Epicardial adipose tissue (EAT) has been recognized as a sensitive marker of cardiometabolic risk. Recent evidence suggests efficacy of long-term statin therapy in reducing EAT in patients with coronary artery disease. Whether short-term statin therapy is associated with changes in the volume of EAT is currently unknown. A cohort of atrial fibrillation (AF) patients undergoing pulmonary vein isolation was randomized to receive either 80 mg/day of atorvastatin (n=38, 32 males, age 56 ± 11 years) or placebo (n=41, 33 males, age 56 ± 10 years) for a 3-month period. EAT volume was assessed by cardiac computed tomography at baseline and at follow-up. Patients randomized to statin treatment exhibited a modest but significant decrease in median EAT volume (baseline vs follow-up: 92.3(62.0–133.3) vs 86.9(64.1–124.8) cm3, p < 0.05) while median EAT remained unchanged in the placebo group (81.9(55.5–110.9) vs 81.3(57.1–110.5) cm3, p = NS). Changes in median systemic inflammatory markers and lipid profile were also seen with statin treatment: C-reactive protein (2.4(0.7–3.7) vs 1.1(0.5–2.7) mg/L, p < 0.05), total cholesterol (186(162.5–201) vs 123(99–162.5) mg/dL, p < 0.001), and low density lipoprotein-cholesterol (116(96.5–132.5) vs 56(40.5–81) mg/dL, p < 0.001) diminished, while median body mass index did not change (27.8(25–30) vs 27.6(25.7–30.5) kg/m2, p = NS). No variations occurred in the placebo group. In conclusion, short-term intensive statin therapy significantly reduced the volume of EAT in AF patients.

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IntroductionObstructive sleep apnea (OSA) is the most common form of sleep disordered breathing and has been associated with major cardiovascular comorbidities. We hypothesized that the microcirculation is impaired in patients with OSA and that the magnitude of impairment correlates to OSA severity.MethodsSubjects were consecutive patients scheduled for routine diagnostic polysomnography (PSG). OSA was defined by paradoxical rib cage movements together with abdominal excursions and by the apnea-hypopnea index (AHI) (events/hour; no apnea AHI<5; mild apnea 5≤AHI<15; moderate apnea 15≤AHI<30; severe apnea AHI ≥30). Sidestream darkfield imaging was used to assess the sublingual microcirculation. Recordings of sublingual microcirculation (5 random sites) were performed before and after overnight PSG. Data are summarized as mean (±SD); p values <0.05 were considered statistically significant.ResultsThirty-three consecutive patients were included. OSA was diagnosed in 16 subjects (4 moderate, 12 severe). There was no significant difference in microcirculation between subjects with moderate OSA and without OSA. However, compared to subjects without OSA, subjects with severe OSA (AHI≥30) showed a significant decrease of microvascular flow index (-0.07±0.17 vs. 0.08±0.14; p = 0.02) and increase of microvascular flow index heterogeneity (0.06±0.15 vs. -0.06±0.11; p = 0.02) overnight. Multiple regression analysis (adjusted for age and gender) showed both decrease of flow and increase of flow heterogeneity associated with AHI (b = -0.41; F = 1.8; p = 0.04 and b = 0.43; F = 1.9; p = 0.03, respectively).ConclusionAcute overnight microcirculatory changes are observed in subjects with severe OSA characterized by decreased flow and increased flow heterogeneity.

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Objective: It has been suggested that regional anesthesia may prevent post -operative exacerbation of obstructive sleep apnea. However, clinical evidence is lacking. We have hypothesized that post -operative exacerbation of sleep -disordered breathing is related to the anesthetic technique. Design: Prospective observational study. Setting: Orthopedic intensive care unit. Material and methods: The inclusion criterion was orthopedic surgery requiring anesthesia. Multichannel polygraphy sleep studies were performed one night before and four consecutive nights after surgery. The Kruskal-Wallis test and Friedman's ANOVA were used. Results: Thirty -five patients completed investigations and were compared according to anesthetic techniques which included 1) general anesthesia (n = 11); 2) subarachnoid anesthesia with intrathecal morphine (n = 11); and 3) subarachnoid anesthesia (without intrathecal morphine) with epidural catheter for opioid -free post -operative analgesia (n = 13). Obstructive sleep apnea was diagnosed pre -operatively in 22 (63%) patients. In the general anesthesia group, hypopnea significantly increased on the third and fourth post -operative nights (p < 0.05). In the subarachnoid anesthesia with intrathecal morphine group, hypopnea and oxygen desaturation index decreased significantly on the first post -operative night and increased on the third and fourth post -operative nights as did the apnea-hypopnea index (all p < 0.05). In the subarachnoid anesthesia with epidural catheter group, there were no significant changes in sleep -disordered breathing parameters. In the subarachnoid anesthesia with epidural catheter group, the cumulative opioid dose was significantly lower compared to the other two groups. Conclusion: Compared to pre -operative findings, changes in sleep -disordered breathing events were less pronounced in patients who received subarachnoid anesthesia (without intrathecal morphine) with epidural catheter for opioid -free post--operative epidural analgesia.

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Background: The epicardial adipose tissue (EAT) has been identified as a sensitive marker of cardiometabolic risk. Recent evidence suggests efficacy of long-term statin therapy in reducing the EAT in patients with coronary artery disease. Whether the volume of EAT changes in patients with atrial fibrillation (AF) treated with a statin for a short time period is currently unknown. Methods: A population of AF patients undergoing pulmonary vein isolation was randomized to receive either 80 mg/day of atorvastatin (n=51, 44 males, age 55±10 years) or placebo (n=51, 41 males, age 56±10) for a 3 month period. EAT volume was assessed by cardiac computed tomography at baseline and after 3-month follow-up. Results: Patients randomized to statin treatment exhibited significant decreases in EAT volume (baseline vs follow-up: 105.8 ± 52.95 vs 103.05 ± 52.55 cm3, p = 0.05), C-reactive protein (2.97 ± 4.3 mg/L vs 2.03 ± 2.2 mg/L, p < 0.05), total cholesterol (182.5 ± 36.9 vs 129.3 ± 40.6 mg/dL, p < 0.001), and low density lipoprotein-cholesterol (111.88 ± 28 vs 61 ± 32.6 mg/dL, p < 0.001) at follow-up, while the body mass index did not vary (29.42 ± 5.2 vs 29.11 ± 4.8 kg/m2, p = 0.28). No changes were seen in the placebo group. Conclusions: Short-term high-dose statin therapy significantly reduced the volume of EAT in AF patients. EAT volume modulation might be an important mechanism by which statins may influence cardiovascular risk.