Critical role of the epicardium in mediating cardiac inflammation and fibrosis in patients with type 2 diabetes

Packer, Milton

doi:10.1111/dom.13792

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…Overall, we now know from several observational studies that EAT shows promise as a modifiable cardiac risk factor. The underlying mechanisms by which EAT may accelerate atherosclerosis and myocardial damage have also been investigated in several studies and summarized in excellent recent reviews by Packer, 26,27,149 Iacobellis 34,150 and others, 21,29,128,151 who shaped the idea that EAT plays a critical role as a metabolic transducer of systematic inflammation and thereby exerts deleterious effects on the myocardium and coronary arteries. Despite this, there are several aspects to be clarified before we understand whether EAT is a clinically relevant risk factor that will improve risk stratification and guide future clinical decision-making.…”

Section: Does Eat Drive the Association Of T2d And Cvd?mentioning

confidence: 99%

“…Since T2D is accompanied by an expansion of EAT and PAT, 25 these depots have been suggested to play a critical role in accelerating CVD and heart failure, particularly in patients with T2D. 26–30 In support of this, high levels of EAT in T2D have been associated with atherosclerosis, 31 diastolic dysfunction, 32 and incident cardiovascular events. 33…”

Section: Introductionmentioning

confidence: 97%

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Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes?

Christensen

Scholten

Lehrskov

et al. 2020

Therapeutic Advances in Endocrinology

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Type 2 diabetes (T2D) is associated with an increased risk of cardiovascular disease and heart failure, which highlights the need for improved understanding of factors contributing to the pathophysiology of these complications as they are the leading cause of mortality in T2D. Patients with T2D have high levels of epicardial adipose tissue (EAT). EAT is known to secrete inflammatory factors, lipid metabolites, and has been proposed to apply mechanical stress on the cardiac muscle that may accelerate atherosclerosis, cardiac remodeling, and heart failure. High levels of EAT in patients with T2D have been associated with atherosclerosis, diastolic dysfunction, and incident cardiovascular events, and this fat depot has been suggested as an important link coupling diabetes, obesity, and cardiovascular disease. Despite this, the predictive potential of EAT in general, and in patients with diabetes, is yet to be established, and, up until now, the clinical relevance of EAT is therefore limited. Should this link be established, importantly, studies show that this fat depot can be modified both by pharmacological and lifestyle interventions. In this review, we first introduce the role of adipose tissue in T2D and present mechanisms involved in the pathophysiology of EAT and pericardial adipose tissue (PAT) in general, and in patients with T2D. Next, we summarize the evidence that these fat depots are elevated in patients with T2D, and discuss whether they might drive the high cardiometabolic risk in patients with T2D. Finally, we discuss the clinical potential of cardiac adipose tissues, address means to target this depot, and briefly touch upon underlying mechanisms and future research questions.

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Section: Does Eat Drive the Association Of T2d And Cvd?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes?

Christensen

Scholten

Lehrskov

et al. 2020

Therapeutic Advances in Endocrinology

View full text Add to dashboard Cite

show abstract

“…CT-FFR, as an indicator of coronary vascular haemodynamic stenosis, provides both physiological and corresponding anatomical information about the coronary vessels [ 47 ]; DS directly reflects the anatomical stenosis of the coronary vessels. Whereas PAT is located near the myocardium, and its excessive activity accelerates coronary atherosclerosis and, thus, cardiovascular disease [ 48 ]. However, logistic regression analysis revealed that PAT volume was not an influential factor in the development of CAD in patients with T2DM, and we speculate that this lack of influence may be because PAT is not in direct contact with the myocardium; therefore, PAT is not directly influenced by paracrine signals from the myocardium [ 23 ], which is similar to the findings of a previous study [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of coronary artery disease in patients with type 2 diabetes mellitus based on computed tomography and pericoronary adipose tissue radiomics: a retrospective cross-sectional study

Dong

Zhu

et al. 2023

Cardiovasc Diabetol

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Background Patients with type 2 diabetes mellitus (T2DM) are highly susceptible to cardiovascular disease, and coronary artery disease (CAD) is their leading cause of death. We aimed to assess whether computed tomography (CT) based imaging parameters and radiomic features of pericoronary adipose tissue (PCAT) can improve the diagnostic efficacy of whether patients with T2DM have developed CAD. Methods We retrospectively recruited 229 patients with T2DM but no CAD history (146 were diagnosed with CAD at this visit and 83 were not). We collected clinical information and extracted imaging manifestations from CT images and 93 radiomic features of PCAT from all patients. All patients were randomly divided into training and test groups at a ratio of 7:3. Four models were constructed, encapsulating clinical factors (Model 1), clinical factors and imaging indices (Model 2), clinical factors and Radscore (Model 3), and all together (Model 4), to identify patients with CAD. Receiver operating characteristic curves and decision curve analysis were plotted to evaluate the model performance and pairwise model comparisons were performed via the DeLong test to demonstrate the additive value of different factors. Results In the test set, the areas under the curve (AUCs) of Model 2 and Model 4 were 0.930 and 0.929, respectively, with higher recognition effectiveness compared to the other two models (each p < 0.001). Of these models, Model 2 had higher diagnostic efficacy for CAD than Model 1 (p < 0.001, 95% CI [0.129–0.350]). However, Model 4 did not improve the effectiveness of the identification of CAD compared to Model 2 (p = 0.776); similarly, the AUC did not significantly differ between Model 3 (AUC = 0.693) and Model 1 (AUC = 0.691, p = 0.382). Overall, Model 2 was rated better for the diagnosis of CAD in patients with T2DM. Conclusions A comprehensive diagnostic model combining patient clinical risk factors with CT-based imaging parameters has superior efficacy in diagnosing the occurrence of CAD in patients with T2DM.

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“…The first incriminated in atherosclerotic CVD is the epicardial and pericardial fat tissue surrounding the coronary arteries, accelerating cardiac atherosclerosis and heart dysfunction [7,9]. This phenomenon of cardiac atherosclerosis augmentation was observed mainly in T2D patients [10][11][12] who have an increased level of epicardial and pericardial fat [13].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Epicardial Fat Volume Decrease after Dapagliflozin Treatment in Patients with Type 2 Diabetes

et al. 2021

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Background and Objectives: Dapagliflozin treatment proved to reduce the epicardial fat volume (EFV) in patients with type 2 diabetes (T2D). Despite the reduction in EFV being associated with improved diastolic function in patients with T2D, EVF is not routinely evaluated in T2D because it is costly and involves radiation exposure. This study aims to identify biomarkers that predict EFV reduction after dapagliflozin treatment in patients with T2D. Materials and Methods: In a prospective, observational, consecutive-case enrollment scenario, 52 patients with T2D were initiated on dapagliflozin 10 mg q.d. as part of the standard of care. At enrollment and after six months of dapagliflozin treatment, patients were evaluated using cardiac ultrasonography, native computer tomography, transient liver elastography, and metabolic lab tests. In addition, the atherogenic index of plasma (AIP), atherogenic coefficient (AC), triglyceride glucose index (TyG), cardiac risk ratio (CRR), and visceral abdominal index (VAI) were calculated. Results: Higher AIP (r = 0.28; p = 0.04), CRR (r = 0.28; p = 0.04), and TyG (r = 0.32; p = 0.01) are associated with more important reductions in the EFV. A lower conicity index (β = −0.29; p = 0.03), visceral fat volume at the 4th vertebrae (L4VFV) (β = −0.32; p = 0.02), left atrium volume (β = −3.08; p = 0.003), and right ventricle diameter (β = −2.13; p = 0.04) are associated with higher reductions in the EFV after six months of dapagliflozin treatment. A valid performance for predicting clinically relevant decreases in EFV after dapagliflozin treatment was observed for AIP (AUROC = 0.903; Youden = 0.732; p < 0.001), CRR (AUROC = 0.772; Youden = 0.595; p = 0.004), TyG (AUROC = 0.957; Youden = 0.904; p < 0.001), and VAI (AUROC = 0.898; Youden = 0.712; p < 0.001). Conclusion: Higher initial EFV values are associated with more important reductions in EFV in patients with T2D treated for six months with dapagliflozin. TyG values have the best prediction performances for EFV reduction, having the highest sum of sensitivity and specificity at the 0.904 threshold level. AIP, CRR, VAI, conicity index, L4VF, left atrium volume, and right ventricle volume are valid biomarkers for a decrease in EFV after dapagliflozin treatment in diabetes patients.

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Critical role of the epicardium in mediating cardiac inflammation and fibrosis in patients with type 2 diabetes

Cited by 6 publications

References 39 publications

Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes?

Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes?

Diagnosis of coronary artery disease in patients with type 2 diabetes mellitus based on computed tomography and pericoronary adipose tissue radiomics: a retrospective cross-sectional study

Predictors of Epicardial Fat Volume Decrease after Dapagliflozin Treatment in Patients with Type 2 Diabetes

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