Epicardial Adipose Tissue Role as a Marker of Higher Vulnerability in Patients with Coronary Artery Disease

Abstract

Background: Epicardial adipose tissue (EAT) has been recently identified as a major player in the development of the atherosclerotic process. This study aimed to investigate the role of EAT as a marker associated with a higher vulnerability of atheromatous coronary plaques in patients with acute myocardial infarction (AMI) as compared to patients with stable angina. Material and methods: This analysis enrolled a total of 89 patients, 47 with stable angina (SA) and 42 with AMI, who underwent echocardiographic investigations and epicardial fat measurement in 2D-parasternal long axis view. The study lot was divided as follows: Group 1 included patients with prior AMI, and Group 2 included patients with SA. Results: There were no significant differences between the two groups regarding cardiovascular risk factors, excepting smoking status, which was recorded more frequently in Group 1 as compared to Group 2 (36.17% vs. 11.63%, p = 0.02). The mean epicardial fat diameter was 9.12 ± 2.28 mm (95% CI: 8.45-9.79 mm) in Group 1 and 6.30 ± 2.03 mm (95% CI: 5.675-6.93 mm) in Group 2, the difference being highly significant statistically (p <0.0001). The mean value of left ventricular ejection fraction was significantly lower in patients with AMI (Group 1 -47.60% ± 7.96 vs. Group 2 -51.23% ± 9.05, p = 0.04). EAT thickness values showed a weak but significant positive correlation with the level of total cholesterol (r = -0.22, p = 0.03) and with the value of end-systolic left ventricle diameter (r = 0.33, = 0.001). Conclusions: The increased thickness of EAT was associated with other serum-or image-based biomarkers of disease severity, such as the left ventricular ejection fraction, end-systolic diameter of the left ventricle, and total cholesterol. Our results indicate that EAT is significantly higher in patients with acute coronary syndrome, proving that EAT could serve as a marker of vulnerability in cardiovascular diseases.

Coronary Plaque Geometry and Thoracic Fat Distribution in Patients with Acute Chest Pain – a CT Angiography Study

“…9,10 Another study showed that the volumes of epicardial fat are significantly higher in patients with acute coronary syndromes compared to stable subjects, identifying also more vulnerable plaques in patients with larger epicardial adipose depots. 11 Another study which evaluated local fat around coronary plaques proved that pericoronary adipose tissue is a more reliable marker of plaque vulnerability than global epicardial fat or total intrathoracic fat. 12 Due to its local paracrine effect, pericoronary plaque adipose tissue can trigger not only atheroma formation but also plaque progression, vulnerabilization, and rupture.…”

Computer-Aided Biomedical Imaging of Periiliac Adipose Tissue Identifies Perivascular Fat as a Marker of Disease Complexity in Patients with Lower Limb Ischemia

“…Epicardial adipose tissue, which is the fat surrounding the coronary arteries, has been demonstrated to represent a powerful marker of atherosclerosis. An increased epicardial fat volume has been associated with a higher vulnerability of the atheromatous coronary plaque and has been recorded in larger amounts in patients with acute myocardial infarction [10].…”

The Multifaceted Role of Epicardial Fat in Cardiovascular Diseases

“…However, few studies succeeded so far to demonstrate any link between epicardial fat and coronary plaque vulnerabilization, while the role of inflammation in acute coronary syndromes is also well-known.Three articles published in this number of JIM address the issue of epicardial fat from the cardiovascular perspective.In the first one, Nyulas et al demonstrate that epicardial fat volumes are significantly higher in patients with acute coronary syndromes as compared to stable patients, identifying the presence of vulnerability features in coronary plaques of hearts surrounded by large epicardial depots. 3 In the second one, Rat et al prove that rather than the global epicardial fat, the local accumulation of fat around a coronary lesion, named periplaque adipose tissue, could serve as a more reliable marker associated with plaque vulnerability, being associated with CT features that characterize unstable plaques in a significantly higher extent that the global epicardial fat or the total intrathoracic fat. 4 In the third article, Rat et al prove that besides its role as marker of plaque vulnerability, epicardial fat could also serve as a marker of increased risk in other diseases such as pulmonary hypertension associated with various conditions: congenital heart diseases and coronary artery diseases, or secondary to sclerodermia.…”