Impact of Body Mass Index on the relationship of epicardial adipose tissue to metabolic syndrome and coronary artery disease in an Asian population

Abstract

BackgroundIn a previous study, we demonstrated that the thickness of epicardial adipose tissue (EAT), measured by echocardiography, was increased in patients with metabolic syndrome (MS) and coronary artery disease (CAD). Several studies on obese patients, however, failed to demonstrate any relationship between EAT and CAD. We hypothesized that body mass index (BMI) affected the link between EAT and MS and CAD.MethodsWe consecutively enrolled 643 patients (302 males, 341 females; 59 ± 11 years), who underwent echocardiography and coronary angiography. The EAT thickness was measured on the free wall of the right ventricle at the end of diastole. All patients were divided into two groups: high BMI group, ≥27 kg/m2 (n = 165), and non-high BMI group, < 27 kg/m2 (n = 478).ResultsThe median and mean EAT thickness of 643 patients were 3.0 mm and 3.1 ± 2.4 mm, respectively. In the non-high BMI group, the median EAT thickness was significantly increased in patients with MS compared to those without MS (3.5 vs. 1.9 mm, p < 0.001). In the high BMI group, however, there was no significant difference in the median EAT thickness between patients with and without MS (3.0 vs. 2.5 mm, p = 0.813). A receiver operating characteristic (ROC) curve analysis predicting MS revealed that the area under the curve (AUC) of the non-high BMI group was significantly larger than that of the high BMI group (0.659 vs. 0.506, p = 0.007). When compared to patients without CAD, patients with CAD in both the non-high and high BMI groups had a significantly higher median EAT thickness (3.5 vs. 1.5 mm, p < 0.001 and 4.0 vs. 2.5 mm, p = 0.001, respectively). However, an ROC curve analysis predicting CAD revealed that the AUC of the non-high BMI group tended to be larger than that of the high BMI group (0.735 vs. 0.657, p = 0.055).ConclusionsWhile EAT thickness was significantly increased in patients with MS and CAD, the power of EAT thickness to predict MS and CAD was stronger in patients with BMI < 27 kg/m2. These findings showed that the measurement of EAT thickness by echocardiography might be especially useful in an Asian population with a non-high BMI, less than 27 kg/m2.

Association of pericardial adipose tissue volume with presence and severity of coronary atherosclerosis

“…Previous studies on non-invasive imaging examinations have shown that CAD patients have more adipose tissues within the pericardium and around arteries compared with patients without CAD, which was consistent with our ndings [17][18]. Logistic regression analysis revealed that PAT volume, WC, and BMI were the independent predictors for CAD; however, a er adjusting other cardiovascular risk factors, the correlation between PAT volume and CAD was weakened.…”

Epicardial Adipose Tissue and Metabolic Syndrome in Hypertensive Patients With Normal Body Weight and Waist Circumference

“…24 Left ventricular mass was calculated using the formula introduced by Devereux et al 25 and was indexed by height 2.7 in each subject. 26 EAT appears as an echo-free space between the free wall of the right ventricle and the pericardium and was measured in this area from parasternal long-axis view, [15][16][17][18][19][20][21][22] at end diastole. [17][18][19]21,22 EAT was measured from long-axis images (Figure 1) at the point on the free wall of the right ventricle along the midline of the ultrasound beam, perpendicular to the aortic annulus, used as an anatomic landmark.…”

“…[16][17][18][19][20][21] A recent report has suggested that the association between EAT and MetS could be affected by body mass index (BMI). 22 Indeed, it has been reported that EAT was a stronger predictor of MetS in normal weight and mildly overweight Asian subjects than in those with higher overweight and obesity. 22 original contributions…”

“…22 Indeed, it has been reported that EAT was a stronger predictor of MetS in normal weight and mildly overweight Asian subjects than in those with higher overweight and obesity. 22 original contributions…”

“…[11][12][13][14] Recently, echocardiographic examination has been proposed as an easy and suitable method to evaluate EAT. [15][16][17][18][19][20][21][22] Some reports [16][17][18][19][20][21][22] have evaluated the association between echocardiographic EAT and MetS or its components. Two studies 17,18 did not report significant correlation between EAT thickness and components of MetS.…”