Epicardial adipose tissue is a promising imaging biomarker of subclinical atherosclerosis

Article Sidebar

PDF Download
Published Jul 29, 2023
DOI: https://doi.org/10.18103/mra.v11i7.2.4016

Downloads

Download data is not yet available.

Submit your own article

Register as an author to reserve your spot in the next issue of the Medical Research Archives.

Author Registration

Join the Society

The European Society of Medicine is more than a professional association. We are a community. Our members work in countries across the globe, yet are united by a common goal: to promote health and health equity, around the world.

Join Europe’s leading medical society and discover the many advantages of membership, including free article publication.

Membership

Main Article Content

Maria Isabel Mendonça
1. Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
João Adriano Sousa
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal; Serviço de Cardiologia, SESARAM, EPERAM
Marco Serrão
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal; 2. Serviço de Cardiologia, SESARAM, EPERAM
Marina Santos
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal; Serviço de Cardiologia, SESARAM, EPERAM
Margarida Temtem
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal; Serviço de Cardiologia, SESARAM, EPERAM
Débora Sá
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal; Serviço de Cardiologia, SESARAM, EPERAM
Francisco Sousa
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal; Serviço de Cardiologia, SESARAM, EPERAM
Eva Henriques
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal;
Sofia Borges
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
Sónia Freitas
1. Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
Mariana Rodrigues
1. Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
Graça Guerra
1. Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal
António Drumond
Serviço de Cardiologia, SESARAM, EPERAM
Ana Célia Sousa
Centro de Investigação Dra Maria Isabel Mendonça, Hospital Dr Nélio Mendonça, SESARAM, EPERAM, Funchal, Madeira, Portugal; Faculdade de Medicina da Universidade da Madeira (UMa), Funchal, Portugal
Roberto Palma Reis
Hospital Pulido Valente EPE, Centro Hospitalar Universitário Lisboa Norte (CHULN); Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Nova Medical School), Lisboa, Portugal

Abstract

Introduction: Identifying markers to discriminate high and low-risk individuals better is essential. Coronary Calcium Score (CAC) is an established marker of subclinical atherosclerosis. Epicardial Adipose Tissue (EAT), a new imaging biomarker, has shown considerable interest in the scientific community.


Purpose: Study the impact of EAT volume in discrimination and reclassification of cardiovascular events when added to CAC score. Investigate whether EAT volume is a good prognosis marker in an asymptomatic population.


Methods: A cohort of 1024 individuals without coronary disease were selected and followed prospectively during an extended period. CAC score was evaluated by cardiac tomography. Quantification of EAT was performed through a semi-automated technique (TeraRecon Aquarius Workstation). Pearson’s or Spearman’s correlations identified EAT-associated parameters. Harrel C-statistics assessed the discriminative ability for events. Categorical free Net Reclassification Improvement (cfNRI) and Integrated Discrimination Index (IDI) reclassified the individuals. Kaplan-Meier evaluated cardiovascular disease prognosis, and Cox regression identified variables independently associated with cardiovascular events.


Results: EAT volume was significantly correlated with age, body mass index, non-high-density lipoprotein (HDL) cholesterol, triglycerides, systolic and diastolic blood pressure, and inversely with HDL cholesterol. CAC score and EAT had a C-Statistic of 0.737 (0.651 - 0.823) and 0.662 (0.564-0.760), respectively. When EAT was added to CAC, it increased to 0.777 (0.681 - 0.873) and 60% of the participants were better reclassified (NRI=60%). Higher EAT volume displayed the worst prognosis (p=0.006) and was associated, independently, with cardiovascular events, even after adjusting for risk factors and CAC score (p=0.021).


Conclusions: EAT may be an essential imaging marker of subclinical atherosclerosis and a potential therapeutic target for primary prevention. Reducing EAT volume with adequate measures (physical exercise, proper diet, pharmacological interventions) could decrease atherosclerosis and improve outcomes.

Keywords: Epicardial adipose tissue, imaging biomarker, subclinical atherosclerosis

Article Details

How to Cite
MENDONÇA, Maria Isabel et al. Epicardial adipose tissue is a promising imaging biomarker of subclinical atherosclerosis. Medical Research Archives, [S.l.], v. 11, n. 7.2, july 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4016>. Date accessed: 23 nov. 2024. doi: https://doi.org/10.18103/mra.v11i7.2.4016.
ABNT APA BibTeX CBE EndNote - EndNote format (Macintosh & Windows) MLA ProCite - RIS format (Macintosh & Windows) RefWorks Reference Manager - RIS format (Windows only) Turabian
Issue
Vol 11 No 7.2 (2023): July Issue, Vol.11, Issue 7.2
Section
Research Articles

The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

 

References

1. Fitzgibbons TP, Czech MP. Epicardial and perivascular adipose tissues and their influence on cardiovascular disease: basic mechanisms and clinical associations. J Am Heart Assoc. 2014;3(2):e000582.
doi: 10.1161/JAHA.113.000582

2. Iacobellis G. Epicardial and pericardial fat: close, but very different. Obesity. 2009;17:625; author reply 626-627.

3. Sacks HS, Fain JN. Human epicardial adipose tissue: A review. Am Heart J. 2007;153:907–917.

4. Szasz T, Webb RC. Perivascular adipose tissue: more than just structural support. Clin Sci. (Lond) 2012;122:1–12.

5. Lo C, Liu H, Xu F, Chen Y. The role of lipotoxicity in cardiovascular disease. Emerg Crit Care Med. 2022;2:4. https://dx.doi.org/10.1097/EC9.0000000000000024.

6. Moriyama H, Endo J, Ikura H, et al. Qualitative and Quantitative Effects of Fatty Acids Involved in Heart Diseases. Metabolites. 2022;12:210. https://doi.org/10.3390/metabo12030210.

7. Konwerski M, Gasecka A, Opolski G, Grabowski M, Mazurek T. Role of epicardial adipose tissue in cardiovascular diseases: a review. Biology. 2022;11:355. https://doi.org/10.3390/biology11030355.

8. Salvatore T, Galiero R, Caturano A, et al. Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of Heart Failure, with preserved ejection fraction, in diabetes. Biomolecules. 2022;12:176. https://doi.org/10.3390/biom12020176.

9. Packer M. Epicardial adipose tissue may mediate the deleterious effects of obesity and inflammation on the myocardium. J Am Coll Cardiol. 2018;71:2360–2372.

10. 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. doi: 10.5935/abc.20130138.

11. Ma C, Peng Y, Li H, Chen W. Organ-on-a-Chip: A new paradigm for drug development. Trends Pharmacol Sci. 2021; 42(2):119–133 doi:10.1016/j.tips.2020.11.009.

12. Sekikawa A, Curb JD, Edmundowicz D, et al. Coronary Artery Calcification by Computed Tomography in Epidemiologic Research and Cardiovascular Disease Prevention. J Epidemiol 2012;22(3):188-198. doi:10.2188/jea.JE20110138.

13. Greeland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol. 2018;72(4):434-447.

14. Adelhoefer S, Uddin SMI, Osei AD, Obisesan OH, Blaha MJ, Dzaye O. Coronary Artery Calcium Scoring: New Insights into Clinical Interpretation-Lessons from the CAC Consortium. Radiol Cardiothorac Imaging. 2020;2(6):e200281. doi: 10.1148/ryct.2020200281.

15. Goeller M, Achenbach S, Marwan M, et al. Affiliations that expand Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. J Cardiovasc Comput Tomogr. 2018;1.

16. Cosson E, Nguyen MT, Rezgani I, et al. Epicardial adipose tissue volume (EAT) and coronary calcification among people living with diabetes: a cross-sectional study. Cardiovasc Diabetology. 2021;20:35. https://doi.org/10.1186/s12933-021-01225-6

17. Mendonça MI, Pereira A, Monteiro J, et al. Impact of genetic information on coronary disease risk in Madeira: The GENEMACOR study. Rev Port Cardiol. 2023;42:193-204.

18. Mendonça MI, Henriques E, Borges S, et al. Genetic information improves the prediction of major adverse cardiovascular events in the GENEMACOR population. Genet Mol Biol. 2021;44:2. https://doi.org/10.1590/1678-4685-GMB-2020-0448.

19. Tran T, Small G, Cocker M, Yam Y, Chow BJ. A single slice measure of epicardial adipose tissue can serve as an indirect measure of total epicardial adipose tissue burden and is associated with obstructive coronary artery disease. Eur Heart J Cardiovasc Imaging. 2014;15(4):423-30. doi: 10.1093/ehjci/jet175.

20. Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and Gender Distributions of Coronary Artery Calcium Detected by Electron Beam Tomography in 35,246 Adults. Am J Card.2001;87(12):P1335-1339.

21. Neves PO, Andrade J, Monção H. Coronary artery calcium score: current status. Radiol Bras. 2017;50(3):182-189. doi: 10.1590/0100-3984.2015.0235.

22. Rozanski A, Gransar H, Shaw LJ, et al. Impact of coronary artery calcium scanning on coronary and downstream testing the EISNER (Early Identification of Subclinical Atherosclerosis by Non-Invasive Imaging Research) Prospective Randomized Study. J Am Coll Cardiol. 2011;57:1622–1632. doi: 10.1016/j.jacc.2011.01.019.

23. Wang CP, Hsu HL, Hung WC, et al. Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis. Clin Endocrinol (Oxf). 2009;70(6):876-82. doi: 10.1111/j.1365-2265.2008.03411.x.

24. Spearman JV, Renker M, Schoepf J, et al. Prognostic value of epicardial fat volume measurements by computed tomography: a systematic literature review. Eur Radiol. 2015; doi: 10.1007/s00330-015-3765-5.

25. Iwasaki K, Urabe N, Kitagawa A, Nagao T. The association of epicardial fat volume with coronary characteristics and clinical outcome. Int J Cardiovasc Imaging. 2018;34(2):301-309. doi: 10.1007/s10554-017-1227-7.

26. Mahabadi AA, Berg MH, Lehmann N, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol. 2013;61(13):1388-95. doi: 10.1016/j.jacc.2012.11.062.

27. Commandeur F, Goeller M, Betancur J, et al. Deep Learning for Quantification of Epicardial and Thoracic Adipose Tissue from Non-Contrast CT. IEEE Trans Med Imaging. 2018;37(8):1835–1846. doi:10.1109/TMI.2018.2804799.

28. Liu J, Yu Q, Li Z, et al. Epicardial adipose tissue density is a better predictor of cardiometabolic risk in HFpEF patients: a prospective cohort study. Cardiovasc Diabetol. 2023;22(1):45.doi: 10.1186/s12933-023-01778-8.

29. Iwasaki K, Matsumoto T, Aono H, Furukawa H, Samukawa M. Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease. Clin Cardiol. 2011;34(3):166-71. doi: 10.1002/clc.20840.

30. Vosko I, Zirlik A, Bugger H. Impact of COVID-19 on Cardiovascular Disease. Viruses. 2023; 15:508. https://doi.org/10.3390/v15020508.

31. Wei Z, Geng Y, Huang J, Qian H. Pathogenesis and management of myocardial injury in coronavirus disease. Eur J Heart Fail. 2020;22(11):1994-2006. doi: 10.1002/ejhf.1967.

32 Slipczuk L, Castagna F, Schonberger A, et al. Coronary artery calcification and epicardial adipose tissue as independent predictors of mortality. Int J Cardiovasc Imaging. 2021;37:3093–3100. https://doi.org/10.1007/s10554-021-02276-2