Epicardial adipose tissue in patients with heart failure

Abstract

PurposeThe aim of this study was to evaluate the extent of epicardial adipose tissue (EAT) and its relationship with left ventricular (LV) parameters assessed by cardiovascular magnetic resonance (CMR) in patients with congestive heart failure (CHF) and healthy controls.BackgroundEAT is the true visceral fat deposited around the heart which generates various bioactive molecules. Previous studies found that EAT is related to left ventricular mass (LVM) in healthy subjects. Further studies showed a constant EAT to myocardial mass ratio in normal, ischemic and hypertrophied hearts.MethodsCMR was performed in 66 patients with CHF due to ischemic cardiomyopathy (ICM), or dilated cardiomyopathy (DCM) and 32 healthy controls. Ventricular volumes, dimensions and LV function were assessed. The amount of EAT was determined volumetrically and expressed as mass indexed to body surface area. Additionally, the EAT/LVM and the EAT/left ventricular remodelling index (LVRI) ratios were calculated.ResultsPatients with CHF had less indexed EAT mass than controls (22 ± 5 g/m2 versus 34 ± 4 g/m2, p < 0.0001). In the subgroup analysis there were no significant differences in indexed EAT mass between patients with ICM and DCM (21 ± 4 g/m2 versus 23 ± 6 g/m2, p = 0.14). Linear regression analysis showed that with increasing LV end-diastolic diameter (LV-EDD) (r = 0.42, p = 0.0004) and LV end-diastolic mass (LV-EDM) (r = 0.59, p < 0.0001), there was a significantly increased amount of EAT in patients with CHF. However, the ratio of EAT mass/LV-EDM was significantly reduced in patients with CHF compared to healthy controls (0.54 ± 0.1 versus 0.21 ± 0.1, p < 0.0001). In CHF patients higher indexed EAT/LVRI-ratios in CHF patients correlated best with a reduced LV-EF (r = 0.49, p < 0.0001).ConclusionPatients with CHF revealed significantly reduced amounts of EAT. An increase in LVM is significantly related to an increase in EAT in both patients with CHF and controls. However, different from previous reports the EAT/LVEDM-ratio in patients with CHF was significantly reduced compared to healthy controls. Furthermore, the LV function correlated best with the indexed EAT/LVRI ratio in CHF patients. Metabolic abnormalities and/or anatomic alterations due to disturbed cardiac function and geometry seem to play a key role and are a possible explanation for these findings.

Impact of Functional, Morphological and Clinical Parameters on Epicardial Adipose Tissue in Patients With Coronary Artery Disease

“…In this larger patient collective, we found in CAD patients with a preserved LVEF an EAT/EDM-ratio that was even slightly higher than that in healthy controls, indicating the excessive augmentation of the EAT mass. Similar to our prior findings 19 in CAD patients with a reduced LVEF <50%, the EAT/EDMratio was significantly reduced compared to patients with preserved LVEF and healthy controls. Although a causal effect of EAT on LV mass remains to be demonstrated, the close anatomical and functional relationship of EAT to the adjacent myocardium may allow due to a lack of fascia, local, paracrine interactions between these tissues.…”

“…However, LVEF impairment is a well established prognostic predictor for the clinical outcome of patients with CAD. [16][17][18] In prior studies of our group, we found significantly decreased amounts of EAT in patients with impaired LVEF due to ischemic or non-ischemic cardiomyopathy in comparison to healthy controls, 19 suggesting a complex interaction of EAT and CAD.…”

Epicardial Fat in the Maintenance of Cardiovascular Health

“…12,14 Epicardial fat measurements are taken in the right ventricular free wall and around the main coronary arteries, and the acquired images are reconstructed in 3D slices with 2-mm to 3-mm thickness. 15,17,18 These higher-resolution images provide more detail but need more technical care and require longer radiation exposure for the patient. Several studies used the semiautomated technique for measuring the volume of epicardial fat, and software has been developed more recently to automate this process.…”

“…Several studies used the semiautomated technique for measuring the volume of epicardial fat, and software has been developed more recently to automate this process. [17][18][19][20] …”

The evaluation of relationship between adiponectin levels and epicardial adipose tissue thickness with low cardiac risk in Gilbert`s syndrome: an observational study

“…Increased epicardial adipose tissue (EAT) has been found to be related to increased ventricular mass (7). This tissue releases inflammatory cytokines (8).…”