Relationship between epicardial adipose tissue thickness and early impairment of left ventricular systolic function in patients with preserved ejection fraction

Abstract

Epicardial adipose tissue (EAT) is metabolically bioactive fat. The present study aimed to clarify the relationship between EAT amount and early impairment of left ventricular (LV) systolic function in patients with preserved ejection fraction (EF), all evaluated echocardiographically. Participants comprised 62 elderly women (mean age ± standard deviation, 68 ± 11 years) with lifestyle-related diseases and EF ≥ 60 %. EAT amount was evaluated as thickness. Parameters suggesting early impairment of systolic function such as decreases in systolic mitral annular velocity (S') and tissue mitral annular displacement percentage (TMAD %) were evaluated along with EF. Correlations between EAT thickness and these LV systolic functions were assessed. Influences of various factors on the resultant significant relationships were also assessed. EAT thickness correlated inversely with S' and TMAD % (r = -0.402, p = 0.001 and r = -0.585, p < 0.001, respectively), but did not correlate with EF (r = 0.054, not significant). These significant relationships were maintained after considering factors such as body mass index, age, presence of lifestyle-related diseases and blood test results. A significant relationship existed between EAT amount and early impairment of LV systolic function in patients with preserved EF. Accumulation of EAT might contribute to the initial development of LV systolic dysfunction.

Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat?

“…This is in accordance with initial necropsic and echographic studies showing an increase in LV mass to be strongly related to EAT, irrespective of CAD or hypertrophy (50,128,131). In a study of 208 non CAD patients evaluated (57,87,128,143,152,177,194,228,238,328). In 75 men with or without metabolic syndrome, the amount of EAT correlated negatively with all parameters of LV diastolic function (LV mass-to-volume ratio, end-diastolic, end-systolic, and indexed stroke volumes) and was an independent determinant of LV early peak filling rate (228).…”

“…EAT has local effects on the structure and function of the heart. Numerous clinical studies have unveiled the association between EAT volume and early defects in cardiac structure, volume and function (50,57,78,87,123,128,131,143,177,328,333). Increased amount of EAT has been associated with increased left ventricular (LV) mass and abnormal right ventricle geometry or subclinical dysfunction (97,330).…”

The epicardial adipose inflammatory triad: coronary atherosclerosis, atrial fibrillation, and heart failure with a preserved ejection fraction

“…6,11 Interestingly, van Woerden et al also noted that epicardial fat was associated with biomarkers of myocardial injury, a finding that is consistent with reports suggesting that the mild systolic dysfunction that is often seen in patients with HFpEF may be related to the quantity of epicardial fat. 12 These novel observations lend strong support to the hypothesis that HFpEF represents the ventricular consequence of epicardial adipose tissue expansion and inflammation, in a manner similar to the premise that the accumulation of periatrial fat depots contributes to atrial fibrillation. Further studies are needed to characterize the secretion of pro-inflammatory adipocytokines in these patients and to determine if changes in epicardial adipose tissue volume are predictably accompanied by changes in cardiac filling dynamics and left atrial size.…”

“…Interestingly, van Woerden et al . also noted that epicardial fat was associated with biomarkers of myocardial injury, a finding that is consistent with reports suggesting that the mild systolic dysfunction that is often seen in patients with HFpEF may be related to the quantity of epicardial fat …”

ACE2/Ang 1-7 axis: A critical regulator of epicardial adipose tissue inflammation and cardiac dysfunction in obesity

“…6 The importance of EAT in the cardiac disease is illustrated by the association between EAT inflammation and cardiac dysfunction. 7,8 Renin-angiotensin system and its role in adipose tissue inflammation…”