Meta-Analysis of the Relation of Echocardiographic Epicardial Adipose Tissue Thickness and the Metabolic Syndrome

Published:October 04, 2012DOI:
      Epicardial adipose tissue (EAT) is an emerging cardiometabolic risk factor, and its thickness can be measured using echocardiography. The relation of EAT to the metabolic syndrome (MS) is still unclear. A meta-analysis of published reports was performed to provide comprehensive insight on the association of EAT thickness as assessed by echocardiography and the MS. A systematic search was conducted for reports on echocardiographic EAT thickness in patients with and without the MS. Nine studies were identified. The pooled population consisted of 2,027 subjects, of whom 1,030 had the MS. EAT thickness was significantly higher in patients with the MS than in those without (standardized difference in means 1.15 mm, 95% confidence interval 0.78 to 1.53, p = 0.0001). Subgroup meta-analysis showed no difference between patients with and those without the MS by MS criteria used and echocardiographic cardiac cycle of measurement but did show a significant difference by ethnicity, with a greater difference in Caucasian subjects (standardized difference in means 1.75 mm, 95% confidence interval 1.43 to 2.07) than in other ethnic groups. In conclusion, echocardiographic EAT thickness is significantly higher in patients with the MS than in those without, but differences exist by ethnicity.
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        • Iacobellis G.
        • Assael F.
        • Ribaudo M.C.
        • Zappaterreno A.
        • Alessi G.
        • Di Mario U.
        • Leonetti F.
        Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction.
        Obes Res. 2003; 11: 304-310
        • 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.
        • Leonetti F.
        Epicardial adipose tissue and insulin resistance in obese subjects.
        J Clin Endocrinol Metab. 2005; 90: 6300-6302
        • Alberti K.G.
        • Eckel R.H.
        • Grundy S.M.
        • Zimmet P.Z.
        • Cleeman J.I.
        • Donato K.A.
        • Fruchart J.C.
        • James W.P.
        • Loria C.M.
        • Smith Jr., S.C.
        Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.
        Circulation. 2009; 120: 1640-1645
        • Iacobellis G.
        • Willens H.J.
        • Barbaro G.
        • Sharma A.M.
        Threshold values of high-risk echocardiographic epicardial fat thickness.
        Obesity. 2008; 16: 887-892
        • Okyay K.
        • Balcioglu A.S.
        • Tavil Y.
        • Tacoy G.
        • Turkoglu S.
        • Abaci A.
        A relationship between echocardiographic subepicardial adipose tissue and metabolic syndrome.
        Int J Cardiovasc Imaging. 2008; 24: 577-583
        • Sade L.E.
        • Eroglu S.
        • Bozbaş H.
        • Ozbiçer S.
        • Hayran M.
        • Haberal A.
        • Müderrisoğlu H.
        Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries.
        Atherosclerosis. 2009; 204: 580-585
        • Park J.S.
        • Ahn S.G.
        • Hwang J.W.
        • Lim H.S.
        • Choi B.J.
        • Choi S.Y.
        • Yoon M.H.
        • Hwang G.S.
        • Tahk S.J.
        • Shin J.H.
        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: 29
        • Sengul C.
        • Cevik C.
        • Ozveren O.
        • Oduncu V.
        • Sunbul A.
        • Akgun T.
        • Can M.M.
        • Semiz E.
        • Dindar I.
        Echocardiographic epicardial fat thickness is associated with carotid intima-media thickness in patients with metabolic syndrome.
        Echocardiography. 2011; 28: 853-858
        • Torres C.
        • Lima-Martínez M.M.
        • Rosa F.J.
        • Guerra E.
        • Paoli M.
        • Iacobellis G.
        • Rodney M.
        • Romero-Vecchione E.
        • Luisa Saadtjian M.
        • Zagala M.
        • Rodney H.
        Epicardial adipose tissue and its association to plasma adrenomedullin levels in patients with metabolic syndrome.
        Endocrinol Nutr. 2011; 58: 401-408
        • Pierdomenico S.D.
        • Pierdomenico A.M.
        • Neri M.
        • Cuccurullo F.
        Epicardial adipose tissue and metabolic syndrome in hypertensive patients with normal body weight and waist circumference.
        Am J Hypertens. 2011; 24: 1245-1249
        • Pierdomenico S.D.
        • Mancini M.
        • Cuccurullo C.
        • Guglielmi M.D.
        • Pierdomenico A.M.
        • Di Nicola M.
        • Di Carlo S.
        • Lapenna D.
        • Cuccurullo F.
        Prediction of carotid plaques in hypertensive patients by risk factors, left ventricular hypertrophy, and epicardial adipose tissue thickness.
        Heart Vessels. 2012; ([Epub ahead of print])
        • Ege M.R.
        • Guray U.
        • Guray Y.
        • Demirkan B.
        • Kisacik H.
        Serum γ-glutamyltransferase levels correlate with epicardial adipose tissue thickness in patients with coronary artery disease.
        Angiology. 2012; ([Epub ahead of print])
        • 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
        • Jeong J.W.
        • Jeong M.H.
        • Yun K.H.
        • Oh S.K.
        • Park E.M.
        • Kim Y.K.
        • Rhee S.J.
        • Lee E.M.
        • Lee J.
        • Yoo N.J.
        • Kim N.H.
        • Park J.C.
        Echocardiographic epicardial fat thickness and coronary artery disease.
        Circ J. 2007; 71: 536-539
        • 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
        • 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 Echocardiogr. 2009; 10: 549-555
        • Stramaglia G.
        • Greco A.
        • Guglielmi G.
        • De Matthaeis A.
        • Vendemiale G.L.
        Echocardiography and dual-energy x-ray absorptiometry in the elderly patients with metabolic syndrome: a comparison of two different techniques to evaluate visceral fat distribution.
        J Nutr Health Aging. 2010; 14: 6-10
        • 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
        • Karadag B.
        • Ozulu B.
        • Ozturk F.Y.
        • Oztekin E.
        • Sener N.
        • Altuntas Y.
        Comparison of epicardial adipose tissue (EAT) thickness and anthropometric measurements in metabolic syndrome (MS) cases above and under the age of 65.
        Arch Gerontol Geriatr. 2011; 52: e79-e84
        • Sicari R.
        • Sironi A.M.
        • Petz R.
        • Frassi F.
        • Chubuchny V.
        • De Marchi D.
        • Positano V.
        • Lombardi M.
        • Picano E.
        • Gastaldelli A.
        Pericardial rather than epicardial fat is a cardiometabolic risk marker: an MRI vs echo study.
        J Am Soc Echocardiogr. 2011; 24: 1156-1162
        • 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
        • 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: e7
        • Sengul C.
        • Duman D.
        The association of epicardial fat thickness with blunted heart rate recovery in patients with metabolic syndrome.
        Tohoku J Exp Med. 2011; 224: 257-262
        • Higgins J.P.T.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Thompson S.G.
        • Higgins J.P.T.
        How should meta-regression analyses be undertaken and interpreted?.
        Stat Med. 2002; 21: 1559-1573
        • Egger M.
        • Smith G.D.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Duval S.
        • Tweedie R.
        A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis.
        J Am Stat Assoc. 2000; 95: 89-98
        • Xu Y.
        • Cheng X.
        • Hong K.
        • Huang C.
        • Wan L.
        How to interpret epicardial adipose tissue as a cause of coronary artery disease: a meta-analysis.
        Coron Artery Dis. 2012; 23: 227-233
        • Willens H.J.
        • Gómez-Marín O.
        • Chirinos J.A.
        • Goldberg R.
        • Lowery M.H.
        • Iacobellis G.
        Comparison of epicardial and pericardial fat thickness assessed by echocardiography in African American and non-Hispanic White men: a pilot study.
        Ethn Dis. 2008; 18: 311-316