Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease

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Abstract

Background and aim

Epicardial adipose tissue (EAT), which is thought to be a component of visceral adiposity, is associated with the metabolic syndrome. We aimed to test the hypothesis that echocardiographic EAT thickness can be a marker for the presence and severity of coronary artery disease (CAD).

Method and results

In all, 150 patients (100 patients with CAD and 50 patients with normal coronary arteries by diagnostic coronary angiography; 65 women, 85 men; mean age 55.7 ± 7.4 years) were enrolled. EAT thickness was measured using 2-D echocardiographic parasternal long- and short-axis views. EAT thickness measurements were compared with angiographic findings.

EAT thickness was significantly higher in patients with CAD in comparison to those with normal coronary arteries (6.9 ± 1.5 mm vs. 4.4 ± 0.8 mm; P < 0.001). Furthermore, EAT thickness increased with the severity of CAD (multivessel disease 7.4 ± 1.2 mm vs. single vessel disease 5.7 ± 1.7 mm; P < 0.001). Gensini's score significantly correlated with EAT thickness (r = 0.600, P < 0.001). EAT thickness of ≥5.2 mm had 85% sensitivity and 81% specificity (ROC area 0.914, P < 0.001, 95% CI [0.86–0.96]) for predicting CAD.

Conclusion

EAT thickness, which is easily and non-invasively evaluated by transthoracic echocardiography, can be an adjunctive marker to classical risk factors for the prediction of CAD.

Introduction

Visceral adiposity is fat deposition around internal organs. It is metabolically active and is an important risk factor for developing the metabolic syndrome (MS) [1], [2], [3], [4]. Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules [5], [6]. Transthoracic echocardiography enables non-invasive assessment of EAT [4], [7]. Several studies have addressed the association between EAT thickness and the severity of coronary artery disease (CAD) with conflicting results [8], [9], [10]. Thus, we aimed to test the hypothesis that echocardiographic EAT thickness could be a marker for the presence and severity of CAD.

Section snippets

Methods

Patients who underwent coronary angiography due to chest pain and/or an abnormal stress test were enrolled. One hundred patients with CAD and 50 patients with normal coronary arteries were consecutively studied. The study complies with the declaration of Helsinki. All participants gave informed consent, and the Institutional Review Board of the University of Baskent approved the research protocol. Patients were excluded if they had abnormal images on transthoracic echocardiography, a history of

Results

There were 65 women and 85 men in the study population. The mean age was 55.7 ± 7.4 years. The demographic and laboratory characteristics of the study groups are presented in Table 1.

Discussion

This study shows an association between EAT thickness and the presence and severity of CAD. EAT thickness emerged as an independent predictor of CAD among other well-known risk factors. Two potential mechanisms for this association have been proposed: First, EAT is a component of visceral adiposity and is related to MS and cardiovascular risk factors [1], [2], [3], [4]; secondly, EAT has paracrine and endocrine functions. It can secrete numerous bioactive molecules (adipokines) such as

Acknowledgements

The authors wish to thank Mrs. Vahide Simsek in the echocardiography laboratory for her devoted co-operation and the nutritionists for their measurements of total fat ratios.

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