Investigation of epicardial adipose tissue index in coronary artery disease

Öz

Objectives: The relationship between epicardial adipose tissue thickness (EFT) and coronary artery disease (CAD) has been the subject of many studies. The relationship between them was shown, but due to the wide range of results obtained, a certain cutoff value could not be shown as a risk indicator. In our study, we aimed to obtain a more sensitive CAD risk marker by indexing epicardial adipose tissue to anthropometric measurements such as body fat ratio and body mass index (BMI). Methods: In the study, 40 people were included in the CAD group and 25 people were included in the control group. The body fat ratio and fat distribution of the participants were analyzed using the bioimpedance device. Epicardial adipose tissue thickness was obtained from the parasternal long axis by transthoracic echocardiography. The indices obtained by the ratio of epicardial adipose tissue thickness to anthropometric measurements were compared between participants with and without coronary artery disease. Results: Epicardial adipose tissue thickness was 6.09±0.9 mm in the CAD group and 5.61±1 mm in the control group (p=0.049). Sensitivity of 76.3% and specificity of 59.3% were obtained for EFT (AUC= 0.688, 95% CI 0.549-0.826). The sensitivity for the EFT/BMI ratio was 78.4%, and the specificity was 60.7% (AUC= 0.744; 95% CI 0.617-0.871). Sensitivity for EFT/body fat ratio was 81.6%, specificity 66.7% (AUC=0.846; 95% CI 0.742-0.950). Conclusion: EFT can be used as a more sensitive risk marker together with BMI or body fat ratio.

Anahtar Kelimeler

• bioimpedance
• body mass index
• coronary artery disease
• epicardial adipose tissue

Koroner arter hastalığında epikardiyal yağ doku indeksinin araştırılması

Öz

Amaç: Epikardiyal yağ dokusu (EYD) kalınlığı ile koroner arter hastalığı (KAH) arasındaki ilişki birçok çalışmaya konu olmuştur. Aralarındaki ilişki gösterilmiş fakat elde edilen sonuçların geniş bir aralıkta olması nedeniyle risk belirteci olarak belirli sınır değer gösterilememiştir. Çalışmamızda EYD kalınlığı vücut yağ oranı, vücut kitle indeksi (VKİ) gibi antropometrik ölçümlere orantılayarak daha hassas bir KAH risk belirteci elde etmeyi hedefledik. Yöntem: Çalışmada KAH grubuna 40 kişi, kontrol grubuna 25 kişi alınmıştır. Biyoempedans cihazı kullanılarak katılımcıların vücut yağ oranı ve yağ dağılımları analiz edilmiştir. EYD kalınlığı transtorasik ekokardiyografi ile parasternal uzun eksenden elde edilmiştir. EYD kalınlığının antropometrik ölçümlere olan oranı ile elde edilen indeksler koroner arter hastalığı olan ve olmayan katılımcılar arasında karşılaştırılmıştır. Bulgular: EYD kalınlığı KAH gurubunda 6.09±0.9 mm, kontrol grubunda ise 5.61±1 mm olarak ölçüldü (p=0.049). EYD kalınlığı için %76.3 duyarlılık ve %59.3 özgüllük değerleri elde edildi (AUC=0.688, %95 CI 0.549-0.826). EYD kalınlığı/VKİ oranı için duyarlılık %78.4 ve özgüllük %60.7 idi (AUC=0.744; %95 CI 0.617- 0.871). EYD kalınlığı/vücut yağ oranı için %81.6 duyarlılık ve %66.7 özgüllük elde edildi (AUC=0.846; %95 CI 0.742-0.950). Sonuç: EYD kalınlığı, VKİ veya vücut yağ oranıyla birlikte daha hassas bir risk belirteci olarak kullanılabilir.

Anahtar Kelimeler

• biyoempedans
• epikardiyal yağ dokusu
• koroner arter hastalığı
• vücut kitle indeksi

Kaynakça

1. 1. 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(11):5163-8.
2. 2. Khaing NEE, Shyong TE, Lee J, Soekojo CY, Ng A, Van Dam RM. Epicardial and visceral adipose tissue in relation to subclinical atherosclerosis in a Chinese population. PLoS One 2018;13(4):1-11.
3. 3. Yu W, Liu B, Zhang F, et al. Association of epicardial fat volume with increased risk of obstructive coronary artery disease in chinese patients with suspected coronary artery disease. J Am Heart Assoc 2021;10(6):1-9.
4. 4. Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: A new method for visceral adipose tissue prediction. Obes Res 2003;11(2):304-10.
5. 5. Talman AH, Psaltis PJ, Cameron JD, Meredith IT, Seneviratne SK, Wong DTL. Epicardial adipose tissue: Far more than a fat depot. Cardiovasc Diagn Ther 2014;4(6):416-29.
6. 6. Iacobellis G, Barbaro G. Epicardial adipose tissue feeding and overfeeding the heart. Nutrition 2019;59:1-6.
7. 7. Konwerski M, Gasecka A, Opolski G, Grabowski M, Mazurek T. Role of epicardial adipose tissue in cardiovascular diseases: A review. Biology (Basel) 2022;11(3):355.
8. 8. Bertaso AG, Bertol D, Duncan BB, Foppa M. Epicardial fat: Definition, measurements and systematic review of main outcomes. Arq Bras Cardiol 2013;101(1):e18-28.

9. 9. Topuz M, Dogan A. The effect of epicardial adipose tissue thickness on left ventricular diastolic functions in patients with normal coronary arteries. Kardiol Pol 2017;75(3):196-203.
10. 10. Sacks HS, Fain JN. Human epicardial adipose tissue: A review. Am Heart J 2007;153(6):907-17.
11. 11. Meenakshi K, Rajendran M, Srikumar S, Chidambaram S. Epicardial fat thickness: A surrogate marker of coronary artery disease - Assessment by echocardiography. Indian Heart J 2016;68(3):336-41.
12. 12. Taha DA, El Shafey RAA, Hamesa MF, Abu-Dewan KAEW, Nagy HA. Relationship between epicardial fat volume measured by multi-detector computed tomography and coronary artery disease. Egypt J Radiol Nucl Med 2021;52(1):235.
13. 13. Wang Z, Zeng X, Chen Z, et al. Association of visceral and total body fat with hypertension and prehypertension in a middle-aged Chinese population. J Hypertens 2015;33(8):1555-62.
14. 14. Eroǧlu S, Sade LE, Yildirir A, Demir Ö, Müderrisoǧlu H. Association of epicardial adipose tissue thickness by echocardiography and hypertension. Turk Kardiyol Dern Ars 2013;41(2):115-22.
15. 15. Iacobellis G, Willens HJ. Echocardiographic epicardial fat: A review of research and clinical applications. J Am Soc Echocardiogr 2009;22(12):1311-9.
16. 16. Iacobellis G, Mohseni M, Bianco SD, Banga PK. Liraglutide causes large and rapid epicardial fat reduction. Obesity 2017;25(2):311-6.
17. 17. Sarmiento-Cobos M, Aleman R, Gomez CO, et al. Weight loss following bariatric surgery decreases pericardial fat thickness lowering the risk of developing coronary artery disease. Surg Obes Relat Dis 2021;17(2):390-7.
18. 18. Eroğlu S. How do we measure epicardial adipose tissue thickness by transthoracic echocardiography? Anadolu Kardiyol Derg 2015;15(5):416-9.
19. 19. Ferreira J, Martins R, Monteiro S, Teixeira R, Gonçalves L. Alternative sites of echocardiographic epicardial fat assessment and coronary artery disease. J Ultrasound 2021;(0123456789).
20. 20. Yañez-Rivera TG, Baños-Gonzalez MA, Ble-Castillo JL, Torres-Hernandez ME, Torres-Lopez JE, Borrayo-Sanchez G. Relationship between epicardial adipose tissue, coronary artery disease and adiponectin in a Mexican population. Cardiovasc Ultrasound 2014;12(1):1-6.
21. 21. Sridhar C, Bhaskar J. Correlation of epicardial adipose tissue thickness with the presence and severity of angiographic coronary artery disease: A cross sectional study. International Journal of Research and Review 2021;8(2):586-90.
22. 22. Naik S, Naik N, Pandey N, Upadhyay A, Roy A. Association of epicardial adipose tissue thickness by echocardiography with coronary artery disease. Authorea 2021. DOI: 10.22541/au.162396304.48228734/v1.
23. 23. Sinha SK, Thakur R, Jha MJ, et al. Epicardial adipose tissue thickness and its association with the presence and severity of coronary artery disease in clinical setting: A cross-sectional observational study. J Clin Med Res 2016;8(5):410-9.
24. 24. Park JS, Ahn SG, Hwang JW, et al. Impact of Body Mass Index on the relationship of epicardial adipose tissue to metabolic syndrome and coronary artery disease in an Asian population. Cardiovasc Diabetol 2010;9:1-8.
25. 25. Özkalayci F, Taylan G, Gürlertop HY, Aksoy UY. Epikardiyal yağ dokusu kalınlığının koroner arter hastalığı yaygınlığı, ciddiyeti ve HOMA indeksi ile ilişkisi. MN Kardiyol 2020;27(1):1-7.
26. 26. Guglielmo M, Lin A, Dey D, et al. Epicardial fat and coronary artery disease: Role of cardiac imaging. Atherosclerosis 2021;321(February):30-8.
27. 27. El Rabbat KE, Mustafa SA, Farag S, Helmy S, Mahm D. Correlation of epicardial adipose tissue and pericoronary fat thickness quantified by coronary computed tomography angiography with severity of coronary artery disease. Benha J Appl Sci 2022;7(2):97-100.