Evaluation of the relation between epicardial adipose tissue and hepatosteatosis with coronary atherosclerosis using multidetector computed tomography

Abstract

Background: In this study, the relationship of CAD (coronary artery disease) with EAT (epicardial adipose tissue) volume and hepatosteatosis were investigated by using multidetector computed tomography (MDCT). Material and Method: EAT (Epicardial Adipose Tissue) volume, CCS (coronary calcium score) and CT density of liver (CTDL) were measured by using 64-detector computed tomography in 96 patients who were clinically referred for the evaluation of CAD. The relationship between EAT volume, CCS, CTDL and their effectiveness in detecting coronary heart disease were investigated. Data analysis was done with MedCalc (Version 9.6.2.0) package program. Results: CCS (AUC=0.866) and EAT volume (AUC=0.672) were significantly effective in determination of CAD. The diagnostic accuracy of CCS in detecting CAD was higher than of EAT volume. EAT volume was higher in patients with CAD (85.81±34.51 cm³), compared to patients without CAD (68.38±29.23 cm³) (P=0.0119). CTDL in patients with CAD (58.74±12.22 HU) was significantly lower than in patients without CAD (63.02±8.93) (P=0.0553). There was no statistically significant relationship between EAT volume and CCS (r=0.1620, P=0.1148), EAT volume and CTDL (r=0.0046, P=0.9648), and CCS and CTDL (r=0.0109, P=0.9162). Conclusion: There was no relationship between EAT volume, CTDL and CCS. EAT volume is higher in patients with CAD than in patients without CAD. EAT volume had moderate but lower diagnostic power than CCS, to determine CAD.

Keywords

• Coronary atherosclerosis
• Epicardial adipose tissue
• Hepatosteatosis
• MDCT

Epikardiyal yağ dokusu ve hepatosteatoz ile koroner ateroskleroz arasındaki ilişkinin çok kesitli bilgisayarlı tomografi ile değerlendirilmesi

Abstract

Giriş: Bu çalışmada çok kesitli bilgisayarlı tomografi (ÇKBT) kullanılarak, epikardiyal yağ doku volümü ve hepatosteatozun koroner arter hastalığı ile ilişkisi araştırıldı. Gereç ve Yöntem: Koroner arter hastalığı (KAH) ön tanısıyla koroner bilgisayarlı tomografi (BT) anjiyografi tetkiki yapılan 96 hastada epikardiyal yağ volümü, koroner kalsiyum skoru ve karaciğer BT dansitesi ölçüldü. Epikardiyal yağ volümü, koroner kalsiyum skoru ve karaciğer dansitesi arasındaki ilişki ile koroner kalp hastalığını saptamadaki performansları araştırıldı. Verilerin analizi MedCalc (Version 9.6.2.0) paket programı ile yapıldı. Bulgular: Koroner kalsiyum skoru (EAA=0,866) ve epikardiyal yağ volümü (EAA=0,672) koroner aterosklerozu belirlemede istatiksel olarak etkin bulundu. Koroner arter hastalığını saptamada koroner kalsiyum skoru ölçümünün tanısal etkinliği, epikardiyal yağ volümü ölçümünün tanısal etkinliğinden yüksek bulundu. KAH olanlarda epikardiyal yağ volümü (85,81±34,51 cm³), KAH olmayanlara göre (68,38±29,23 cm³) daha yüksek bulundu (P=0,0119). KAH olanlarda karaciğer BT dansitesi (58,74±12,22 HU), KAH olmayanlara göre (63,02±8,93) istatistiksel olarak sınırda düşük bulundu (P=0,0553). Epikardiyal yağ volümü ile kalsiyum skoru arasında (r=0,1620, P=0,1148), epikardiyal yağ volümü ile karaciğer BT dansitesi arasında (r=0,0046, P=0,9648) ve kalsiyum skoru ile karaciğer BT dansitesi arasında (r=0,0109, P=0,9162) istatistiksel olarak anlamlı ilişki saptanmadı. Sonuç: Epikardiyal yağ volümü, hepatosteatoz ve koroner kalsiyum skoru arasında bir ilişki yoktur. Epikardiyal yağ volümü KAH olanlarda, KAH olmayanlara göre daha yüksektir. Epikardiyal yağ volümü ölçümü, KAH’ı göstermede orta derecede tanısal etkinliğe sahiptir ancak gücü koroner kalsiyum skorlamasına göre daha azdır.

Keywords

• Koroner Ateroskleroz
• Epikardiyal Yağ Doku
• Hepatosteatoz
• ÇKBT

References

1. Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 2004; 89: 2548–56.
2. Iacobellis G, Leonetti F, Mario UD. Images in cardiology: massive epicardial adipose tissue indicating severe visceral obesity. Clin Cardiol 2003; 26: 237.
3. Sharma AM. Adipose tissue: a mediator of cardiovascular risk. Int J Obes Relat Metab Disord 2004; 26: S5–S7.
4. Carr DB, Utzschneider KM, Hull RL, et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes 2004; 53: 2087–94.
5. Yusuf S, Hawken S, Ounpuu S et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: A case-control study. Lancet 2005 Nov 5; 366: 1640-9.
6. Kremen J, Dolinkova M, Krajickova J, et al. Increased subcutaneous and epicardial adipose tissue production of procytokines in cardiac surgery patients: possible role in postoperative insulin resistance. J Clin Endocrinol Metab 2006; 91: 4620-7.
7. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002; 105: 1135-43.
8. Iacobellis G, Ribaudo MC, Assael F, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: A new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003; 88: 5163-8.

9. Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of mediators. Circulation 2003; 108: 2460-6.
10. Rabkin SW. Epicardial fat: properties, function and relationship to obesity. Obes Rev 2007; 8: 253-61.
11. Baker AR, Silva NF, Quinn DW, et al. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol 2006; 5: 1.
12. de Vos AM, Prokop M, Roos CJ, et al. Peri-coronary epicardial adipose tissue is related to cardiovascular risk factors and coronary artery calcification in postmenopausal women. Eur Heart J 2008; 29: 777 – 83.
13. Chaowalit N, Somers VK, Pellikka PA, Rihal CS, Lopez-Jimenez F. Subepicardial adipose tissue and the presence and severity of coronary artery disease. Atherosclerosis 2006; 186: 354-9.
14. Jeong JW, Jeong MH, Yun KH, et al. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J 2007; 71: 536-9.
15. Djaberi R, Schuijf JD, van Werkhoven JM, Nucifora G, Jukema JW, Bax JJ. Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol 2008; 102: 1602–7.
16. Wu FZ, Chou KJ, Huang YL, Wu MT. The relation of location-specific epicardial adipose tissue thickness and obstructive coronary artery disease: systemic review and meta-analysis of observational studies. BMC Cardiovasc Disord 2014; 14:62.
17. Vega GL, Chandalia M, Szczepaniak LS, Grundy SM. Metabolic correlates of nonalcoholic fatty liver in women and men. Hepatology 2007; 46: 716-22.
18. Shores NJ,  Link K , Fernandez A, et al. Non-contrasted computed tomography for the accurate measurement of liver steatosis in obese patients. Dig Dis Sci. 2011; 56: 2145–51.
19. Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304–10.
20. Ahn SG, Lim HS, Joe DY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 2008; 94: e7.
21. Sarin S, Wenger C, Marwaha A, et al. Clinical significance of epicardial fat measured using cardiac multislice computed tomography. Am J Cardiol 2008; 102: 767–71.
22. Demircelik MD, Yilmaz OÇ, Gurel OM, et al. Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease. Clinics 2014; 69: 388- 92.
23. Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic individuals. Mayo Clin Proc. 1999; 74: 243–52.
24. Raggi P. Coronary calcium on electron beam tomography imaging as a surrogate marker of coronary artery disease. Am J Cardiol 2001; 87: 27A-34A.
25. Alper AT, Hasdemir H, Sahin S, et al. The relationship between nonalcoholic fatty liver disease and the severity of coronary artery disease in patients with metabolic syndrome. Turk Kardiyol Dern Ars. 2008; 36: 376- 81.
26. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413- 19.