Epicardial adipose tissue volume and myocardial ischemia in asymptomatic people living with diabetes: a cross-sectional study

Abstract

Background Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. This study aimed to evaluate whether EAT volume was associated with stress-induced myocardial ischemia in asymptomatic people living with diabetes—independently of confounding factors—and whether it could predict this condition. Methods We included asymptomatic patients with diabetes and no coronary history, who had undergone both a stress a myocardial scintigraphy to diagnose myocardial ischemia, and a computed tomography to measure their coronary artery calcium (CAC) score. EAT volume was retrospectively measured from computed tomography imaging. Determinants of EAT volume and asymptomatic myocardial ischemia were evaluated. Results The study population comprised 274 individuals, including 153 men. Mean (± standard deviation) age was 62 ± 9 years, and 243, 23 and 8 had type 2, type 1, or another type of diabetes, respectively. Mean body mass index was 30 ± 6 kg/m2, and mean EAT volume 96 ± 36 cm3. Myocardial ischemia was detected in 32 patients (11.7%). EAT volume was positively correlated with age, body mass index and triglyceridemia, but negatively correlated with HbA1c, HDL- and LDL-cholesterol levels. Furthermore, EAT volume was lower in people with retinopathy, but higher in men, in current smokers, in patients with nephropathy, those with a CAC score > 100 Agatston units, and finally in individuals with myocardial ischemia (110 ± 37 cm3 vs 94 ± 37 cm3 in those without myocardial ischemia, p < 0.05). The association between EAT volume and myocardial ischemia remained significant after adjustment for gender, diabetes duration, peripheral macrovascular disease and CAC score. We also found that area under the ROC curve analysis showed that EAT volume (AROC: 0.771 [95% confidence interval 0.683–0.858]) did not provide improved discrimination of myocardial ischemia over the following classic factors: gender, diabetes duration, peripheral macrovascular disease, retinopathy, nephropathy, smoking, atherogenic dyslipidemia, and CAC score (AROC 0.773 [0.683–0.862]). Conclusions EAT may play a role in coronary atherosclerosis and coronary circulation in patients with diabetes. However, considering EAT volume is not a better marker for discriminating the risk of asymptomatic myocardial ischemia than classic clinical data.

Epicardial adipose tissue, pulmonary veins anatomy, and the P-wave/PR interval ratio in young patients with atrial fibrillation

“…It is a source of free fatty acids for myocardial energetic metabolism and may protect the heart against their toxic levels. This might explain our findings, consistent with another study, 11 showing a positive, albeit weak, correlation between the level of triglycerides and the EAT volume and a negative correlation with the level of low-density lipoprotein, even though both were not statistically significant, likely because of the relatively small number of patients. Adipose tissue also produces several bioactive molecules, including infilammatory mediators and adipocytokines.…”

Association between epicardial adipose tissue and incident heart failure mediating by alteration of natriuretic peptide and myocardial strain

“…As a risk factor in the general population, EAT was found to correlate with the risk of incident HF and the composite outcome of MACE in our study. In prior cross-sectional analyses, peri-atrial and peri-coronary EAT were related to the development of AF and coronary atherosclerosis, respectively [ 4 , 5 , 25 ]. In a longitudinal study, EAT volume was also positively related to the duration and recurrence of AF [ 26 ].…”

“…Increased EAT has been suggested to play a role in the development of coronary heart disease (CHD), atrial fibrillation (AF), and heart failure (HF) with preserved ejection fraction (HFpEF) [ 3 ]. Recent studies have linked coronary atherosclerosis and myocardial ischemia to EAT in patients with diabetes mellitus and in post-menopausal women [ 4 , 5 ]. EAT also contributes to adverse myocardial remodeling after myocardial infarction [ 6 ].…”

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

“…Risk factors for CAD are classified according to the following criteria: (A) Hypertension: systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg and/or use of antihypertensive medication according to the guidelines [ 29 ]; (B) Dyslipidaemia: dyslipidaemia defined as fasting total cholesterol > 6.2 mmol/L, low-density lipoprotein (LDL) cholesterol > 3.4 mmol/L, high-density lipoprotein (HDL) cholesterol < 1.0 mmol/L, serum triglycerides > 1.7 mmol/L (outpatient only), or diagnosis/treatment of dyslipidaemia [ 30 ]; (C) Diabetes mellitus: patients on oral hypoglycaemic agents or insulin or with fasting blood glucose ≥ 7.0 mmol/L are defined as T2DM [ 31 ]; (D) Family history of CAD: family history of ≥ 1 degree of consanguinity with CAD before age 60 [ 20 ]; (E) Obesity: BMI ≥ 28 kg/m 2 is considered to be obese [ 32 ]. Diabetes-related complications include (A) retinopathy: any medical basis for retinopathy; (B) neuropathy: any sign or symptom of polyneuropathy; (C) peripheral arterial occlusive disease: 50% stenosis on ultrasonography; and (D) nephropathy: renal failure, i.e., glomerular filtration rate < 60 mL/min and/or micro or macro proteinuria [ 33 , 34 ].…”