Epicardial adipose tissue thickness is associated with myocardial infarction and impaired coronary perfusion

Abstract

Objective:Epicardial adipose tissue (EAT) is associated with the presence, severity and extent of atherosclerotic coronary artery disease (CAD) in addition to subclinical atherosclerosis. We investigated if EAT thickness is related to acute myocardial infarction in patients with CAD. We also searched for the association between EAT thickness and objective coronary flow and myocardial perfusion parameters such as Thrombolysis in Myocardial Infarction Frame count (TFC) and myocardial blush grade (MBG).Methods:Two-hundred consecutive patients with stable angina pectoris or acute coronary syndrome who were admitted to Ufuk University Faculty of Medicine, Dr Ridvan Ege Hospital cardiology department were included in this observational, cross-sectional study. EAT thickness was evaluated by conventional transthoracic echocardiography. Coronary angiography was performed to determine the coronary involvement and perfusion.Results:Mean EAT thicknesses were 5.4±1.9 mm, 6.3±1.8 mm, and 8.5±1.4 mm in the stable angina pectoris (SAP), unstable angina pectoris (USAP) and acute myocardial infarction groups, respectively (p<0.001). With increasing EAT thickness, TFC increases whereas mean MBG values decrease (for EAT thickness <5 mm, 5-7 mm, >7 mm; mean TFC: 21.6±2.2, 25.3±3.3 and 35.2±7.7; and MBG values: 2.98±0.14, 2.83±0.57 and 1.7±1.16, respectively; both p<0.001). Cut-off EAT value to predict AMI was identified as 7.8 mm (ROC analysis AUC: 0.876; p<0.001, 95% CI: 0.822-0.927). Sensitivity and specificity of EAT cut-off value 7.8 mm to predict AMI were 81.8% and 82.5% respectively.Conclusion:Increased EAT is associated with AMI and it may prove beneficial for choosing patients who would need more aggressive approach in terms of risk reduction using echocardiography which is a relatively cheap and readily available tool as a follow-up parameter.

Original research. The Assessment of Epicardial Adipose Tissue in Acute Coronary Syndrome Patients. A Systematic Review

“…[38][39][40][41][42][43][44][45] Table 1 presents a summary of the included manuscripts. All systematized manuscripts contain a concise and clear portrayal of the inclusion and exclusion criteria and the method for assessing EAT, either through cardiac CT or TTE (Table 1).…”

“…There was no significant coronary artery stenosis, and healthy individuals had a significantly lower EFV compared to the case lot (p <0.001). showed that patients with AMI have a significantly higher EAT thickness compared to unstable angina or stable CAD patients (p <0.001) 39 (Table 5).…”

“…[38][39][40][41][43][44][45] Zencirci et al (2014) hypothesized that there is an inverse association between the EAT and the STsegment resolution following primary PCI for acute STE-MI. 45 Other studied risk scores are the SYNTAX score for coronary atherosclerosis severity, the GRACE and TIMI risk scores for survival following an acute cardiac event,…”

“…42 Most researchers (n = 6) used the Receiver Operator Characteristics (ROC) curve and the area under the curve for the determination of the cut-off value for EAT values that predicted the study outcome. [37][38][39][40][41]45 All selected articles used Spearman or Pearson correlation coefficient statistics for evaluating the link between epicardial fat and other clinical and laboratory variables.…”

Epicardial Fat-mediated Inflammation: a Major Player in Cardiovascular Diseases

“…6 It is well-known that in the period following an acute myocardial infarction, an exacerbated inflammation is responsible for worse outcomes and ventricular remodeling. 6,16,17 To what extent is this the result of the local release of inflammatory mediators from the area surrounding the infarcted tissue, as well as the link between local activity of the epicardial fat and atrial remodeling in AF, remains to be established.…”