinical suspicion of coronary artery disease. DISH, CAC score and EAT attenuation were quantified using non-contrast imaging. Diagnosis of DISH was based on Resnick criteria. The CCTA was assessed for the presence of obstructive coronary artery disease (CAD). The association between DISH and the extent of CAC was explored, using correlation analysis and multivariate regression. RESULTS The study cohort included 219 participants. The prevalence of DISH was 7.8%. In univariate logistic regression, body mass index (BMI) (odds ratio [OR] 1.133, p = 0,005), age (OR 1.055, p = 0,032) and diabetes (OR 3.840, p = 0,015) were significantly associated with the condition. However, this association did not persist on multinomial multivariate analysis, but gender, age, hypertension and EAT attenuation were found to be significantly associated with the increasing CAC strata. CONCLUSIONS The prevalence of DISH found is comparable with prior literature. There was no independent relationship between the prevalence of DISH and CAC. Our data point to a more nuanced and perhaps non-causal link between coronary artery disease and DISH.
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Affiliation(s)
- Vesna Lesjak
- Radiology Department, University Medical Centre Maribor, Maribor, Slovenia
| | - Timea Hebar
- Radiology Department, University Medical Centre Maribor, Maribor, Slovenia
| | - Maja Pirnat
- Radiology Department, University Medical Centre Maribor, Maribor, Slovenia
- Medical Faculty, University of Maribor, Maribor, Slovenia
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Oh M, Choi HI, Lee JY, Lee DH, Jeon JY. Physical Activity, Sedentary Behavior, Cardiorespiratory Fitness with Cardiac Adiposity: A Narrative Review. Pulse (Basel) 2025; 13:92-102. [PMID: 40330436 PMCID: PMC12052383 DOI: 10.1159/000544804] [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: 10/22/2024] [Accepted: 02/06/2025] [Indexed: 05/08/2025] Open
Abstract
Background Pericardial adipose tissue (PAT), an ectopic fat depot surrounding the coronary arteries, is a significant pathogenic risk factor for cardiometabolic diseases. Due to its anatomical proximity to the heart, PAT is considered a more potent risk factor for cardiovascular conditions compared to other visceral adipose tissues located in other parts of body. Modifiable lifestyle factors such as physical activity (PA), sedentary behavior (SB), exercise interventions, and cardiorespiratory fitness (CRF) have been associated with various health outcomes, but their relationship with PAT remains less understood. Summary This review synthesizes current evidence on the associations of PA, SB, exercise interventions, and CRF with PAT. Increasing PA and CRF while reducing SB appears to be associated with lower PAT accumulation with age, independent of key health characteristics across diverse populations. Also, exercise interventions may be effective in reducing PAT. PAT is emerging as a critical cardiovascular disease and cardiometabolic risk factor. The review highlights the importance of PA, SB, exercise participations, and CRF as modifiable strategies to potentially mitigate this risk. Despite the documented benefits of PA, exercise interventions, and CRF and the negative impacts of SB on health, further research is warranted to explore these associations more comprehensively. Most existing studies are limited by small sample sizes, cross-sectional designs, and reliance on self-reported measures. Recent longitudinal studies suggest that PA, SB, and CRF may influence PAT volumes over time, though findings are often affected by baseline abdominal adiposity and the use of indirect measures. Key Messages (i) Increasing PA, exercise participation, and CRF while reducing SB may prevent PAT accumulation with age, independent of other health factors. (ii) PAT is a significant, emerging risk factor for cardiovascular and metabolic diseases, underscoring the need for effective lifestyle interventions. (iii) Future research should focus on larger, more diverse cohorts using objective measures to better understand the complex relationships between PA, SB, CRF, and PAT. (iv) Comprehensive exploration of these associations will aid in developing interventions to reduce cardiac adiposity and enhance cardiovascular health outcomes.
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Affiliation(s)
- Minsuk Oh
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea
- Frontiers Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea
| | - Hyo-In Choi
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Hoon Lee
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
| | - Justin Y. Jeon
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea
- Frontiers Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea
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Mohamed WAS, Ishak KN, Baharum N, Zainudin NAZ, Lim HY, Noh MFM, Ahmad WAW, Zaman Huri H, Zuhdi ASM, Sukahri S, Govindaraju K, Abd Jamil AH. Ethnic disparities and its association between epicardial adipose tissue thickness and cardiometabolic parameters. Adipocyte 2024; 13:2314032. [PMID: 38373876 PMCID: PMC10877981 DOI: 10.1080/21623945.2024.2314032] [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: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Excessive deposit of epicardial adipose tissue (EAT) were recently shown to be positively correlated with cardiovascular disease (CVD). This study aims to investigate the thickness of EAT and its association with the components of metabolic syndrome among multi-ethnic Malaysians with and without acute coronary syndrome (ACS). A total of 213 patients were recruited, with the thickness of EAT were quantified non-invasively using standard two-dimensional echocardiography. EAT thickness among the Malaysian population was prompted by several demographic factors and medical comorbidities, particularly T2DM and dyslipidaemia. ACS patients have significantly thicker EAT compared to those without ACS (4.1 mm vs 3.7 mm, p = 0.035). Interestingly, among all the races, Chinese had the thickest EAT distribution (4.6 mm vs 3.8 mm), with age (p = 0.04 vs p < 0.001), and overall diastolic blood pressure (p = 0.028) was also found to be associated with EAT thickness. Further study is warranted to investigate its role as a cardiovascular risk marker among Malaysians with ACS.
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Affiliation(s)
- WAS Mohamed
- Nutrition, Metabolism and Cardiovascular Research Centre (NMCRC), Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health (MOH), Shah Alam, Malaysia
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - KN Ishak
- Nutrition, Metabolism and Cardiovascular Research Centre (NMCRC), Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health (MOH), Shah Alam, Malaysia
| | - N Baharum
- Centre for Coordination of Clinical Research Network (CCRN), Institute for Clinical Research (ICR), Shah Alam, Malaysia
| | - NAZ Zainudin
- Infectious Disease Research Centre (IDRC), Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health (MOH), Shah Alam, Malaysia
| | - Han Yin Lim
- Nutrition, Metabolism and Cardiovascular Research Centre (NMCRC), Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health (MOH), Shah Alam, Malaysia
| | - MFM Noh
- Nutrition, Metabolism and Cardiovascular Research Centre (NMCRC), Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health (MOH), Shah Alam, Malaysia
| | - WAW Ahmad
- Cardiology Unit, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - H Zaman Huri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - ASM Zuhdi
- Infectious Disease Research Centre (IDRC), Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health (MOH), Shah Alam, Malaysia
| | - S Sukahri
- Infectious Disease Research Centre (IDRC), Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health (MOH), Shah Alam, Malaysia
| | - K Govindaraju
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - AH Abd Jamil
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
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Lee TL, Hsuan CF, Lu NH, Tsai IT, Hsu CC, Wang CP, Lu YC, Hu TM, Chung FM, Lee YJ, Tang WH. Circulating RBP4 and FABP4 concentrations in patients with chronic schizophrenia are associated with increased epicardial adipose tissue volume and metabolic syndrome. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01950-5. [PMID: 39604670 DOI: 10.1007/s00406-024-01950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 11/20/2024] [Indexed: 11/29/2024]
Abstract
Schizophrenia has been linked to an elevated cardiovascular risk profile and premature onset of cardiovascular disease. Quantifying epicardial adipose tissue (EAT) volume provides insight into its correlation with coronary artery disease (CAD) severity and associated risk factors. Previous research indicates higher pericardial adipose tissue in individuals with schizophrenia compared to non-schizophrenic counterparts. RBP4, FABP3, and FABP4 have been implicated in CAD pathogenesis. In this study, we examined the potential increase in EAT volume in individuals with chronic schizophrenia and aimed to elucidate the relationship between circulating levels of RBP4, FABP3, and FABP4 with EAT volume and coronary artery calcium score within this cohort. We recruited 186 consecutive patients with chronic schizophrenia and utilized enzyme-linked immunosorbent assay to assess plasma concentrations of RBP4, FABP3, and FABP4. Cardiac multislice computed tomography measured EAT volume and coronary artery calcium scores. Significantly higher EAT volume in patients with chronic schizophrenia compared to controls. RBP4 associated positively with metabolic factors and EAT volumes, while FABP3 associated positively with creatinine and coronary atherosclerosis markers. FABP4 showed positive associations with metabolic factors, hypertension, and EAT volumes, but negative associations with HDL-C and eGFR. Logistic regression identified RBP4 and FABP4 as independent factors associated with increased EAT volumes, even after adjusting for known biomarkers. Both RBP4 and FABP4 were significantly associated with metabolic syndrome components and EAT volume. This study elucidates the association between chronic schizophrenia and augmented EAT volume, suggesting plausible correlations with CAD-related health complications through RBP4 and FABP4 pathways.
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Affiliation(s)
- Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, 807066, Taiwan
| | - Nan-Han Lu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
- Department of Radiology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Chia-Chang Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
- Health Examination Center, E-Da Dachang Hospital, I-Shou University, Kaohsiung, 807066, Taiwan
- The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Chao-Ping Wang
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Yung-Chuan Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Tsung-Ming Hu
- Department of Psychiatry, Taipei Veterans General Hospital, Yuli Branch, Hualien, 98142, Taiwan
- Department of Management, Fo Guang University, Jiaosi, Yilan, 262307, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Yau-Jiunn Lee
- Lee's Endocrinologic Clinic, Pingtung, 90000, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, No. 91, Xinxing St., Yuli Township, Hualien, 981002, Taiwan.
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan.
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Braescu L, Sturza A, Sosdean R, Aburel OM, Lazar MA, Muntean D, Luca CT, Brie DM, Feier H, Crisan S, Mornos C. Echocardiographic assessment of epicardial adipose tissue thickness as independent predictor in coronary artery disease. Can J Physiol Pharmacol 2024; 102:648-660. [PMID: 39226407 DOI: 10.1139/cjpp-2024-0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
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.
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Affiliation(s)
- Laurentiu Braescu
- Department VI Cardiology - Cardiovascular Surgery Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Doctoral School Medicine-Pharmacy, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Adrian Sturza
- Department III Functional Sciences - Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Raluca Sosdean
- Department VI Cardiology - Cardiovascular Surgery Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Department VI Cardiology - Cardiology Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Oana Maria Aburel
- Department III Functional Sciences - Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Mihai Andrei Lazar
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Department VI Cardiology - Cardiology Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timișoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Danina Muntean
- Department III Functional Sciences - Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Constantin Tudor Luca
- Department VI Cardiology - Cardiovascular Surgery Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Department VI Cardiology - Cardiology Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Daniel Miron Brie
- Department VI Cardiology - Cardiovascular Surgery Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Department VI Cardiology - Cardiology Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Horea Feier
- Department VI Cardiology - Cardiovascular Surgery Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Department VI Cardiology - Cardiology Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Simina Crisan
- Department VI Cardiology - Cardiovascular Surgery Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Department VI Cardiology - Cardiology Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
| | - Cristian Mornos
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Department VI Cardiology - Cardiology Clinic, Institute for Cardiovascular Diseases of Timișoara, "Victor Babeș" University of Medicine and Pharmacy from Timișoara, E. Murgu Sq. No.2, 300041 Timișoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timișoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Habib S. Team players in the pathogenesis of metabolic dysfunctions-associated steatotic liver disease: The basis of development of pharmacotherapy. World J Gastrointest Pathophysiol 2024; 15:93606. [PMID: 39220834 PMCID: PMC11362842 DOI: 10.4291/wjgp.v15.i4.93606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/14/2024] [Accepted: 07/23/2024] [Indexed: 08/22/2024] Open
Abstract
Nutrient metabolism is regulated by several factors. Social determinants of health with or without genetics are the primary regulator of metabolism, and an unhealthy lifestyle affects all modulators and mediators, leading to the adaptation and finally to the exhaustion of cellular functions. Hepatic steatosis is defined by presence of fat in more than 5% of hepatocytes. In hepatocytes, fat is stored as triglycerides in lipid droplet. Hepatic steatosis results from a combination of multiple intracellular processes. In a healthy individual nutrient metabolism is regulated at several steps. It ranges from the selection of nutrients in a grocery store to the last step of consumption of ATP as an energy or as a building block of a cell as structural component. Several hormones, peptides, and genes have been described that participate in nutrient metabolism. Several enzymes participate in each nutrient metabolism as described above from ingestion to generation of ATP. As of now several publications have revealed very intricate regulation of nutrient metabolism, where most of the regulatory factors are tied to each other bidirectionally, making it difficult to comprehend chronological sequence of events. Insulin hormone is the primary regulator of all nutrients' metabolism both in prandial and fasting states. Insulin exerts its effects directly and indirectly on enzymes involved in the three main cellular function processes; metabolic, inflammation and repair, and cell growth and regeneration. Final regulators that control the enzymatic functions through stimulation or suppression of a cell are nuclear receptors in especially farnesoid X receptor and peroxisome proliferator-activated receptor/RXR ligands, adiponectin, leptin, and adiponutrin. Insulin hormone has direct effect on these final modulators. Whereas blood glucose level, serum lipids, incretin hormones, bile acids in conjunction with microbiota are intermediary modulators which are controlled by lifestyle. The purpose of this review is to overview the key players in the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) that help us understand the disease natural course, risk stratification, role of lifestyle and pharmacotherapy in each individual patient with MASLD to achieve personalized care and target the practice of precision medicine. PubMed and Google Scholar databases were used to identify publication related to metabolism of carbohydrate and fat in states of health and disease states; MASLD, cardiovascular disease and cancer. More than 1000 publications including original research and review papers were reviewed.
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Affiliation(s)
- Shahid Habib
- Department of Hepatology, Liver Institute PLLC, Tucson, AZ 85712, United States
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11
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Sîrbu Prisecaru RV, Riahi L, Abagiu M, Purcar OE, Vlădoianu MCC, Leaţu CG, Sîrbu AD, Maniţiu I. Fatty infiltration and ventricular premature beats originating from right ventricular outflow tract: association or causality? ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:291-295. [PMID: 39020544 PMCID: PMC11384033 DOI: 10.47162/rjme.65.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
BACKGROUND Anatomical evidence reveals heterogeneous fat distribution in both atrial and ventricular myocardium that are considered normal, but at the same time arrhythmogenic, and numerous cardiac pathophysiological conditions are associated with myocardial fat deposits. The relationship between fatty infiltration, especially in the epicardial layer and its pathophysiological implication is not completely understood. AIM The aim of this study was to establish a positive or negative relationship between the ventricular burden and several parameters related to right ventricle (RV) adipose tissue - the RV thickness, RV indexed mass, body mass index (BMI), age, gender. PATIENTS, MATERIALS AND METHODS Twenty-three patients with documented premature ventricular contractions (PVCs) originating from right ventricular outflow tract based on electrocardiography (ECG) evaluation were hospitalized between January 2018-November 2022 for electrophysiological study and PVCs ablation. Data obtained after collecting the clinical characteristics, ECG, RV measurements from transthoracic echocardiography (TTE), cardiac computed tomography (CT) and magnetic resonance imaging (MRI) were analyzed. RESULTS A weak positive relationship between the ventricular burden and BMI (r=0.14, p=0.49), tricuspid annular plane systolic excursion (TAPSE) (r=0.07, p=0.7), the RV thickness (r=0.03, p=0.8), epicardial adipose tissue (r=0.13, p=0.55), RV mass indexed (r=0.05, p=0.82) was observed. No clear cut-off of the PVCs burden could be established in terms related to the increase in BMI, RV thickness, epicardial adipose tissue, RV mass indexed. CONCLUSIONS No significant positive or negative relationship between the ventricular burden and the RV thickness, RV indexed mass were found in individuals with a high PVCs originating from right ventricular outflow tract (RVOT) burden.
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12
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Roehl M, Conway M, Ghonim S, Ferreira PF, Nielles-Vallespin S, Babu-Narayan SV, Pennell DJ, Gatehouse PD, Scott AD. STEAM-SASHA: a novel approach for blood- and fat-suppressed native T1 measurement in the right ventricular myocardium. MAGMA (NEW YORK, N.Y.) 2024; 37:295-305. [PMID: 38216813 PMCID: PMC10995026 DOI: 10.1007/s10334-023-01141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE The excellent blood and fat suppression of stimulated echo acquisition mode (STEAM) can be combined with saturation recovery single-shot acquisition (SASHA) in a novel STEAM-SASHA sequence for right ventricular (RV) native T1 mapping. MATERIALS AND METHODS STEAM-SASHA splits magnetization preparation over two cardiac cycles, nulling blood signal and allowing fat signal to decay. Breath-hold T1 mapping was performed in a T1 phantom and twice in 10 volunteers using STEAM-SASHA and a modified Look-Locker sequence at peak systole at 3T. T1 was measured in 3 RV regions, the septum and left ventricle (LV). RESULTS In phantoms, MOLLI under-estimated while STEAM-SASHA over-estimated T1, on average by 3.0% and 7.0% respectively, although at typical 3T myocardial T1 (T1 > 1200 ms) STEAM-SASHA was more accurate. In volunteers, T1 was higher using STEAM-SASHA than MOLLI in the LV and septum (p = 0.03, p = 0.006, respectively), but lower in RV regions (p > 0.05). Inter-study, inter-observer and intra-observer coefficients of variation in all regions were < 15%. Blood suppression was excellent with STEAM-SASHA and noise floor effects were minimal. DISCUSSION STEAM-SASHA provides accurate and reproducible T1 in the RV with excellent blood and fat suppression. STEAM-SASHA has potential to provide new insights into pathological changes in the RV in future studies.
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Affiliation(s)
- Malte Roehl
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Miriam Conway
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarah Ghonim
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sonia Nielles-Vallespin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sonya V Babu-Narayan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
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13
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Vasileva F, Carreras-Badosa G, Bassols J, Serrano-Ferrer J, Font-Lladó R, López-Ros V, Osiniri I, Martínez-Calcerrada JM, San Millán M, López-Bermejo A, Prats-Puig A. Insulin resistance, C-reactive protein, diastolic to systolic blood pressure ratio and epicardial fat are related to sedentary time, and inversely related to physical activity in school-aged children. Front Public Health 2024; 12:1339860. [PMID: 38577274 PMCID: PMC10993728 DOI: 10.3389/fpubh.2024.1339860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Background Physical activity (PA) is beneficial for the overall health. Objectives are: (1) To compare metabolic (MRM) and cardiovascular-risk-markers (CRM) in children according to their PA-level; (2) to explore the associations of MRM and CRM with PA and sedentary time (ST); and (3) to identify the associations between MRM and CRM in less (LA) and more active (MA) children. Methods A total of 238 apparently healthy school-aged children were enrolled (132 boys/106 girls; 9.1 ± 1.8 years) and body mass index standard deviation score (BMI SDS) and blood pressure were assessed. Fasting venous blood sampling was performed to assess insulin resistance (HOMA-IR) and high-sensitivity-C-reactive protein (hsCRP). Epicardial fat, interventricular septal and left ventricular posterior wall thicknesses were assessed by high-resolution ultrasonography. PA and ST were assessed by enKid-questionnaire. Children were classified based on enKid-score as being LA and MA (below and above 50th percentile for PA). Results MA-children had lower values for: BMI SDS, diastolic-to-systolic blood pressure ratio, HOMA-IR and hsCRP (7.02 to 61.5% lower, p = 0.040 to p < 0.0001) compared to LA-children. MRM and CRM were positively associated with ST (p = 0.003 to p < 0.001), and negatively associated with PA (p = 0.044 to p < 0.001). Finally, MRM were positively associated with CRM (p = 0.008 to p < 0.0001). Interestingly, the latter associations were observed in LA-children but were not present in MA-children. Conclusion More PA is associated with better cardio-metabolic profile in school-aged children. PA seems to modulate the associations between MRM and CRM, thus reinforcing the idea that fostering PA in children may lower the risk for development of a cardio-metabolic disease.
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Affiliation(s)
- Fidanka Vasileva
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research, Girona, Spain
- University School of Health and Sport, University of Girona, Girona, Spain
| | - Gemma Carreras-Badosa
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research, Girona, Spain
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Institute for Biomedical Research, Girona, Spain
| | | | - Raquel Font-Lladó
- University School of Health and Sport, University of Girona, Girona, Spain
- Research Group of Culture and Education, Institute of Educational Research, University of Girona, Girona, Spain
| | - Victor López-Ros
- Chair of Sport and Physical Education – Centre of Olympic Studies, University of Girona, Girona, Spain
| | | | | | - Marta San Millán
- University School of Health and Sport, University of Girona, Girona, Spain
- Research Group of Clinical Anatomy, Embryology and Neuroscience, Department of Medical Sciences, University of Girona, Girona, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- Pediatric Endocrinology, Dr. Josep Trueta Hospital, Girona, Spain
| | - Anna Prats-Puig
- University School of Health and Sport, University of Girona, Girona, Spain
- Research Group of Clinical Anatomy, Embryology and Neuroscience, Department of Medical Sciences, University of Girona, Girona, Spain
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14
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Dinning E, Muttana S, Bardarov S. Cor Adiposum as the Cause of Sudden Cardiac Death: A Case Report and Literature Review. Cureus 2024; 16:e55561. [PMID: 38576691 PMCID: PMC10993091 DOI: 10.7759/cureus.55561] [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] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
We present a case of sudden cardiac death in a 65-year-old patient who came to the emergency room with shortness of breath. The gross examination of the heart was significant for extensive left ventricular lipomatosis in association with myocardial fibrosis. Microscopic examination revealed extensive fatty replacement of the myocardial tissue throughout the entire thickness of the ventricular wall (transmural lipomatous myocardial remodeling). We suggest using the term "cor adiposum" to categorize this morphological condition when the transmural lipomatous transformation of the myocardium is present. The fatty replacement of the heart muscle would have led to impaired cardiac function, ultimately resulting in sudden cardiac death in this patient. We also hypothesize that the accumulation of fat in the myocardium might be a compensatory process to preserve ventricular wall compliance.
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Affiliation(s)
- Emily Dinning
- Pathology, Richmond University Medical Center, New York, USA
| | - Srinuvasula Muttana
- Pathology and Laboratory Medicine, Richmond University Medical Center, New York, USA
| | - Svetoslav Bardarov
- Pathology and Laboratory Medicine, Richmond University Medical Center, New York, USA
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15
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Park S, Kim DE, Kim SM, Choi J, Park SJ, Lee HY, Chun EJ. Association of epicardial adipose tissue with metabolic risk factors on cardiovascular outcomes: serial coronary computed tomography angiography study. Korean J Intern Med 2024; 39:283-294. [PMID: 38351679 PMCID: PMC10918372 DOI: 10.3904/kjim.2023.389] [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: 09/18/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND/AIMS Epicardial adipose tissue (EAT) shares pathophysiological properties with other visceral fats and potentially triggers local inflammation. However, the association of EAT with cardiovascular disease (CVD) is still debatable. The study aimed to observe the changes and associations in EAT and risk factors over time, as well as to investigate whether EAT was associated with CVD. METHODS A total of 762 participants from Seoul National University Hospital (SNUH) and SNUH Gangnam Center were included in this study. EAT was measured using coronary computed tomography angiography. RESULTS Baseline EAT level was positively associated with body mass index (BMI), calcium score, atherosclerotic cardiovascular disease (ASCVD) 10-year risk score, glucose, triglycerides (TG)/high-density lipoprotein (HDL), but not with total cholesterol, low-density lipoprotein (LDL). At follow-up, EAT levels increased in all groups, with low EAT groups demonstrating a significant increase in EAT per year. Change in EAT was associated with a change in BMI, TG/HDL, and glucose, while changes in LDL, calcium score, and ASCVD 10-year risk score were not associated. Although calcium score and ASCVD 10-year risk score were associated with CVD events, baseline information of EAT, baseline EAT/body surface area, or EAT change was not available. CONCLUSION Metabolic risks, e.g., BMI, TG/HDL, and glucose, were associated with EAT change per year, whereas classical CVD risks, e.g., LDL, calcium score, and ASCVD 10-year risk score, were not. The actual CVD event was not associated with EAT volume, warranting future studies combining qualitative assessments with quantitative ones.
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Affiliation(s)
- Sungjoon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Eun Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Su Min Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Joon Park
- Research and Science Division, Research and Development Center, MEDICALIP Co. Ltd., Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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16
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Weidlich M, Hamm B, Schaafs LA, Elgeti T. Epicardial fat volume and its association with cardiac arrhythmias in CT coronary angiography. Pol J Radiol 2024; 89:e122-e127. [PMID: 38510546 PMCID: PMC10953510 DOI: 10.5114/pjr.2024.135797] [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: 11/22/2023] [Accepted: 02/01/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose This retrospective study aimed to investigate the epicardial fat volume in cardiac computed tomography (CT), its relationship with cardiac arrhythmias, and its correlation with the coronary artery disease reporting and data system (CAD-RADS) score. Material and methods Ninety-six patients who underwent CT coronary angiography (CTCA) were included in this study. Patient data, including demographic information, clinical history, and imaging data were collected retrospectively. Epicardial fat volume was quantified using a standardised algorithm, the CAD-RADS scoring system was applied to assess the extent of coronary artery disease (CAD). Descriptive statistics, correlation analyses, and receiver operating characteristics methods were used. Results The study found a significant correlation between epicardial fat volume and CAD-RADS score (r2 = 0.31; p < 0.001), indicating the known influence of epicardial fat on CAD risk. Moreover, patients with higher epicardial fat volumes were more likely to experience cardiac tachyarrhythmia (p < 0.001). Receiver operating characteristic analysis established a threshold value of 123 cm3 for epicardial fat volume to predict tachyarrhythmia with 80% sensitivity (AUC = 0.69). Conclusions In this study a volume of at least 123 cm3 epicardial fat in native coronary calcium scans is associated with cardiac tachyarrhythmia. In these patients, careful selection of suitable imaging protocols is advised.
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Affiliation(s)
- Matthias Weidlich
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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17
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Miller RJH, Shanbhag A, Killekar A, Lemley M, Bednarski B, Van Kriekinge SD, Kavanagh PB, Feher A, Miller EJ, Einstein AJ, Ruddy TD, Liang JX, Builoff V, Berman DS, Dey D, Slomka PJ. AI-derived epicardial fat measurements improve cardiovascular risk prediction from myocardial perfusion imaging. NPJ Digit Med 2024; 7:24. [PMID: 38310123 PMCID: PMC10838293 DOI: 10.1038/s41746-024-01020-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
Epicardial adipose tissue (EAT) volume and attenuation are associated with cardiovascular risk, but manual annotation is time-consuming. We evaluated whether automated deep learning-based EAT measurements from ungated computed tomography (CT) are associated with death or myocardial infarction (MI). We included 8781 patients from 4 sites without known coronary artery disease who underwent hybrid myocardial perfusion imaging. Of those, 500 patients from one site were used for model training and validation, with the remaining patients held out for testing (n = 3511 internal testing, n = 4770 external testing). We modified an existing deep learning model to first identify the cardiac silhouette, then automatically segment EAT based on attenuation thresholds. Deep learning EAT measurements were obtained in <2 s compared to 15 min for expert annotations. There was excellent agreement between EAT attenuation (Spearman correlation 0.90 internal, 0.82 external) and volume (Spearman correlation 0.90 internal, 0.91 external) by deep learning and expert segmentation in all 3 sites (Spearman correlation 0.90-0.98). During median follow-up of 2.7 years (IQR 1.6-4.9), 565 patients experienced death or MI. Elevated EAT volume and attenuation were independently associated with an increased risk of death or MI after adjustment for relevant confounders. Deep learning can automatically measure EAT volume and attenuation from low-dose, ungated CT with excellent correlation with expert annotations, but in a fraction of the time. EAT measurements offer additional prognostic insights within the context of hybrid perfusion imaging.
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bryan Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Valerie Builoff
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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18
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Espinosa Reyes TM, Pesántez Velepucha AK, Cabrera Rego JO, Valdés Gómez W, Domínguez Alonso E, Falhammar H. Cardiovascular risk in Cuban adolescents and young adults with congenital adrenal hyperplasia. BMC Endocr Disord 2023; 23:241. [PMID: 37919699 PMCID: PMC10621154 DOI: 10.1186/s12902-023-01499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Hyperandrogenism and supraphysiologic glucocorticoid replacement may lead to subclinical atherosclerosis in people with congenital adrenal hyperplasia (CAH) and predispose the development of cardiovascular diseases from an early age. OBJECTIVES To determine if cardiometabolic risk factors and subclinical atherosclerosis are more frequent in patients with CAH due to 21-hydroxylase deficiency (21OHD) and if there is an association with clinical, hormonal and treatment of 21OHD. MATERIAL AND METHODS A descriptive prospective cross-sectional study exploring clinical variables, biochemical, hormonal variables, endothelial dysfunction (flow-mediated dilation < 5%) and carotid intima media thickness (≥ 95 percentile in adolescents and ≥ 75 percentile in adults) and epicardial fat. Adolescents and young patients with 21OHD were compared with controls matched by age, sex, body mass index and Tanner stage. RESULTS Forty four subjects (22 with CAH), 36 (82%) females, with a mean age of 17.1 ± 5.5 years (range 10-30 years) were included. Family history revealed diabetes, hypertension, and hypercholesterolemia with high frequencies in both groups. The blood pressure was similar in both groups. Blood glucose levels were lower and triglycerides higher in patient (both p < 0.01). Epicardial fat was similar between groups and in patients with CAH it was related to cholesterol levels (r = 0.679, p < 0.01), time since CAH diagnosis (r = 0.462, p = 0.03) and glucocorticoid dose (r = 0.499, p = 0.04). Carotid intima media thickness (CIMT) had a tendency to be increased in patients (p = 0.07) and was directly related to 17-hydroxyprogesterone (r = 0.510, p = 0.018), diastolic blood pressure (r = 0.444, p = 0.04) and the homeostatic model assessment (HOMA) index (r = 0.507, p = 0.01). Endothelial dysfunction was not different between groups. CONCLUSIONS Some cardiometabolic risk factors were increased in patients with CAH and were associated with clinical, hormonal and treatment parameters of CAH. Cardiometabolic risk should be evaluated regularly in patients with CAH.
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Affiliation(s)
- Tania M Espinosa Reyes
- Department of Pediatric Endocrinology, National Institute of Endocrinology, Havana, Cuba
| | | | | | - Wendy Valdés Gómez
- Department of Pediatric Endocrinology, National Institute of Endocrinology, Havana, Cuba
| | - Emma Domínguez Alonso
- Department of Pediatric Endocrinology, National Institute of Endocrinology, Havana, Cuba
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Endocrinology, QB85 Karolinska University Hospital, 171 76, Stockholm, Sweden.
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19
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Brandt-Jacobsen NH, Jürgens M, Hasbak P, Gaede P, Rossing P, Rasmussen JJ, Andersen CF, Forman JL, Faber J, Inzucchi SE, Gustafsson F, Schou M, Kistorp C. Reduction of cardiac adipose tissue volume with short-term empagliflozin treatment in patients with type 2 diabetes: A substudy from the SIMPLE randomized clinical trial. Diabetes Obes Metab 2023; 25:844-855. [PMID: 36484428 PMCID: PMC10107109 DOI: 10.1111/dom.14933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/19/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Ectopic accumulation of cardiac adipose tissue volume (CAT) has been associated with cardiac remodelling and cardiac dysfunction in type 2 diabetes and may be a future therapeutic target. In this substudy from the SIMPLE-trial, we investigated short-term empagliflozin therapy's effects on CAT in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Between 4 April 2017 and 11 May 2020, we randomized 90 patients with type 2 diabetes and established or high risk of cardiovascular disease to 25 mg empagliflozin or placebo for 13 weeks. The substudy focused on change in CAT evaluated by images acquired during 82 Rubidium-positron emissions tomography/computed tomography. The analysis included 78 patients who had at least one scan. Furthermore, we report on the relation to the concurrent effects on left ventricular mass, end-diastolic volume and end-systolic volume, body composition and glucometabolic status. RESULTS Mean ± SD baseline CAT was 258.5 ± 117.9 ml. Empagliflozin reduced CAT after 13 weeks by 12.41 ml [95% CI (-23.83 to -0.99), p = .034] as compared with placebo. Similarly, left ventricular mass [-5.16 g, 95% CI (-8.80 to -1.52), p = .006], end-diastolic volume and end-systolic volume decreased with empagliflozin. In addition, significant improvements were observed in body composition, with reduced total fat mass, and in measures of glucose and lipid metabolism. However, no correlation was observed between changes in CAT and changes in cardiac parameters and change in CAT appeared mediated primarily by concurrent change in weight. CONCLUSIONS Empagliflozin provides an early reduction of CAT; however, no association was observed with concurrent changes in cardiac volumetrics.
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Affiliation(s)
- Niels H Brandt-Jacobsen
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Jürgens
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Gaede
- Department of Intern Medicine, Slagelse Hospital, Slagelse, Denmark
| | - Peter Rossing
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Jon J Rasmussen
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Camillla Fuchs Andersen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens Faber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Caroline Kistorp
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Walpot J, Van Herck P, Van de Heyning CM, Bosmans J, Massalha S, Malbrain ML, Heidbuchel H, Inácio JR. Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events (MACE) and mortality in patients with heart disease and critically ill patients. Part I: Epicardial adipose tissue. Anaesthesiol Intensive Ther 2023; 55:141-157. [PMID: 37728441 PMCID: PMC10496106 DOI: 10.5114/ait.2023.130922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/28/2023] [Indexed: 09/21/2023] Open
Abstract
Over the last two decades, the potential role of epicardial adipocyte tissue (EAT) as a marker for major adverse cardiovascular events has been extensively studied. Unlike other visceral adipocyte tissues (VAT), EAT is not separated from the adjacent myocardium by a fascial layer and shares the same microcirculation with the myocardium. Adipocytokines, secreted by EAT, interact directly with the myocardium through paracrine and vasocrine pathways. The role of the Randle cycle, linking VAT accumulation to insulin resistance, and the relevance of blood flow and mitochondrial function of VAT, are briefly discussed. The three available imaging modalities for the assessment of EAT are discussed. The advantages of echocardiography, cardiac CT, and cardiac magnetic resonance (CMR) are compared. The last section summarises the current stage of knowledge on EAT as a clinical marker for major adverse cardiovascular events (MACE). The association between EAT volume and coronary artery disease (CAD) has robustly been validated. There is growing evidence that EAT volume is associated with computed tomography coronary angiography (CTCA) assessed high-risk plaque features. The EAT CT attenuation coefficient predicts coronary events. Many studies have established EAT volume as a predictor of atrial fibrillation after cardiac surgery. Moreover, EAT thickness has been independently associated with severe aortic stenosis and mitral annular calcification. Studies have demonstrated that EAT volume is associated with heart failure. Finally, we discuss the potential role of EAT in critically ill patients admitted to the intensive care unit. In conclusion, EAT seems to be a promising new biomarker to predict MACE.
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Affiliation(s)
| | - Paul Van Herck
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Caroline M. Van de Heyning
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Manu L.N.G. Malbrain
- International Fluid Academy, Lovenjoel, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - João R. Inácio
- Centro Universitario Hospitalar Lisboa Norte, Faculdade de Medicina de Lisboa, UL, Portugal
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21
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Role of obesity and blood pressure in epicardial adipose tissue thickness in children. Pediatr Res 2022; 92:1681-1688. [PMID: 35322187 DOI: 10.1038/s41390-022-02022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Elevated body mass index (BMI) has been associated with cardiac changes, such as higher epicardial adipose tissue (EAT) thickness. This fat has been identified as a predictive factor of cardiovascular diseases during adulthood. However, few studies have tested the association of multiple cardiovascular risk factors (high weight or blood pressure) with EAT in adolescents and children. Therefore, the main objective of this current research was to determine the impact of BMI, overweight, obesity, and blood pressure on EAT thickness in children. METHODS A descriptive cross-sectional study focused on elementary and high school students aged 6-16 years was carried out by utilizing diverse measurements and instruments, such as echocardiography. RESULTS EAT thickness (N = 228) was linked to sex (more predominant in boys 2.3 ± 0.6; p = 0.044), obesity (2.3 ± 0.6; p < 0.001), and hypertension (2.6 ± 0.6; p = 0.036). The logistic regression indicated that age, sex, and BMI seemed to be more relevant factors in EAT thickness in children (adjusted R square = 0.22; p < 0.001). CONCLUSIONS This paper examined the associations of sex, age, and cardiovascular risk factors (arthrometric measures and blood pressure) with EAT thickness, indicating that it is necessary to assess whether the findings are associated with future events. IMPACT Excessive weight gain and blood pressure in the early stages of life have been associated with adipose tissue. This increase in weight and blood pressure has been attributed to alterations in the epicardial adipose tissue linked to anthropometric markers in adults, but no related study has been implemented in Spanish children. This study revealed how higher epicardial adipose tissue is linked to body mass index, other anthropometric parameters, and blood pressure in Spanish children. These measurements are related to high epicardial adipose tissue thickness, which in early stages does not imply pathology but increases the risk of developing cardiovascular diseases.
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22
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Yamamoto C, Trayanova NA. Atrial fibrillation: Insights from animal models, computational modeling, and clinical studies. EBioMedicine 2022; 85:104310. [PMID: 36309006 PMCID: PMC9619190 DOI: 10.1016/j.ebiom.2022.104310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Atrial fibrillation (AF) is the most common human arrhythmia, affecting millions of patients worldwide. A combination of risk factors and comorbidities results in complex atrial remodeling, which increases AF vulnerability and persistence. Insights from animal models, clinical studies, and computational modeling have advanced the understanding of the mechanisms and pathophysiology of AF. Areas of heterogeneous pathological remodeling, as well as altered electrophysiological properties, serve as a substrate for AF drivers and spontaneous activations. The complex and individualized presentation of this arrhythmia suggests that mechanisms-based personalized approaches will likely be needed to overcome current challenges in AF management. In this paper, we review the insights on the mechanisms of AF obtained from animal models and clinical studies and how computational models integrate this knowledge to advance AF clinical management. We also assess the challenges that need to be overcome to implement these mechanistic models in clinical practice.
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Affiliation(s)
- Carolyna Yamamoto
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, MD, USA,Corresponding author. Johns Hopkins, Johns Hopkins University, United States.
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23
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Patel V, Patel J. Cellular cross talk between epicardial fat and cardiovascular risk. J Basic Clin Physiol Pharmacol 2022; 33:683-694. [PMID: 36220013 DOI: 10.1515/jbcpp-2022-0230] [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: 08/28/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022]
Abstract
A variety of fat compartments have several local and systemic effect and play a crucial role in the maintenance of health and development of disease. For the past few years, special attention has been paid to epicardial fat. It is the visceral fat compartment of the heart and has several local and systemic effects. It can perform a role in the development of cardiometabolic risk. The epicardial adipose tissue (EAT) is a unique and multifunctional fat compartment of the heart. It is located between the myocardium and the visceral pericardium. During normal physiological conditions, the EAT has metabolic, thermogenic, and mechanical (cardioprotective) characteristics. The EAT can produce several adipocytokines and chemokines depending on microenvironments. It can influence through paracrine and vasocrine mechanism and participate in the development and progression of cardiovascular (CVS) diseases. In addition, metabolic disease leads to changes in both thickness and volume of the EAT, and it can modify the structure and the function of heart. It has been associated with various CVS diseases such as, cardiomyopathy, atrial fibrillation, and coronary artery disease. Therefore, EAT is a potential therapeutic target for CVS risk.
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Affiliation(s)
- Vishwa Patel
- University of Texas at Austin, Austin 78712, Texas, USA
| | - Jimik Patel
- Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA 19144, USA
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24
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Biomarkers extracted by fully automated body composition analysis from chest CT correlate with SARS-CoV-2 outcome severity. Sci Rep 2022; 12:16411. [PMID: 36180519 PMCID: PMC9524347 DOI: 10.1038/s41598-022-20419-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
The complex process of manual biomarker extraction from body composition analysis (BCA) has far restricted the analysis of SARS-CoV-2 outcomes to small patient cohorts and a limited number of tissue types. We investigate the association of two BCA-based biomarkers with the development of severe SARS-CoV-2 infections for 918 patients (354 female, 564 male) regarding disease severity and mortality (186 deceased). Multiple tissues, such as muscle, bone, or adipose tissue are used and acquired with a deep-learning-based, fully-automated BCA from computed tomography images of the chest. The BCA features and markers were univariately analyzed with a Shapiro–Wilk and two-sided Mann–Whitney-U test. In a multivariate approach, obtained markers were adjusted by a defined set of laboratory parameters promoted by other studies. Subsequently, the relationship between the markers and two endpoints, namely severity and mortality, was investigated with regard to statistical significance. The univariate approach showed that the muscle volume was significant for female (pseverity ≤ 0.001, pmortality ≤ 0.0001) and male patients (pseverity = 0.018, pmortality ≤ 0.0001) regarding the severity and mortality endpoints. For male patients, the intra- and intermuscular adipose tissue (IMAT) (p ≤ 0.0001), epicardial adipose tissue (EAT) (p ≤ 0.001) and pericardial adipose tissue (PAT) (p ≤ 0.0001) were significant regarding the severity outcome. With the mortality outcome, muscle (p ≤ 0.0001), IMAT (p ≤ 0.001), EAT (p = 0.011) and PAT (p = 0.003) remained significant. For female patients, bone (p ≤ 0.001), IMAT (p = 0.032) and PAT (p = 0.047) were significant in univariate analyses regarding the severity and bone (p = 0.005) regarding the mortality. Furthermore, the defined sarcopenia marker (p ≤ 0.0001, for female and male) was significant for both endpoints. The cardiac marker was significant for severity (pfemale = 0.014, pmale ≤ 0.0001) and for mortality (pfemale ≤ 0.0001, pmale ≤ 0.0001) endpoint for both genders. The multivariate logistic regression showed that the sarcopenia marker was significant (pseverity = 0.006, pmortality = 0.002) for both endpoints (ORseverity = 0.42, 95% CIseverity: 0.23–0.78, ORmortality = 0.34, 95% CImortality: 0.17–0.67). The cardiac marker showed significance (p = 0.018) only for the severity endpoint (OR = 1.42, 95% CI 1.06–1.90). The association between BCA-based sarcopenia and cardiac biomarkers and disease severity and mortality suggests that these biomarkers can contribute to the risk stratification of SARS-CoV-2 patients. Patients with a higher cardiac marker and a lower sarcopenia marker are at risk for a severe course or death. Whether those biomarkers hold similar importance for other pneumonia-related diseases requires further investigation.
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25
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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; 11:5621. [PMID: 36233489 PMCID: PMC9570982 DOI: 10.3390/jcm11195621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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
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26
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Associations of the Mediterranean-Style Dietary Pattern Score with Coronary Artery Calcification and Pericardial Adiposity in a Sample of US Adults. Nutrients 2022; 14:nu14163385. [PMID: 36014891 PMCID: PMC9415980 DOI: 10.3390/nu14163385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have identified improvements in the risks of cardiovascular disease in adults following a Mediterranean dietary pattern. However, data are scarce on its association with coronary artery calcification (CAC) and pericardial adiposity (PAT) in US adults with and without diabetes. To address this gap, we conducted a case-control study using baseline data from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study [n = 1255; Type 1 Diabetes (T1D): n = 563; non-Diabetes Mellitus (non-DM): n = 692]. Participants completed a validated food frequency questionnaire, fasting (12 h overnight fast) biochemical analyses, and a physical examination including anthropometric measures. CAC and PAT were measured using electron beam-computed tomography. Logistic regression models were used to examine the associations of the Mediterranean-Style Dietary Pattern Score (MSDPS) with CAC (presence or absence), and linear regression models were applied to PAT analyses. In all of the adjusted models, no significant associations with CAC were found. For PAT, an increasing MSDPS was consistently associated with its lower volume in models adjusted for age, sex, diabetes status, total calories, and body mass index (all p < 0.05). The association between MSDPS and PAT was attenuated after adjusting for serum lipids and physical activity. In conclusion, the baseline data from the CACTI study show that a greater adherence to MSDPS is associated with a lower PAT volume and provide evidence that the Mediterranean dietary pattern is associated with lower cardiovascular risk markers.
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27
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The association of pericardial fat and peri-aortic fat with severity of nonalcoholic fatty liver disease. Sci Rep 2022; 12:14014. [PMID: 35982232 PMCID: PMC9388488 DOI: 10.1038/s41598-022-18499-9] [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: 10/14/2021] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
Visceral adipose tissue (VAT) is associated with central obesity, insulin resistance and metabolic syndrome. However, the association of body-site specific adiposity and non-alcoholic fatty liver disease (NAFLD) has not been well characterized. We studies 704 consecutive subjects who underwent annual health survey in Taiwan. All subjects have been divided into three groups including normal (341), mild (227) and moderate and severe (136) NAFLD according to ultrasound finding. Pericardial (PCF) and thoracic peri-aortic adipose tissue (TAT) burden was assessed using a non-contrast 16-slice multi-detector computed tomography (MDCT) dataset with off-line measurement (Aquarius 3DWorkstation, TeraRecon, SanMateo, CA, USA). We explored the relationship between PCF/TAT, NAFLD and cardiometabolic risk profiles. Patients with moderate and mild NAFLD have greater volume of PCF (100.7 ± 26.3vs. 77.1 ± 21.3 vs. 61.7 ± 21.6 ml, P < 0.001) and TAT (11.2 ± 4.1 vs. 7.6 ± 2.6 vs. 5.5 ± 2.6 ml, P < 0.001) when compared to the normal groups. Both PCF and TAT remained independently associated with NAFLD after counting for age, sex, triglyceride, cholesterol and other cardiometabolic risk factors. In addition, both PCF and TAT provided incremental prediction value for NAFLD diagnosis. (AUROC: 0.85 and 0.87, 95%, confidence interval: 0.82-0.89 and 0.84-0.90). Both visceral adipose tissues strongly correlated with the severity of NAFLD. Compared to PCF, TAT is more tightly associated with NAFLD diagnosis in a large Asian population.
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The Role and Implications of Epicardial Fat in Coronary Atherosclerotic Disease. J Clin Med 2022; 11:jcm11164718. [PMID: 36012956 PMCID: PMC9410442 DOI: 10.3390/jcm11164718] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Chen Q, Chen X, Wang J, Zhong J, Zhang H, Wu B, Zheng Z, Xie X, Zhu J, Tang X, Li S. Redistribution of adipose tissue is associated with left atrial remodeling and dysfunction in patients with atrial fibrillation. Front Cardiovasc Med 2022; 9:969513. [PMID: 36035916 PMCID: PMC9403614 DOI: 10.3389/fcvm.2022.969513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAdipose tissue is recognized as a crucial regulator of atrial fibrillation (AF). However, the effect of epicardial adipose tissue (EAT) on the pathophysiology of AF might be different from that of other adipose tissues. The purpose of this study was to explore the distribution features of different adipose tissues in AF patients and their relationships with left atrial (LA) remodeling and function.MethodsA total of 205 participants (including 112 AF and 93 non-AF patients) were recruited. Color doppler ultrasound was used to measure the thickness of subcutaneous, extraperitoneal, and intra-abdominal adipose tissue. Cardiac CT scan was performed to measure the mean thickness of EAT surrounding the whole heart (total-EAT) and specific regions, including left atrium (LA-EAT), left ventricle, right ventricle, interventricular groove, and atrioventricular groove. LA anatomical remodeling and function were measured by echocardiography, while electrical remodeling was evaluated by P-wave duration and dispersion using Electrocardiography (obtained after cardioversion or ablation in AF patients). Relationship between the thickness of different adipose tissues and LA remodeling and function was analyzed.ResultsThe thickness of subcutaneous, extraperitoneal, and intra-abdominal adipose tissue was similar between AF and non-AF patients, and had no or only weak association with LA remodeling and dysfunction. However, compared to non-AF participants, total-EAT thickness significantly increased in both paroxysmal and persistent AF patients (non-AF vs. paroxysmal AF vs. persistent AF: 6.31 ± 0.63 mm vs. 6.76 ± 0.79 mm vs. 7.01 ± 1.18 mm, P < 0.001), which was positively correlated with the LA size and P-wave duration and dispersion, and negatively correlated with LA ejection fraction and peak strain rate. More interestingly, EAT thickness in AF patients did not increase uniformly in different regions of the heart. Compared to EAT surrounding the other regions, LA-EAT was found to accumulate more greatly, and had a closer relationship to LA remodeling and dysfunction. Multivariate logistic regression analysis also showed that LA-EAT was significantly correlated with the presence of AF (OR = 4.781; 95% CI 2.589–8.831, P < 0.001).ConclusionRather than other adipose tissues, accumulation and redistribution of EAT, especially surrounding the LA, is associated with LA remodeling and dysfunction in AF patients.
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Affiliation(s)
- Qian Chen
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiuzhen Chen
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiafu Wang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junlin Zhong
- Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Zhang
- Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingyuan Wu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenda Zheng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xujing Xie
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieming Zhu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Jieming Zhu,
| | - Xixiang Tang
- VIP Medical Service Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Xixiang Tang,
| | - Suhua Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Suhua Li,
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Conte M, Petraglia L, Cabaro S, Valerio V, Poggio P, Pilato E, Attena E, Russo V, Ferro A, Formisano P, Leosco D, Parisi V. Epicardial Adipose Tissue and Cardiac Arrhythmias: Focus on Atrial Fibrillation. Front Cardiovasc Med 2022; 9:932262. [PMID: 35845044 PMCID: PMC9280076 DOI: 10.3389/fcvm.2022.932262] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 01/02/2023] Open
Abstract
Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia and its prevalence increases with age. AF is strongly associated with an increased risk of stroke, heart failure and cardiovascular mortality. Among the risk factors associated with AF onset and severity, obesity and inflammation play a prominent role. Numerous recent evidence suggested a role of epicardial adipose tissue (EAT), the visceral fat depot of the heart, in the development of AF. Several potential arrhythmogenic mechanisms have been attributed to EAT, including myocardial inflammation, fibrosis, oxidative stress, and fat infiltration. EAT is a local source of inflammatory mediators which potentially contribute to atrial collagen deposition and fibrosis, the anatomical substrate for AF. Moreover, the close proximity between EAT and myocardium allows the EAT to penetrate and generate atrial myocardium fat infiltrates that can alter atrial electrophysiological properties. These observations support the hypothesis of a strong implication of EAT in structural and electrical atrial remodeling, which underlies AF onset and burden. The measure of EAT, through different imaging methods, such as echocardiography, computed tomography and cardiac magnetic resonance, has been proposed as a useful prognostic tool to predict the presence, severity and recurrence of AF. Furthermore, EAT is increasingly emerging as a promising potential therapeutic target. This review aims to summarize the recent evidence exploring the potential role of EAT in the pathogenesis of AF, the main mechanisms by which EAT can promote structural and electrical atrial remodeling and the potential therapeutic strategies targeting the cardiac visceral fat.
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Affiliation(s)
- Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Casa di Cura San Michele, Maddaloni, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Serena Cabaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Emanuele Pilato
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Emilio Attena
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli” – Monaldi and Cotugno Hospital, Naples, Italy
| | - Adele Ferro
- Institute of Biostructure and Bioimaging, Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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Karampetsou N, Alexopoulos L, Minia A, Pliaka V, Tsolakos N, Kontzoglou K, Perrea DN, Patapis P. Epicardial Adipose Tissue as an Independent Cardiometabolic Risk Factor for Coronary Artery Disease. Cureus 2022; 14:e25578. [PMID: 35784958 PMCID: PMC9248997 DOI: 10.7759/cureus.25578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Nikoleta Karampetsou
- Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, GRC
| | | | | | | | | | | | - Despoina N Perrea
- Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, GRC
| | - Paulos Patapis
- Surgery, National and Kapodistrian University of Athens, Athens, GRC
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32
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Marcucci M, Fogante M, Tagliati C, Papiri G. Cut-off point of CT-assessed epicardial adipose tissue volume for predicting worse clinical burden of SARS-CoV-2 pneumonia. Emerg Radiol 2022; 29:645-653. [PMID: 35606630 PMCID: PMC9126108 DOI: 10.1007/s10140-022-02059-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022]
Abstract
Objective To identify a cut-off value of epicardial adipose tissue (EAT) volume quantified by CT associated with a worse clinical outcome in patients with SARS-CoV-2 pneumonia. Materials and methods In this retrospective study, sixty patients with a diagnosis of laboratory-confirmed COVID-19 pneumonia and a chest CT exam on admission were enrolled. Based on a total severity score (range 0–20), patients were divided into two groups: ordinary group (total severity score < 7) and severe/critical group (total severity score > 7). Clinical results and EAT volume were compared between the two groups. Results The severe/critical patients, compared to the ordinary ones, were older (66.83 ± 11.72 vs 58.57 ± 16.86 years; p = 0.031), had higher body mass index (27.77 ± 2.11 vs 25.07 ± 2.80 kg/m2; p < 0.001) and higher prevalence of comorbidities. EAT volume was higher in severe/critical group, compared with the ordinary group (151.40 ± 66.22 cm3 vs 92.35 ± 44.46 cm3, p < 0.001). In severe/critical group, 19 (73%) patients were admitted in intensive care unit (ICU), compared with 6 (20%) patients in the ordinary group (p < 0.001). The area under the ROC curve (AUC) is equal to 0.781 (p < 0.001) (95% CI: 0.662–0.900). The cut-off found, in correspondence with the highest value of the Youden Index, is 97 cm3: the sensitivity is equal to 83.3%, while the specificity is equal to 70% for predicting a worse outcome. The risk (odds ratio) of belonging to the severe/critical group in this population due to EAT ≥ 97 cm3 is 11.667 (95% CI: 3.384–40.220; p < 0.001). Conclusion An EAT volume of 97 cm3 has good sensitivity and specificity to predict a greater extent of pulmonary involvement and therefore a worse clinical outcome in patients with SARS-CoV-2 pneumonia.
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Affiliation(s)
- Matteo Marcucci
- U.O.C. Radiodiagnostica, Ospedale Generale Provinciale Di Macerata, Via Santa Lucia, 2, 62100, Macerata, Italy.
| | - Marco Fogante
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Via Conca, 71, 60126, Ancona, Italy
| | - Corrado Tagliati
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento Dei Servizi - ASL Teramo, Viale del Risorgimento, 1158, 64032, Atri, Teramo, Italy
| | - Giulio Papiri
- Neurology Unit, Ospedale Provinciale "Madonna del Soccorso", Via Luciano Manara, 8, 63074, San Benedetto del Tronto, Ascoli Piceno, Italy
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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; 11:1034. [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;
| | - 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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Conte M, Petraglia L, Poggio P, Valerio V, Cabaro S, Campana P, Comentale G, Attena E, Russo V, Pilato E, Formisano P, Leosco D, Parisi V. Inflammation and Cardiovascular Diseases in the Elderly: The Role of Epicardial Adipose Tissue. Front Med (Lausanne) 2022; 9:844266. [PMID: 35242789 PMCID: PMC8887867 DOI: 10.3389/fmed.2022.844266] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
Human aging is a complex phenomenon characterized by a wide spectrum of biological changes which impact on behavioral and social aspects. Age-related changes are accompanied by a decline in biological function and increased vulnerability leading to frailty, thereby advanced age is identified among the major risk factors of the main chronic human diseases. Aging is characterized by a state of chronic low-grade inflammation, also referred as inflammaging. It recognizes a multifactorial pathogenesis with a prominent role of the innate immune system activation, resulting in tissue degeneration and contributing to adverse outcomes. It is widely recognized that inflammation plays a central role in the development and progression of numerous chronic and cardiovascular diseases. In particular, low-grade inflammation, through an increased risk of atherosclerosis and insulin resistance, promote cardiovascular diseases in the elderly. Low-grade inflammation is also promoted by visceral adiposity, whose accumulation is paralleled by an increased inflammatory status. Aging is associated to increase in epicardial adipose tissue (EAT), the visceral fat depot of the heart. Structural and functional changes in EAT have been shown to be associated with several heart diseases, including coronary artery disease, aortic stenosis, atrial fibrillation, and heart failure. EAT increase is associated with a greater production and secretion of pro-inflammatory mediators and neuro-hormones, so that thickened EAT can pathologically influence, in a paracrine and vasocrine manner, the structure and function of the heart and is associated to a worse cardiovascular outcome. In this review, we will discuss the evidence underlying the interplay between inflammaging, EAT accumulation and cardiovascular diseases. We will examine and discuss the importance of EAT quantification, its characteristics and changes with age and its clinical implication.
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Affiliation(s)
- Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Casa di Cura San Michele, Maddaloni, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Serena Cabaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Campana
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Comentale
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Emilio Attena
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Campania, Italy
| | - Emanuele Pilato
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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Kim JH, Song JY, Shim HS, Lee S, Youn YN, Joo HC, Yoo KJ, Lee SH. Human Tissue Analysis of Left Atrial Adipose Tissue and Atrial Fibrillation after Cox Maze Procedure. J Clin Med 2022; 11:jcm11030826. [PMID: 35160277 PMCID: PMC8837174 DOI: 10.3390/jcm11030826] [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: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiac adipose tissue is a well-known risk factor for the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation, but its correlation with maze surgery remains unknown. The aim of this study was to investigate the correlation between the recurrence of AF and the adipose component of the left atrium (LA) in patients who underwent a modified Cox maze (CM) III procedure. We reviewed the pathology data of resected LA tissues from 115 patients, including the adipose tissue from CM-III procedures. The mean follow-up duration was 30.05 ± 23.96 months. The mean adipose tissue component in the AF recurrence group was 16.17% ± 14.32%, while in the non-recurrence group, it was 9.48% ± 10.79% (p = 0.021), and the cut-off value for the adipose component for AF recurrence was 10% (p = 0.010). The rates of freedom from AF recurrence at 1, 3, and 5 years were 84.8%, 68.8%, and 38.6%, respectively, in the high-adipose group (≥10%), and 96.3%, 89.7%, and 80.3%, respectively, in the low-adipose group (<10%; p = 0.002). A high adipose component (≥10%) in the LA is a significant risk factor for AF recurrence after CM-III procedures. Thus, it may be necessary to attempt to reduce the perioperative adipose portion of the cardiac tissue using a statin in a randomized study.
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Affiliation(s)
- Jung-Hwan Kim
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea; (J.-H.K.); (J.-Y.S.); (S.L.); (Y.-N.Y.); (H.-C.J.); (K.-J.Y.)
| | - Joon-Young Song
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea; (J.-H.K.); (J.-Y.S.); (S.L.); (Y.-N.Y.); (H.-C.J.); (K.-J.Y.)
| | - Hyo-Sup Shim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Sak Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea; (J.-H.K.); (J.-Y.S.); (S.L.); (Y.-N.Y.); (H.-C.J.); (K.-J.Y.)
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea; (J.-H.K.); (J.-Y.S.); (S.L.); (Y.-N.Y.); (H.-C.J.); (K.-J.Y.)
| | - Hyun-Chel Joo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea; (J.-H.K.); (J.-Y.S.); (S.L.); (Y.-N.Y.); (H.-C.J.); (K.-J.Y.)
| | - Kyung-Jong Yoo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea; (J.-H.K.); (J.-Y.S.); (S.L.); (Y.-N.Y.); (H.-C.J.); (K.-J.Y.)
| | - Seung-Hyun Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea; (J.-H.K.); (J.-Y.S.); (S.L.); (Y.-N.Y.); (H.-C.J.); (K.-J.Y.)
- Correspondence: ; Tel.: +82-02-2228-8491
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Vanegas-Cedillo PE, Bello-Chavolla OY, Ramírez-Pedraza N, Rodríguez Encinas B, Pérez Carrión CI, Jasso-Ávila MI, Valladares-García JC, Hernández-Juárez D, Vargas-Vázquez A, Antonio-Villa NE, Chapa-Ibarguengoitia M, Ponce de Leon A, Sifuentes-Osornio J, Aguilar-Salinas CA, Mehta R. Serum Vitamin D Levels Are Associated With Increased COVID-19 Severity and Mortality Independent of Whole-Body and Visceral Adiposity. Front Nutr 2022; 9:813485. [PMID: 35155539 PMCID: PMC8825804 DOI: 10.3389/fnut.2022.813485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease (COVID-19) is a global pandemic. Vitamin D deficiency has been associated with susceptibility to infectious disease. In this study, the association between COVID-19 outcomes and vitamin D levels in patients attending a COVID-19 reference center in Mexico City are examined. METHODS Consecutive patients with confirmed COVID-19 were evaluated. All patients underwent clinical evaluation and follow-up, laboratory measurements and a thoracic computerized tomography, including the measurement of epicardial fat thickness. Low vitamin D was defined as levels <20 ng/ml (<50nmol/L) and deficient Vitamin D as a level ≤12 ng/ml (<30 nmol/L). RESULTS Of the 551 patients included, low vitamin D levels were present in 45.6% and deficient levels in 10.9%. Deficient Vitamin D levels were associated with mortality (HR 2.11, 95%CI 1.24-3.58, p = 0.006) but not with critical COVID-19, adjusted for age, sex, body-mass index and epicardial fat. Using model-based causal mediation analyses the increased risk of COVID-19 mortality conferred by low vitamin D levels was partly mediated by its effect on D-dimer and cardiac ultrasensitive troponins. Notably, increased risk of COVID-19 mortality conferred by low vitamin D levels was independent of BMI and epicardial fat. CONCLUSION Vitamin D deficiency (≤12 ng/ml or <30 nmol/L), is independently associated with COVID-19 mortality after adjustment for visceral fat (epicardial fat thickness). Low vitamin D may contribute to a pro-inflammatory and pro-thrombotic state, increasing the risk for adverse COVID-19 outcomes.
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Affiliation(s)
- Pablo Esteban Vanegas-Cedillo
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Natalia Ramírez-Pedraza
- MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Bethsabel Rodríguez Encinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carolina Isabel Pérez Carrión
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Isabel Jasso-Ávila
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jorge Carlos Valladares-García
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana Hernández-Juárez
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Monica Chapa-Ibarguengoitia
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce de Leon
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Internal Medicine Division, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Mexico City, Mexico
| | - Carlos A. Aguilar-Salinas
- Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Mexico City, Mexico
- Division of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Mehta R, Bello-Chavolla OY, Mancillas-Adame L, Rodriguez-Flores M, Pedraza NR, Encinas BR, Carrión CIP, Ávila MIJ, Valladares-García JC, Vanegas-Cedillo PE, Juárez DH, Vargas-Vázquez A, Antonio-Villa NE, Chapa-Ibarguengoitia M, Almeda-Valdés P, Elias-Lopez D, Galindo-Fraga A, Gulias-Herrero A, de Leon AP, Sifuentes-Osornio J, Aguilar-Salinas CA. Epicardial adipose tissue thickness is associated with increased COVID-19 severity and mortality. Int J Obes (Lond) 2022; 46:866-873. [PMID: 35017712 PMCID: PMC8749108 DOI: 10.1038/s41366-021-01050-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/01/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
Background Increased adiposity and visceral obesity have been linked to adverse COVID-19 outcomes. The amount of epicardial adipose tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 adverse outcomes. Methods We included 748 patients with COVID-19 attending a reference center in Mexico City. EAT thickness, sub-thoracic and extra-pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with COVID-19 mortality and severe COVID-19 (defined as mortality and need for invasive mechanical ventilation), according to the presence or absence of obesity. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with COVID-19 outcomes. Results EAT thickness was associated with increased risk of COVID-19 mortality (HR 1.18, 95% CI 1.01–1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, fibrinogen, C-reactive protein, and 4 C severity score, independent of obesity. EAT mediated 13.1% (95% CI 3.67–28.0%) and 5.1% (95% CI 0.19–14.0%) of the effect of age and 19.4% (95% CI 4.67–63.0%) and 12.8% (95% CI 0.03–46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction during COVID-19. Conclusion EAT is an independent risk factor for severe COVID-19 and mortality independent of obesity. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 outcomes.
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Affiliation(s)
- Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico. .,Department of Endocrinology and Metabolism, INCMNSZ, Mexico City, Mexico.
| | | | | | | | | | | | | | | | | | | | | | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Paloma Almeda-Valdés
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,Department of Endocrinology and Metabolism, INCMNSZ, Mexico City, Mexico
| | - Daniel Elias-Lopez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,Department of Endocrinology and Metabolism, INCMNSZ, Mexico City, Mexico
| | | | | | | | - José Sifuentes-Osornio
- Department of Infectology, INCMNSZ, Mexico City, Mexico.,Internal Medicine Division, Albuquerque, NM, USA
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico. .,Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Monterrey, Mexico. .,Division of Nutrition, INCMNSZ, Mexico City, Mexico.
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Siriapisith T, Kusakunniran W, Haddawy P. A 3D deep learning approach to epicardial fat segmentation in non-contrast and post-contrast cardiac CT images. PeerJ Comput Sci 2021; 7:e806. [PMID: 34977354 PMCID: PMC8670388 DOI: 10.7717/peerj-cs.806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
Epicardial fat (ECF) is localized fat surrounding the heart muscle or myocardium and enclosed by the thin-layer pericardium membrane. Segmenting the ECF is one of the most difficult medical image segmentation tasks. Since the epicardial fat is infiltrated into the groove between cardiac chambers and is contiguous with cardiac muscle, segmentation requires location and voxel intensity. Recently, deep learning methods have been effectively used to solve medical image segmentation problems in several domains with state-of-the-art performance. This paper presents a novel approach to 3D segmentation of ECF by integrating attention gates and deep supervision into the 3D U-Net deep learning architecture. The proposed method shows significant improvement of the segmentation performance, when compared with standard 3D U-Net. The experiments show excellent performance on non-contrast CT datasets with average Dice scores of 90.06%. Transfer learning from a pre-trained model of a non-contrast CT to contrast-enhanced CT dataset was also performed. The segmentation accuracy on the contrast-enhanced CT dataset achieved a Dice score of 88.16%.
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Affiliation(s)
- Thanongchai Siriapisith
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Worapan Kusakunniran
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Peter Haddawy
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
- Bremen Spatial Cognition Center, University of Bremen, Bremen, Germany
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Salman AA, Salman MA, Soliman A, Youssef A, Labib S, Helmy MY, Marie MA, Shawkat M, Mostafa A, Tourky MS, Sarhan MD, Qassem MG, Shaaban HED, Omar MG, Abouelregal TE. Changes of epicardial fat thickness after laparoscopic sleeve gastrectomy: a prospective study. Ann Med 2021; 53:523-530. [PMID: 34008443 PMCID: PMC8143592 DOI: 10.1080/07853890.2021.1903072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Epicardial fat thickness is an interesting parameter of early atherosclerosis. We prospectively assessed whether weight loss following laparoscopic sleeve gastrectomy (LSG) leads to a significant reduction in the epicardial fat thickness (EFT) and the correlation between the decline in the epicardial fat thickness with other clinical parameters. METHODS A prospective analysis of 98 cases that were scheduled to undergo LSG and followed up for 12 months was conducted. EFT was assessed using two-dimensional (2 D) echocardiography. RESULTS A total of 98 cases and 70 controls were enrolled. EFT demonstrated a significant reduction at follow-up in the whole group (median 8.9 (1.95) versus 7.65 (1.67) mm, respectively). The degree of reduction was higher in the LSG cohort compared to control cohort 1.3 (0.4) versus 1 (0.4), respectively; p < .001). The univariate regression analysis demonstrated a notable correlation of the EFT with the weight, body mass index (BMI), fasting blood glucose (FBG), and creatinine with a p-value of <.0001, .001, .022, and .018, respectively while the multivariate analysis showed a strong correlation between EFT and weight and creatinine with a p-value of <.0001 and .033 respectively. CONCLUSION LSG can have a favourable impact on metabolic syndrome aspects, namely EFT, as it can decrease it considerably.
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Affiliation(s)
| | | | - Ahmed Soliman
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmed Youssef
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Safa Labib
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mona Youssry Helmy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed A. Marie
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Shawkat
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amir Mostafa
- Cardiovascular Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Sabry Tourky
- Department of Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Mohamed D. Sarhan
- General Surgery Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Gamal Qassem
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam El-Din Shaaban
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mahmoud Gouda Omar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
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40
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Salem NA, Batouty NM, Tawfik AM, Sobh DM, Gadelhak B, Hendawy SR, Laimon W. Epicardial and Perihepatic Fat as Cardiometabolic Risk Predictors in Girls with Turner Syndrome: A Cardiac Magnetic Resonance Study. J Clin Res Pediatr Endocrinol 2021; 13:408-417. [PMID: 34013713 PMCID: PMC8638625 DOI: 10.4274/jcrpe.galenos.2021.2021.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/19/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Turner syndrome (TS) patients are at high risk of cardiometabolic disorders. Cardiometabolic risk factors are more commonly related to visceral rather than total body adiposity. Adipocytokines have been explored as a potential link between obesity and obesity-related cardiometabolic dysfunction. This study explored the validity of epicardial fat-thickness (EFT) and perihepatic fat-thickness (PHFT) measurement as cardiometabolic-risk predictors in TS-girls in relation to standard obesity-indices and metabolic syndrome (MetS) components. Methods Forty-six TS girls and twenty-five controls (10-16 years) were subdivided into two age-groups (10 to less than 13 and 13-16). Participants were assessed for body mass index (BMI) Z-scores, waist circumference (WC), total-fat mass (FM) and trunk-FM by bioimpedance-technique, EFT and PHFT by cardiovascular magnetic resonance, lipid-profile, homeostasis model assessment of insulin resistance (HOMA-IR), and serum chemerin. MetS was defined according to International Diabetes Federation criteria. Results Overweight/obesity and MetS were detected in 45.7% and 37% of TS-girls respectively. BMI Z-score, WC, total-FM, trunk-FM, EFT and PHFT values were significantly higher in TS-age groups compared to age-matched control groups, being more pronounced in the older group when TS-girls had been exposed to estrogen. Dyslipidemia, higher HOMA-IR, chemerin, EFT and PHFT values were observed in lean-Turner compared to BMI-Z-matched controls. EFT and PHFT were significantly correlated with chemerin and several components of MetS. EFT at a cut-off-value of 6.20 mm (area under the curve=0.814) can predict MetS in TS-girls. Conclusion TS-girls displayed an adverse cardiometabolic profile during late childhood and adolescence. EFT and PHFT are emerging cardiometabolic risk predictors in TS-patients. Excess EFT rather than total body adiposity may contribute to altered metabolic profile among lean-Turner patients.
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Affiliation(s)
- Nanees A. Salem
- Mansoura University Faculty of Medicine, Department of Pediatrics, Unit of Pediatric Endocrinology and Diabetes, Dakahlia, Egypt
| | - Nihal M. Batouty
- Mansoura University Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Dakahlia, Egypt
| | - Ahmed M. Tawfik
- Mansoura University Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Dakahlia, Egypt
| | - Donia M. Sobh
- Mansoura University Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Dakahlia, Egypt
| | - Basma Gadelhak
- Mansoura University Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Dakahlia, Egypt
| | - Shimaa R. Hendawy
- Mansoura University Faculty of Medicine, Department of Clinical Pathology, Dakahlia, Egypt
| | - Wafaa Laimon
- Mansoura University Faculty of Medicine, Department of Pediatrics, Unit of Pediatric Endocrinology and Diabetes, Dakahlia, Egypt
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Relationship between Epicardial Fat Tissue Thickness and CRP and Neutrophil-Lymphocyte Ratio in Metabolic Syndrome Patients Over 65 Years. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:405-411. [PMID: 34712084 PMCID: PMC8526237 DOI: 10.14744/semb.2021.91455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/07/2021] [Indexed: 01/05/2023]
Abstract
Objective: There are no data evaluating the association of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) with epicardial fat tissue thickness (EFTT) in elderly metabolic syndrome (MS) patients. In this study, we aimed to investigate the relationship of EFTT with CRP and NLR in patients with MS over 65 years. Methods: A cross-sectional study was performed. Fifty patients (patient group) with MS and 25 subjects (control group) without MS were allocated in the study. All parameters were compared in patient and control groups. The correlations between NLR, CRP, and EFTT were evaluated. Results: White blood cell and neutrophil levels were higher in MS group (p=0.020 and p=0.019, respectively). Both transverse and longitudinal EFTT were increased in MS patients (p<0.001). There was a significant correlation between the EFTT and NLR but not with CRP in the MS group (r=0.4, p=0.003). Conclusion: Our study showed that both longitudinal and transverse EFTT are associated with NLR in patients older than 65 years with MS. In geriatric MS patients, higher NLR level may be an indicator of increased visceral fat around the myocardium.
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Haberka M, Kubicius A, Starzak M, Partyka M, Gąsior Z. Adiposity, fat depots and the prediction of stroke. Cardiol J 2021; 30:810-816. [PMID: 34708862 PMCID: PMC10635733 DOI: 10.5603/cj.a2021.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/26/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite the progress in research, the utility of clinical assessment for the prediction of stroke is limited. The aim herein, was to evaluate the predictive values of major ultrasound indexes of carotid artery and fat depots for stroke in patients with high and very high cardiovascular (CV) risk. METHODS The study group included 364 patients (age: 61.3 ± 7.2 years old) with typical CV risk factors scheduled for elective coronary angiography (2012-2013). A comprehensive baseline assessment included the following ultrasound indexes: carotid artery intima-media thickness (IMT), extra-media thickness (EMT), epicardial (EFT) and pericardial fat thickness (PFT), abdominal subcutaneous (ASF) and visceral fat (AVF) and combined periarterial adipose tissue intima-media adventitia (PATIMA) index. Afterwards, all patients were followed for 80.9 ± 7.1 months. RESULTS There were 23 strokes and 25 cases with new-onset atrial fibrillation during follow-up. Receiver operating characteristics (ROC) analysis showed, that selected clinical parameters (age, waist circumference [WC], waist-hip ratio [WHR]) and ultrasound indexes (EFT: area under curve [AUC] 0.672, p < 0.01 and PATIMA index: AUC 0.658, p < 0.01) were predictive for stroke. However, their predictive values showed no significant differences (p = NS). The baseline body mass index (BMI) was the only parameter, which showed a prediction for new-onset atrial fibrillation (BMI > 33 kg/m2: sensitivity 65%, specificity 76%). CONCLUSIONS It was found that age, WC and echocardiographic EFT revealed significant predictive values for stroke. Both WC and EFT showed a very high NPV suggesting that they should be implemented into the clinical practice as a tool affirming a very low risk of stroke.
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Affiliation(s)
- Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland.
| | - Andrzej Kubicius
- Department of Cardiology, Upper Silesia Medical Center, Katowice, Poland
| | - Monika Starzak
- Department of Cardiology, General Hospital No. 4, Gliwice, Poland
| | | | - Zbigniew Gąsior
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
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Chun KH. Mouse model of the adipose organ: the heterogeneous anatomical characteristics. Arch Pharm Res 2021; 44:857-875. [PMID: 34606058 DOI: 10.1007/s12272-021-01350-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022]
Abstract
Adipose tissue plays a pivotal role in energy storage, hormone secretion, and temperature control. Mammalian adipose tissue is largely divided into white adipose tissue and brown adipose tissue, although recent studies have discovered the existence of beige adipocytes. Adipose tissues are widespread over the whole body and each location shows distinctive metabolic features. Mice are used as a representative experimental model system in metabolic studies due to their numerous advantages. Importantly, the adipose tissues of experimental animals and humans are not perfectly matched, and each adipose tissue exhibits both similar and specific characteristics. Nevertheless, the diversity and characteristics of mouse adipose tissue have not yet been comprehensively summarized. This review summarizes diverse information about the different types of adipose tissue being studied in mouse models. The types and characteristics of adipocytes were described, and each adipose tissue was classified by type, and features such as its distribution, origin, differences from humans, and metabolic characteristics were described. In particular, the distribution of widely studied adipose tissues was illustrated so that researchers can comprehensively grasp its location. Also, the adipose tissues misused or confusingly used among researchers were described. This review will provide researchers with comprehensive information and cautions needed to study adipose tissues in mouse models.
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Affiliation(s)
- Kwang-Hoon Chun
- Gachon Institute of Pharmaceutical Sciences, College of Pharmacy, Gachon University, Inchon, 21936, Republic of Korea.
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Vučić D, Bijelić N, Rođak E, Rajc J, Dumenčić B, Belovari T, Mihić D, Selthofer-Relatić K. Right Heart Morphology and Its Association With Excessive and Deficient Cardiac Visceral Adipose Tissue. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2021; 15:11795468211041330. [PMID: 34602829 PMCID: PMC8485260 DOI: 10.1177/11795468211041330] [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: 03/20/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022]
Abstract
Visceral adipose tissue is an independent risk factor for the development of atherosclerotic coronary disease, arterial hypertension, diabetes and metabolic syndrome. Right heart morphology often involves the presence of adipose tissue, which can be quantified by non-invasive imaging methods. The last decade brought a wealth of new insights into the function and morphology of adipose tissue, with great emphasis on its role in the pathogenesis of heart disease. Cardiac adipose tissue is involved in thermogenesis, mechanical protection of the heart and energy storage. However, it can also be an endocrine organ that synthesises numerous pro-inflammatory and anti-inflammatory cytokines, the effect of which is accomplished by paracrine and vasocrine mechanisms. Visceral adipose tissue has several compartments that differ in their embryological origin and vascularisation. Deficiency of cardiac adipose tissue, often due to chronic pathological conditions such as oncological diseases or chronic infectious diseases, predicts increased mortality and morbidity. To date, knowledge about the influence of visceral adipose tissue on cardiac morphology is limited, especially the effect on the morphology of the right heart in a state of excess or deficient visceral adipose tissue.
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Affiliation(s)
- Domagoj Vučić
- Department for Internal Medicine, Division of Cardiology, General Hospital Doctor Josip Benčević, Slavonski Brod, Croatia
| | - Nikola Bijelić
- Department for Histology and Embriology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Edi Rođak
- Department for Histology and Embriology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Jasmina Rajc
- Department for Pathology and Forensic Medicine, University Hospital Center Osijek, Osijek, Croatia.,Department for Pathology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Boris Dumenčić
- Department for Pathology and Forensic Medicine, University Hospital Center Osijek, Osijek, Croatia.,Department for Pathology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Tatjana Belovari
- Department for Histology and Embriology, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Damir Mihić
- Department of Intensive Care Medicine, University Center Hospital Osijek, Osijek, Croatia.,Department for Internal Medicine, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Kristina Selthofer-Relatić
- Department for Internal Medicine, Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Department for Heart and Vascular Diseases, University Center Hospital Osijek, Osijek, Croatia
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45
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Phan F, Boussouar S, Lucidarme O, Zarai M, Salem JE, Kachenoura N, Bouazizi K, Charpentier E, Niati Y, Bekkaoui H, Amoura Z, Mathian A, Benveniste O, Cacoub P, Allenbach Y, Saadoun D, Lacorte JM, Fourati S, Laroche S, Hartemann A, Bourron O, Andreelli F, Redheuil A. Cardiac adipose tissue volume and IL-6 level at admission are complementary predictors of severity and short-term mortality in COVID-19 diabetic patients. Cardiovasc Diabetol 2021; 20:165. [PMID: 34384426 PMCID: PMC8358546 DOI: 10.1186/s12933-021-01327-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 diabetic adults are at increased risk of severe forms irrespective of obesity. In patients with type-II diabetes, fat distribution is characterized by visceral and ectopic adipose tissues expansion, resulting in systemic inflammation, which may play a role in driving the COVID-19 cytokine storm. Our aim was to determine if cardiac adipose tissue, combined to interleukin-6 levels, could predict adverse short-term outcomes, death and ICU requirement, in COVID-19 diabetic patients during the 21 days after admission. METHODS Eighty one consecutive patients with type-II diabetes admitted for COVID-19 were included. Interleukin-6 measurement and chest computed tomography with total cardiac adipose tissue index (CATi) measurement were performed at admission. The primary outcome was death during the 21 days following admission while intensive care requirement with or without early death (ICU-R) defined the secondary endpoint. Associations of CATi and IL-6 and threshold values to predict the primary and secondary endpoints were determined. RESULTS Of the enrolled patients (median age 66 years [IQR: 59-74]), 73% male, median body mass index (BMI) 27 kg/m2 [IQR: 24-31]) 20 patients had died from COVID-19, 20 required intensive care and 41 were in conventional care at day 21 after admission. Increased CATi and IL-6 levels were both significantly related to increased early mortality (respectively OR = 6.15, p = 0.002; OR = 18.2, p < 0.0001) and ICU-R (respectively OR = 3.27, p = 0.01; OR = 4.86, p = 0.002). These associations remained significant independently of age, sex, BMI as well as troponin-T level and pulmonary lesion extension in CT. We combined CATi and IL-6 levels as a multiplicative interaction score (CATi*IL-6). The cut-point for this score was ≥ 6386 with a sensitivity of 0.90 and a specificity of 0.87 (AUC = 0.88) and an OR of 59.6 for early mortality (p < 0.0001). CONCLUSIONS Cardiac adipose tissue index and IL-6 determination at admission could help physicians to better identify diabetic patients with a potentially severe and lethal short term course irrespective of obesity. Diabetic patients with high CATi at admission, a fortiori associated with high IL-6 levels could be a relevant target population to promptly initiate anti-inflammatory therapies.
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Affiliation(s)
- Franck Phan
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Samia Boussouar
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Olivier Lucidarme
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Mohamed Zarai
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, CIC-1901, INSERM, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Khaoula Bouazizi
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Etienne Charpentier
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Yasmine Niati
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Hasnae Bekkaoui
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Patrice Cacoub
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Yves Allenbach
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - David Saadoun
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Jean-Marc Lacorte
- Department of Endocrine and Oncologic Biochemistry, Inserm, UMR_S 1166, Research Institute of Cardiovascular Disease, Metabolism and Nutrition, Paris, France
| | - Salma Fourati
- Department of Endocrine and Oncologic Biochemistry, Inserm, UMR_S 1166, Research Institute of Cardiovascular Disease, Metabolism and Nutrition, Paris, France
| | - Suzanne Laroche
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France
| | - Agnes Hartemann
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Fabrizio Andreelli
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, INSERM, UMRS U1269, Paris, France
| | - Alban Redheuil
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France. .,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France. .,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.
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46
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Chew NWS, Wong RC, Kong WWF, Low A, Tan HC. Rare Klebsiella pneumoniae anterior mediastinal abscess masquerading as cardiac tamponade. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:655-656. [PMID: 34472564 DOI: 10.47102/annals-acadmedsg.202143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, Singapore
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Sousa JA, Mendonça MI, Serrão M, Borges S, Henriques E, Freitas S, Tentem M, Santos M, Freitas P, Ferreira A, Guerra G, Drumond A, Palma Reis R. Epicardial Adipose Tissue: The Genetics Behind an Emerging Cardiovascular Risk Marker. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2021; 15:11795468211029244. [PMID: 34276231 PMCID: PMC8255575 DOI: 10.1177/11795468211029244] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/07/2021] [Indexed: 12/16/2022]
Abstract
Evidence points epicardial adipose tissue (EAT) as an emerging cardiovascular risk marker. Whether genetic polymorphisms linked with atherosclerosis are associated with higher EAT is still unknown. We aim to assess the role of genetic burden of atherosclerosis and its association to EAT in a cohort of asymptomatic individuals without coronary disease. A total of 996 participants were prospectively enrolled in a single Portuguese center. EAT volume was measured by Cardiac Computed Tomography and participants were distributed into 2 groups, above and below median EAT. SNPs were genotyped and linked to their respective pathophysiological axes. A multiplicative genetic risk score (mGRS) was constructed, representing the genetic burden of the studied SNPs. To evaluate the association between genetics and EAT, we compared both groups by global mGRS, mGRS by functional axes, and SNPs individually. Individuals above-median EAT were older, had a higher body mass index (BMI) and higher prevalence of hypertension, metabolic syndrome, diabetes, and dyslipidemia. They presented higher GRS, that remained an independent predictor of higher EAT volumes. The group with more EAT consistently presented higher polymorphic burden across numerous pathways. After adjustment, age, BMI, and mGRS of each functional axis emerged as independently related to higher EAT volumes. Amongst the 33 SNPs, MTHFR677 polymorphism emerged as the only significant and independent predictor of higher EAT volumes. Patients with higher polymorphism burden for atherosclerosis present higher EAT volumes. We present the first study in a Portuguese population, evaluating the genetic profile of EAT through GWAS and GRS, casting further insight into this complicated matter.
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Affiliation(s)
- João Adriano Sousa
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Maria Isabel Mendonça
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Marco Serrão
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Sofia Borges
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Eva Henriques
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Sónia Freitas
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Margarida Tentem
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Marina Santos
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Pedro Freitas
- Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, CHLO, Carnaxide, Portugal
| | - António Ferreira
- Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, CHLO, Carnaxide, Portugal
| | - Graça Guerra
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - António Drumond
- Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
| | - Roberto Palma Reis
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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48
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Emamat H, Tangestani H, Behrad Nasab M, Ghalandari H, Hekmatdoost A. The association between epicardial adipose tissue and non-alcoholic fatty liver disease: A systematic review of existing human studies. EXCLI JOURNAL 2021; 20:1096-1105. [PMID: 34345229 PMCID: PMC8326500 DOI: 10.17179/excli2021-3815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD) has significantly risen all around the world. Although visceral fat mass has been identified as an independent risk factor for NAFLD, the association of other ectopic fat depots, such as Epicardial adipose tissue (EAT), with the disease has not been fully elucidated. The aim of the current study was to systematically review all available human studies conducted on the associations between EAT and NAFLD. All human studies published in English, which examined the association between the thickness or the volume of EAT and the incidence of NAFLD were systematically searched on PubMed, Scopus, and Google Scholar search engines, from inception up to April 2021. Eighteen studies that met inclusion criteria were included in the final review. A total of 86 studies were found through searching the databases. After excluding duplicates, seventy six remained studies were scanned by title and abstract, out of which, 58 were excluded. Finally, eighteen articles (thirteen cross-sectional studies and five case-control studies) published between 2008 and 2021, were included in the review. According to the results of the reviewed articles, EAT was associated with the presence and progression of NAFLD. Furthermore, NAFLD patients with thicker EAT may need a more intensive hepatic follow-up. However, we suggest further investigation to find out the underlying mechanisms describing the observed association.
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Affiliation(s)
- Hadi Emamat
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadith Tangestani
- Department of Nutrition, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mojgan Behrad Nasab
- Nutritionist, Emam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Hamid Ghalandari
- Department of Clinical Nutrition, Faculty of Nutrition and Food Sciences, Shiraz University of Medical Sciences
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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49
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Ying W, Sharma K, Yanek LR, Vaidya D, Schär M, Markl M, Subramanya V, Soleimani S, Ouyang P, Michos ED, Shah SJ, Hays AG. Visceral adiposity, muscle composition, and exercise tolerance in heart failure with preserved ejection fraction. ESC Heart Fail 2021; 8:2535-2545. [PMID: 33939300 PMCID: PMC8318398 DOI: 10.1002/ehf2.13382] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Aims Visceral adipose tissue (AT) promotes inflammation and may be associated with disease progression in heart failure with preserved ejection fraction (HFpEF). We characterized regional AT distribution in HFpEF patients and controls and analysed associations with co‐morbidities and exercise tolerance. Methods and results Magnetic resonance imaging was performed to quantify epicardial, liver, abdominal, and thigh skeletal muscle AT. We assessed New York Heart Association (NYHA) class, 6 min walk distance, and global well‐being score. Multivariable linear regression models adjusting for body surface area were used. We studied 55 HFpEF patients (41 women, mean age 67 ± 11 years) and 33 controls (21 women, mean age 57 ± 10 years). Epicardial AT (median [interquartile range] 4.6 [2.0] vs. 3.2 [1.4] mm, P < 0.001), thigh intermuscular fat (11.0 [11.5] vs. 5.0 [2.7] cm2, P < 0.001) and liver fat fraction (6.4% [6.1] vs. 4.1% [5.5], P = 0.001) were higher in HFpEF patients than controls. Women with HFpEF had higher abdominal and thigh subcutaneous AT than men. Greater thigh intermuscular fat was associated with higher blood pressure (β [SE] 0.73 [0.17], P < 0.001) and diabetes (odds ratio [95% confidence interval] 1.2 [1.0–1.5], P = 0.03). Greater thigh intramuscular fat was associated with both worse NYHA class (β [SE] 2.7 [1.0], P = 0.01) and shorter 6 min walk distance (β [SE] −4.1 [1.9], P = 0.03), and greater epicardial AT (β [SE] −0.2 [0.1], P < 0.001) and liver fat fraction (β [SE] −0.4 [0.2], P = 0.04) were associated with lower global well‐being score. Conclusions Heart failure with preserved ejection fraction patients have increased epicardial, liver, and skeletal muscle fat compared with controls out of proportion to their increased body size, and adiposity was associated with worse NYHA class and exercise tolerance in HFpEF. These results provide the basis for further investigation into the effect of interventions to reduce regional AT distribution in relation to HFpEF symptoms and pathophysiology.
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Affiliation(s)
- Wendy Ying
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Kavita Sharma
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Lisa R Yanek
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Dhananjay Vaidya
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Schär
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Michael Markl
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Sahar Soleimani
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Pamela Ouyang
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Erin D Michos
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allison G Hays
- School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 21287, USA
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50
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Rosa MI, Grande AJ, Lima LD, Dondossola ER, Uggioni MLR, Hernandez AV, Tse G, Liu T, Pontes-Neto OM, Biondi-Zoccai G, Neto MG, Durães AR, Sá MPBO, Resende ES, Roever L. Association Between Epicardial Adipose Tissue and Stroke. Front Cardiovasc Med 2021; 8:658445. [PMID: 33969022 PMCID: PMC8096977 DOI: 10.3389/fcvm.2021.658445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
Epicardial adipose tissue (EAT) is correlated with endothelial dysfunction, metabolic syndrome, increased mortality and recent studies showed a possible association with the increased risk of stroke. We performed a systematic review of studies evaluating the association between EAT and stroke. Eighty studies met the inclusion criteria and were consequently analyzed. The review had Five main findings. First, the increased epicardial fat thickness (EFT) may be associated with the stroke episode. Second, regardless of the imaging method (echocardiography, MRI, and CT) this association remains. Third, the association of metabolic syndrome and atrial fibrillation seems to increase the risk of stroke. Fourth, this systematic review was considered as low risk of bias. Despite being unable to establish a clear association between EAT and stroke, we have organized and assessed all the research papers on this topic, analyzing their limitations, suggesting improvements in future pieces of research and pointing out gaps in the literature. Furthermore, the mechanistic links between increased EAT and stroke incidence remains unclear, thus, further research is warranted.
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Affiliation(s)
- Maria Inês Rosa
- Laboratory of Biomedicine Translational, University of Extremo Sul Catarinense, Criciúma, Brazil
| | - Antonio José Grande
- Department of Medicine, State University of Mato Grosso Do Sul, Mato Grosso, Brazil
| | - Leticia Dorsa Lima
- Department of Medicine, State University of Mato Grosso Do Sul, Mato Grosso, Brazil
| | | | | | - Adrian V. Hernandez
- Hartford Hospital Evidence-Based Practice Center, University of Connecticut, Hartford, CT, United States
- Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola, Lima, Peru
| | - Gary Tse
- Xiamen Cardiovascular Hospital, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Octávio Marques Pontes-Neto
- Stroke Service, Neurology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Mansueto Gomes Neto
- Mediterranea Cardiocentro, Naples, Italy
- Physical Therapy Department, Federal University of Bahia—Universidade Federal Da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde—Universidade Federal Da Bahia, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - André Rodrigues Durães
- Physical Therapy Department, Federal University of Bahia—Universidade Federal Da Bahia, Salvador, Brazil
| | - Michel Pompeu B. O. Sá
- The GREAT Group, Salvador, Brazil
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- Department of Surgery, University of Pernambuco—Universidade de Pernambuco, Recife, Brazil
| | - Elmiro Santos Resende
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
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