Advertisement

Usefulness of Epicardial Adipose Tissue as Predictor of Cardiovascular Events in Patients With Coronary Artery Disease

      Several studies have suggested that epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD). However, the role of EAT as a potential risk factor for, and predictor of, long-term cardiovascular outcomes in patients with CAD requires additional investigation. We investigated the relation among EAT, cardiovascular events, and measures of adiposity in patients with CAD. The study was a prospective cohort study of 194 consecutive patients with CAD who entered a phase II cardiac rehabilitation program at the Mayo Clinic. EAT was measured using echocardiography. The primary outcome was the long-term recurrence of major adverse cardiovascular events (MACE). The outcomes were assessed using the Mayo Clinic electronic medical records. The mean age was 59.4 ± 10.8 years, the body mass index was 28.7 ± 4.6 kg/m2, 80% were men, and 21% of the patients underwent coronary artery bypass grafting. The mean follow-up period was 3.6 ± 1.3 years, and 52 MACE occurred. EAT was not a predictor of MACE (hazard ratio 1.32, 95% confidence interval 0.75 to 2.31; p = 0.33) when used as a continuous variable and correlated poorly with the measures of adiposity. However, a nonsignificant trend was seen for a greater incidence of cardiovascular events when EAT was stratified by tertile (hazard ratio for third tertile 1.77, 95% confidence interval 0.84 to 3.32; p = 0.11), after statistical adjustments for age, gender, body mass index, and other covariates. In conclusion, the results of the present longitudinal study suggest that EAT, as measured using echocardiography, does not strongly predict for MACE and is poorly associated with measures of obesity in patients with CAD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mazurek T.
        • Zhang L.
        • Zalewski A.
        • Mannion J.D.
        • Diehl J.T.
        • Arafat H.
        • Sarov-Blat L.
        • O'Brien S.
        • Keiper E.A.
        • Johnson A.G.
        • Martin J.
        • Goldstein B.J.
        • Shi Y.
        Human epicardial adipose tissue is a source of inflammatory mediators.
        Circulation. 2003; 108: 2460-2466
        • Iacobellis G.
        • Barbaro G.
        The double role of epicardial adipose tissue as pro- and anti-inflammatory organ.
        Horm Metab Res. 2008; 40: 442-445
        • Natale F.
        • Tedesco M.A.
        • Mocerino R.
        • de Simone V.
        • Di Marco G.M.
        • Aronne L.
        • Credendino M.
        • Siniscalchi C.
        • Calabrò P.
        • Cotrufo M.
        • Calabrò R.
        Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives.
        Eur J Echocardiog. 2009; 10: 549-555
        • Ahn S.G.
        • Lim H.S.
        • Joe D.Y.
        • Kang S.J.
        • Choi B.J.
        • Choi S.Y.
        • Yoon M.H.
        • Hwang G.S.
        • Tahk S.J.
        • Shin J.H.
        Relationship of epicardial adipose tissue by echocardiography to coronary artery disease.
        Heart. 2008; 94: 97
        • Chaowalit N.
        • Somers V.K.
        • Pellikka P.A.
        • Rihal C.S.
        • Lopez-Jimenez F.
        Subepicardial adipose tissue and the presence and severity of coronary artery disease.
        Atherosclerosis. 2006; 186: 354-359
        • Nakanishi R.
        • Rajani R.
        • Cheng V.Y.
        • Gransar H.
        • Nakazato R.
        • Shmilovich H.
        • Otaki Y.
        • Hayes S.W.
        • Thomson L.E.
        • Friedman J.D.
        • Slomka P.J.
        • Berman D.S.
        • Dey D.
        Increase in epicardial fat volume is associated with greater coronary artery calcification progression in subjects at intermediate risk by coronary calcium score: a serial study using non-contrast cardiac CT.
        Atherosclerosis. 2011; 218: 363-368
        • Mookadam F.
        • Goel R.
        • Alharthi M.S.
        • Jiamsripong P.
        • Cha S.
        Epicardial fat and its association with cardiovascular risk: a cross-sectional observational study.
        Heart Views. 2010; 11: 103-108
        • Ding J.
        • Hsu F.C.
        • Harris T.B.
        • Liu Y.
        • Kritchevsky S.B.
        • Szklo M.
        • Ouyang P.
        • Espeland M.A.
        • Lohman K.K.
        • Criqui M.H.
        • Allison M.
        • Bluemke D.A.
        • Carr J.J.
        The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Am J Clin Nutr. 2009; 90: 499-504
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        • Cushman W.C.
        • Green L.A.
        • Izzo Jr, J.L.
        • Jones D.W.
        • Materson B.J.
        • Oparil S.
        • Wright Jr, J.T.
        • Roccella E.J.
        • Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee
        Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
        Hypertension. 2003; 42: 1206-1252
        • Iacobellis G.
        • Willens H.J.
        Echocardiographic epicardial fat: a review of research and clinical applications.
        J Am Soc Echocardiogr. 2009; 22: 1311-1319
        • McCrory M.A.
        • Gomez T.D.
        • Bernauer E.M.
        • Molé P.A.
        Evaluation of a new air displacement plethysmography for measuring human body composition.
        Med Sci Sports Exerc. 1995; 27: 1686-1691
        • Lockner D.W.
        • Heyward V.H.
        • Baumgartner R.N.
        • Jenkins K.A.
        Comparison of air-displacement plethysmography, hydrodensitometry, and dual x-ray absorptiometry for assessing body composition of children 10 to 18 years of age.
        Ann N Y Acad Sci. 2000; 904: 72-78
        • Melton III, L.J.
        History of the Rochester Epidemiology Project.
        Mayo Clin Proc. 1996; 71: 266-274
        • Chaowalit N.
        • Somers V.K.
        • Pellikka P.A.
        • Rihal C.S.
        • Lopez-Jimenez F.
        Adipose tissue of atrial septum as a marker of coronary artery disease.
        Chest. 2007; 132: 817-822
        • Eroglu S.
        • Sade L.E.
        • Yildirir A.
        • Bal U.
        • Ozbicer S.
        • Ozgul A.S.
        • Bozbas H.
        • Aydinalp A.
        • Muderrisoglu H.
        Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease.
        Nutr Metab Cardiovasc Dis. 2009; 19: 211-217
        • Nelson M.R.
        • Mookadam F.
        • Thota V.
        • Emani U.
        • Al Harthi M.
        • Lester S.J.
        • Cha S.
        • Stepanek J.
        • Hurst R.T.
        Epicardial fat: an additional measurement for subclinical atherosclerosis and cardiovascular risk stratification?.
        J Am Soc Echocardiogr. 2011; 24: 339-345
        • Silaghi A.
        • Achard V.
        • Paulmyer-Lacroix O.
        • Scridon T.
        • Tassistro V.
        • Duncea I.
        • Clément K.
        • Dutour A.
        • Grino M.
        Expression of adrenomedullin in human epicardial adipose tissue: role of coronary status.
        Am J Physiol Endocrinol Metab. 2007; 293: 1443-1450
        • Coutinho T.
        • Goel K.
        • Corrêa de Sá D.
        • Kragelund C.
        • Kanaya A.M.
        • Zeller M.
        • Park J.S.
        • Kober L.
        • Torp-Pedersen C.
        • Cottin Y.
        • Lorgis L.
        • Lee S.H.
        • Kim Y.J.
        • Thomas R.
        • Roger V.L.
        • Somers V.K.
        • Lopez-Jimenez F.
        Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data.
        J Am Coll Cardiol. 2011; 57: 1877-1886
        • Lavie C.J.
        • Milani R.V.
        • Artham S.M.
        • Patel D.A.
        • Ventura H.O.
        The obesity paradox, weight loss, and coronary disease.
        Am J Med. 2009; 122: 1106-1114
        • Romero-Corral A.
        • Somers V.K.
        • Sierra-Johnson J.
        • Jensen M.D.
        • Thomas R.J.
        • Squires R.W.
        • Allison T.G.
        • Korinek J.
        • Lopez-Jimenez F.
        Diagnostic performance of body mass index to detect obesity in patients with coronary artery disease.
        Eur Heart J. 2007; 28: 2087-2093
        • Lai Y.H.
        • Yun C.H.
        • Yang F.S.
        • Liu C.C.
        • Wu Y.J.
        • Kuo J.Y.
        • Yeh H.I.
        • Lin T.Y.
        • Bezerra H.G.
        • Shih S.C.
        • Tsai C.H.
        • Hung C.L.
        Epicardial adipose tissue relating to anthropometrics, metabolic derangements and fatty liver disease independently contributes to serum high-sensitivity C-reactive protein beyond body fat composition: a study validated with computed tomography.
        J Am Soc Echocardiogr. 2012; 25: 234-241
        • Canto J.G.
        • Kiefe C.I.
        • Rogers W.J.
        • Peterson E.D.
        • Frederick P.D.
        • French W.J.
        • Gibson C.M.
        • Pollack Jr, C.V.
        • Ornato J.P.
        • Zalenski R.J.
        • Penney J.
        • Tiefenbrunn A.J.
        • Greenland P.
        • NRMI Investigators
        Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction.
        JAMA. 2011; 306: 2120-2127
        • Iacobellis G.
        • Ribaudo M.C.
        • Assael F.
        • Vecci E.
        • Tiberti C.
        • Zappaterreno A.
        • Di Mario U.
        • Leonetti F.
        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: 5163-5168
        • Iacobellis G.
        • Barbaro G.
        • Gerstein H.C.
        Relationship of epicardial fat thickness and fasting glucose.
        Int J Cardiol. 2008; 128: 424-426
        • Iacobellis G.
        • Willens H.J.
        • Barbaro G.
        • Sharma A.M.
        Threshold values of high-risk echocardiographic epicardial fat thickness.
        Obesity. 2008; 16: 887-892