open access

Vol 76, No 6 (2018)
Original articles
Published online: 2018-02-02
Submitted: 2017-07-23
Accepted: 2018-02-01
Get Citation

Clinical usefulness of epicardial adipose tissue in patients with high-intermediate pre-test probability for coronary artery disease

Regayip Zehir, Ahmet Güner, Mert Ilker Hayiroglu, Tugba Kemaloğlu Oz, Altug Osken, Huseyin Aksu, Sennur Unal Dayi, Gultekin Faik Hobikoğlu
DOI: 10.5603/KP.a2018.0054
·
Kardiol Pol 2018;76(6):1002-1008.

open access

Vol 76, No 6 (2018)
Original articles
Published online: 2018-02-02
Submitted: 2017-07-23
Accepted: 2018-02-01

Abstract

Background: Epicardial adipose tissue (EAT) is thought to be associated with the extension and severity of coronary artery disease (CAD), and echocardiographic measurement of EAT thickness is considered to be a possible cardiovascular risk indica­tor. The European Society of Cardiology Task Force recommends further non-invasive testing in patients with an intermediate pre-test probability (PTP) for the diagnosis of CAD.

Aim: We sought to evaluate the clinical usefulness of performing EAT measurements in patients with a high-intermediate PTP.

Methods: Patients referred to an outpatient clinic with stable chest pain symptoms, with PTP for CAD between 66% and 85%, were included in the study. Echocardiographic measurement of the EAT was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. Single-photon emission computed tomography (SPECT) was performed in all patients. The diagnosis of CAD was based on the presence of reversible perfusion defects on SPECT.

Results: A total of 126 patients (76 men, 60.3%) with a mean age of 65.3 ± 9.1 years were recruited. The EAT thickness was 7.3 ± 0.7 mm in patients with positive SPECT and 6.2 ± 0.6 mm in patients with negative SPECT (p < 0.001). Multivariable analysis revealed higher rates of positive SPECT in patients with higher EAT (odds ratio [OR] 9.80; 95% confidence interval [CI] 3.72–25.79; p < 0.001), and receiver operating characteristic curve analysis showed that the greatest specificity was obtained when the cut-off value of EAT thickness was 6.75 mm (sensitivity 76%; specificity 74%).

Conclusions: In patients with high-intermediate PTP, EAT is a useful measurement that may assist in risk stratification.

Abstract

Background: Epicardial adipose tissue (EAT) is thought to be associated with the extension and severity of coronary artery disease (CAD), and echocardiographic measurement of EAT thickness is considered to be a possible cardiovascular risk indica­tor. The European Society of Cardiology Task Force recommends further non-invasive testing in patients with an intermediate pre-test probability (PTP) for the diagnosis of CAD.

Aim: We sought to evaluate the clinical usefulness of performing EAT measurements in patients with a high-intermediate PTP.

Methods: Patients referred to an outpatient clinic with stable chest pain symptoms, with PTP for CAD between 66% and 85%, were included in the study. Echocardiographic measurement of the EAT was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. Single-photon emission computed tomography (SPECT) was performed in all patients. The diagnosis of CAD was based on the presence of reversible perfusion defects on SPECT.

Results: A total of 126 patients (76 men, 60.3%) with a mean age of 65.3 ± 9.1 years were recruited. The EAT thickness was 7.3 ± 0.7 mm in patients with positive SPECT and 6.2 ± 0.6 mm in patients with negative SPECT (p < 0.001). Multivariable analysis revealed higher rates of positive SPECT in patients with higher EAT (odds ratio [OR] 9.80; 95% confidence interval [CI] 3.72–25.79; p < 0.001), and receiver operating characteristic curve analysis showed that the greatest specificity was obtained when the cut-off value of EAT thickness was 6.75 mm (sensitivity 76%; specificity 74%).

Conclusions: In patients with high-intermediate PTP, EAT is a useful measurement that may assist in risk stratification.

Get Citation

Keywords

echocardiography, epicardial adipose tissue, pre-test probability, single-photon emission computed tomography

About this article
Title

Clinical usefulness of epicardial adipose tissue in patients with high-intermediate pre-test probability for coronary artery disease

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 6 (2018)

Pages

1002-1008

Published online

2018-02-02

DOI

10.5603/KP.a2018.0054

Bibliographic record

Kardiol Pol 2018;76(6):1002-1008.

Keywords

echocardiography
epicardial adipose tissue
pre-test probability
single-photon emission computed tomography

Authors

Regayip Zehir
Ahmet Güner
Mert Ilker Hayiroglu
Tugba Kemaloğlu Oz
Altug Osken
Huseyin Aksu
Sennur Unal Dayi
Gultekin Faik Hobikoğlu

References (24)
  1. Eiras S, Teijeira-Fernández E, Shamagian LG, et al. Extension of coronary artery disease is associated with increased IL-6 and decreased adiponectin gene expression in epicardial adipose tissue. Cytokine. 2008; 43(2): 174–180.
  2. Löhn M, Dubrovska G, Lauterbach B, et al. Periadventitial fat releases a vascular relaxing factor. FASEB J. 2002; 16(9): 1057–1063.
  3. Cheng KH, Chu CS, Lee KT, et al. Adipocytokines and proinflammatory mediators from abdominal and epicardial adipose tissue in patients with coronary artery disease. Int J Obes (Lond). 2008; 32(2): 268–274.
  4. Iwasaki K, Matsumoto T, Aono H, et al. Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease. Clin Cardiol. 2011; 34(3): 166–171.
  5. Nelson MR, Mookadam F, Thota V, et al. Epicardial fat: an additional measurement for subclinical atherosclerosis and cardiovascular risk stratification? J Am Soc Echocardiogr. 2011; 24(3): 339–345.
  6. Chaowalit N, Somers VK, Pellikka PA, et al. Subepicardial adipose tissue and the presence and severity of coronary artery disease. Atherosclerosis. 2006; 186(2): 354–359.
  7. de Vos AM, Prokop M, Roos CJ, et al. Peri-coronary epicardial adipose tissue is related to cardiovascular risk factors and coronary artery calcification in post-menopausal women. Eur Heart J. 2008; 29(6): 777–783.
  8. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013; 34(38): 2949–3003.
  9. Hesse B, Tägil K, Cuocolo A, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005; 32(7): 855–897.
  10. Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res. 2003; 11(2): 304–310.
  11. Jeong JW, Jeong M, Yun K, et al. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J. 2007; 71(4): 536–539.
  12. Mustelier JV, Rego JO, González AG. Echocardiographic parameters of epicardial fat deposition and its relation to coronary artery disease. Arq Bras Cardiol. 2011; 97(2): 122–129.
  13. Shemirani H, Khoshavi M. Correlation of echocardiographic epicardial fat thickness with severity of coronary artery disease-an observational study. Anadolu Kardiyol Derg. 2012; 12(3): 200–205.
  14. Seker T, Turkoglu C, Harbalıoglu H, et al. The impact of diabetes on the association between epicardial fat thickness and extent and complexity of coronary artery disease in patients with non-ST elevation myocardial infarction. Kardiol Pol. 2017; 75(11): 1177–1184.
  15. Iozzo P. Myocardial, perivascular, and epicardial fat. Diabetes Care. 2011; 34 Suppl 2: S371–S379.
  16. Miyata K, Shimokawa H, Kandabashi T, et al. Rho-Kinase Is Involved in Macrophage-Mediated Formation of Coronary Vascular Lesions in Pigs In Vivo. Arterioscler Thromb Vasc Biol. 2000; 20(11): 2351–2358.
  17. Iacobellis G, Ribaudo MC, Assael F, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab. 2003; 88(11): 5163–5168.
  18. Canpolat U, Aytemir K, Yorgun H, et al. The Impact of Echocardiographic Epicardial Fat Thickness on Outcomes of Cryoballoon-Based Atrial Fibrillation Ablation. Echocardiography. 2016; 33(6): 821–829.
  19. Ding J, Hsu FC, Harris TB, et al. The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2009; 90(3): 499–504.
  20. Eroglu S, Sade LE, Yildirir A, et al. Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutr Metab Cardiovasc Dis. 2009; 19(3): 211–217.
  21. Khawaja T, Greer C, Thadani SR, et al. Increased regional epicardial fat volume associated with reversible myocardial ischemia in patients with suspected coronary artery disease. J Nucl Cardiol. 2015; 22(2): 325–333.
  22. Uygur B, Celik O, Ozturk D, et al. The relationship between location-specific epicardial adipose tissue volume and coronary atherosclerotic plaque burden in type 2 diabetic patients. Kardiol Pol. 2017; 75(3): 204–212.
  23. Tabakci MM, Durmuş Hİ, Avci A, et al. Relation of epicardial fat thickness to the severity of heart failure in patients with nonischemic dilated cardiomyopathy. Echocardiography. 2015; 32(5): 740–748.
  24. Alexopoulos N, McLean DS, Janik M, et al. Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis. 2010; 210(1): 150–154.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl