Epicardial fat thickness is associated with impaired coronary flow reserve in hemodialysis patients

Atakan, Aydın; Macunluoğlu, Beyza; Kaya, Yüksel; Arı, Elif; Demır, Halit; Aşıcıoğlu, Ebru; Kaspar, Çiğdem

doi:10.1111/hdi.12091

Cited by 17 publications

(19 citation statements)

References 36 publications

(90 reference statements)

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“…The present study, revealed that epicardial fat thickness was highly significantly increased in hemodialysis group than the control group (P<0.01). Our study agrees with a recent study which demonstrated that EFT was significantly higher among HD patients compared to healthy controls [41].…”

Section: Discussionsupporting

confidence: 93%

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Correlation Between Epicardial Fat Thickness and Cardiovascular Risk in Hemodialysis Patients

Barakat¹

2015

AJIM

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Background: Cardiovascular diseases are common in hemodialysis (HD) patients and cardiovascular mortality is responsible for 50% of overall deaths in these patients. Epicardial fat thickness (EpFT) may be an effective marker for the prediction of cardiovascular diseases in hemodialysis patients. The thickness of EpF can be measured by echocardiography that can accurately estimate the actual amount of EpF. The aim of the current study is to assess the association between EpFT and carotid intima-media thickness (CIMT), left ventricular systolic and diastolic function and left ventricular mass index in patients with chronic kidney disease (CKD) undergoing hemodialysis to clarify the relationships between EpF and cardiovascular disease risk in these patients. Materials and Methods: Forty adult uremic patients from dialysis unit and twenty (age and sex matched) healthy control subjects were included in this study. Clinical evaluation, routine laboratory investigations, echocardiographic study including measurement of EpFT and carotid Duplex to estimate CIMT were done to all subjects. Results: we found highly significant increase in serum C-reactive protein and significant increase in serum phosphorus and triglyceride with significant decrease in serum calcium and high-density lipoprotein cholesterol in hemodialysis patients compared to the controls. Also, there were significant increases in left ventricular mass index, left atrium diameter, carotid intima-media thickness, epicardial fat thickness, peak velocity of the late filling wave due to atrial contraction (A wave) and deceleration time of E wave in hemodialysis patients compared to the controls. There were also highly significant decrease in E/A ratio in hemodialysis patients compared to healthy control subjects. EpFT measured by echocardiography in hemodialysis patients was positively correlated with body mass index, CRP, left atrium diameter, left ventricular mass index, deceleration time and CIMT and negatively correlated with high-density lipoprotein cholesterol and E/A ratio. Conclusion: Hemodialysis patients can be evaluated routinely by echocardiography for early detection of cardiovascular structural and functional changes which are common in these patients and epicardial fat thickness is an effective marker for the prediction of cardiovascular risk in hemodialysis patients.

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Section: Discussionsupporting

confidence: 93%

“…Atakan et al, found that epicardial fat thickness was significantly higher among HD patients compared to healthy controls. In addition, their study was the first to demonstrate an inverse correlation between EpFT and coronary flow reserve in these patients [41].…”

Section: Introductionmentioning

confidence: 95%

Correlation Between Epicardial Fat Thickness and Cardiovascular Risk in Hemodialysis Patients

Barakat¹

2015

AJIM

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“…In turn, this pro-inflammatory milieu has been linked to abnormalities in ventricular structure 30, 31 and incident HF 32 . Accordingly, pericardial and other similar fat depots have been associated with prevalent abnormalities in cardiac structure 6 , including coronary artery disease, hypertrophy, vascular stiffness, coronary vasomotor dysfunction, and diastolic function 8, 9, 18, 29, 33, 34 .…”

Section: Discussionmentioning

confidence: 99%

Pericardial, But Not Hepatic, Fat by CT Is Associated With CV Outcomes and Structure

Shah

Anderson

Ding

et al. 2017

JACC: Cardiovascular Imaging

115

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Objectives To determine the associations between local (pericardial) fat and incident CV disease (CVD) events and cardiac remodeling independent of markers of overall adiposity. Background The impact of pericardial fat—a local fat depot encasing the heart—on myocardial function and long-term cardiovascular (CV) prognosis independent of systemic consequences of adiposity or hepatic fat is an area of active debate. Methods We studied 4,234 participants enrolled in the Multi-Ethnic Study of Atherosclerosis with concomitant cardiac magnetic resonance (CMR) imaging and computed tomographic (CT) measurements for pericardial fat volume and hepatic attenuation (a measure of liver fat). Poisson and Cox regression were used to estimate the annualized risk of incident hard atherosclerotic CVD (ASCVD), all-cause death, heart failure, all-cause CVD, hard CHD and stroke as a function of pericardial and hepatic fat. Generalized additive models were used to assess the association between CMR indices of left ventricular (LV) structure and function and pericardial fat. Models were adjusted for relevant clinical, demographic, and cardiometabolic covariates. Results MESA participants with higher pericardial and hepatic fat were more likely to be older, more frequently male, and had a higher prevalence of cardiometabolic risk factors (including dysglycemia, dyslipdemia, hypertension), as well as adiposity-associated inflammation. Over a median 12.2-year follow-up (IQR 11.6–12.8 years), pericardial fat was associated with a higher rate of incident hard ASCVD (standardized hazard ratio [SHR] 1.22, 95% confidence interval [CI] 1.10–1.35, P=0.0001; hepatic fat by CT was not significantly associated with hard ASCVD (SHR 0.96, 95% CI 0.86–1.08, P=0.52). Higher pericardial fat was associated with greater indexed LV mass (37.8 vs. 33.9 g/m2.7, highest vs. lowest quartile, P<0.01), LV mass-to-volume ratio (1.2 vs. 1.1, highest vs. lowest quartile, P<0.01). In adjusted models, a higher pericardial fat volume was associated with greater LV mass (P<0.0001) and concentricity (P<0.0001). Conclusion Pericardial fat is associated with poorer CVD prognosis and LV remodeling, independent of insulin resistance, inflammation and CT measures of hepatic fat.

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“…Sade et al demonstrated a negative association between EAT and the coronary flow reserve in patients with angiographically normal coronary arteries 27) . Atakan et al also demonstrated a negative association between the EAT and the coronary flow reserve in 71 patients on chronic hemodialysis 28) . FMD measurement is also a predictor of endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 91%

A Low Serum Free Triiodothyronine Level is Associated with Epicardial Adipose Tissue in Peritoneal Dialysis Patients

Koçyiğit

Güngör

Ünal

et al. 2014

JAT

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Aim: Cardiovascular disease is a major cause of mortality in dialysis patients. Epicardial adipose tissue (EAT) has been proposed as a cardiovascular risk marker in this population. Subclinical hypothyroidism and low free triiodothyronine (fT3) levels are associated with EAT in patients without chronic renal failure. The aim of this study was to investigate the relationship between EAT and low free T3 levels in peritoneal dialysis (PD) patients. Methods: A total of 125 prevalent PD patients were enrolled in this cross-sectional study. The epicardial fat thickness (EFT) was measured by echocardiography, and the endothelial function was assessed by flow mediated dilatation (FMD). Thyroid function tests were performed by an enzyme immunoassay. Results: The mean age of the patients was 51±13, and the time on PD was 36 months. The mean EFT was 6.7±2.9 mm. The EFT correlated positively with the patient age, systolic blood pressure (BP), mean BP, high sensitivity C-reactive protein (hs-CRP) level and body mass index (BMI), and negatively with the fT3 level and FMD. The median fT3 value was 2.53, and patients were divided according to their serum fT3 values (within the normal range and below the reference level). Compared with patients in the low fT3 group, the subjects in the normal fT3 group had higher serum albumin levels and FMD, but a lower BMI, plasma fasting glucose level, EFT, TSH level, hs-CRP level, low density lipoprotein (LDL) cholesterol level and mean BP in office measurements, and both the diastolic BP and mean BP by ambulatory blood pressure measurement. A multivariate linear regression analysis showed that the EFT was predicted by the hs-CRP and fT3 levels. Conclusion: Low free T3 levels are associated with the epicardial fat thickness in PD patients. Further studies are needed to evaluate the pathogenesis and to support these findings.

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Epicardial fat thickness is associated with impaired coronary flow reserve in hemodialysis patients

Cited by 17 publications

References 36 publications

Correlation Between Epicardial Fat Thickness and Cardiovascular Risk in Hemodialysis Patients

Correlation Between Epicardial Fat Thickness and Cardiovascular Risk in Hemodialysis Patients

Pericardial, But Not Hepatic, Fat by CT Is Associated With CV Outcomes and Structure

A Low Serum Free Triiodothyronine Level is Associated with Epicardial Adipose Tissue in Peritoneal Dialysis Patients

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