To access this material please log in or register

Register Authorize

Epicardial fat pad and rates of cardiovascular remodeling in normotensive patients with abdominal obesity

Druzhilov M. A., Otmakhov V. V., Beteleva Yu. E., Korneva V. A., Kuznetsova T. Yu.

Keywords: abdominal obesity, diagnostics, remodeling, epicardial fat pad

DOI: 10.18087/rhfj.2013.1.1768

Relevance. Connection between obesity and CVD is determined not only by overall amount of fatty tissue, but also by a type of its distribution. New method of studying visceral fat has been described, which consists in measurement of epicardial fat pad thickness (EFT) using transtoracal EchoCG. Now, epicardial fat pad is recognized as a new CVD marker. Objective. Echocardiographic quantitative estimation of EFT in CVD-asymptomatic normotensive patients with abdominal obesity and low risk according to risk measuring scales, search for correlation between EFT and indices of cardiovascular remodeling and definition of EFT threshold, associated with strong possibility of subclinical organ lesions. Materials and methods. 95 patients (average age 44.9±5.1 years) were examined. Family history of CVD, smoking habits, Score and Procam risk assessment, lipid specter and blood sugar profile were studied. Triplex scanning of brachiocephalic arteries (BCA), EchoCG, bifunctional 24hour BP monitoring with assessment of arterial stiffness were carried out. Epicardial fat pad was visualized behind RV free wall in В-mode at the parasternal position along LV long axis at the end of systole. Results. Average EFT was 4.6±1.2 mm. Higher values of EFT were noted in patients with subclinical carotid atherosclerosis (5.5±1.1 mm vs. 4.5±1.2 mm; р<0.05), with EchoCG signs of LV diastolic dysfunction (5.8±1.3 mm vs. 4.7±1.2 mm; р<0.05). Medium correlation of EFT with age, waist circumference (WC) and BMI, BCA carotid intimal medial thickness (CIMT), mean pulse wave velocity (PWV) in aorta and augmentation indexes, reflecting increased arterial stiffness, was revealed. EFT more than 6 mm were significantly combined with stronger possibility of subclinical organ lesions, subclinical carotid atherosclerosis and increased vascular stiffness in the first place. Conclusion. Study of EFT with use of EchoCG can become a potentially simple and reproducible low-cost method of estimation of subclinical atherosclerosis probability and high risk.
  1. Beer-Borst S, Morabia A, Hercberg S et al. Obesity and other health determinants across Europe: the EURALIM project. J Epidemiol Community Health. 2000;54 (6):424–430.
  2. Van Gaal L, Mertens I, De Block C. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444 (7121):875–880.
  3. Lapidus L, Bengtsson C, Larsson B et al. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12‑year follow-up of participants in the population study of women in Gothenberg, Sweden. Br Med J (Clin Res Ed). 1984;289 (6454):1257–1261.
  4. Rexrode K, Carey V, Hennekens C et al. Abdominal adiposity and coronary heart disease in women. JAMA. 1998;280 (21):1843–1848.
  5. Han S, Quon M, Kim J et al. Adiponectin and cardiovascular disease: response to therapeutic interventions. J Am Coll Cardiol. 2007;49 (5):531–538.
  6. Iacobellis G. Imaging of visceral adipose tissue: an emerging diagnostic tool and therapeutic target. Curr Drug Targets Cardiovasc Haematol Disord. 2005;5 (4):345–353.
  7. 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):304–310.
  8. Iacobellis G, Willens HJ. Echocardiographic Epicardial Fat:A Review of Research and Clinical Applications. JASE. 2009;22 (12):1311–1319.
  9. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue:anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2 (10):536–543.
  10. Mazurek T, Zhang L, Zalewski A et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108 (20):2460–2466.
  11. Jeong JW, Jeong MH, Yun KH et al. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J. 2007;71 (4):536–539.
  12. Bachar GN, Dicker D, Kornowski R, Atar E. Epicardial adipose tissue as a predictor of coronary artery disease in asymptomatic subjects. Am J Cardiol. 2012;110 (4):534–538.
  13. Iacobellis G, Ribaudo MC, Zappaterreno A et al. Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol. 2004;94 (8):1084–1087.
  14. Iacobellis G, Leonetti F, Singh N et al. Relationship of epicardial adipose tissue with atrial dimensions and diastolic function in morbidly obese subjects. Int J Cardiol. 2007;115 (2):272–273.
  15. 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):5163–5168.
  16. Park EM, Choi J-H, Shin I-S et al. Echocardiographic Epicardial Fat Thickness on Short Term Prognosis in Patients With Acute Coronary Syndrome. Journal of Cardiovascular Ultrasound 2008;16 (2):42–47.
  17. Веселовская Н. Г, Чумакова Г. А, Козаренко А. А. и др. Взаимо­связь эпикардиального ожирения и коронарного атеросклероза у пациентов с метаболическим синдромом. Российский медицинский журнал. 2011;6:6–12.
  18. Рекомендации экспертов ВНОК по кардиоваскулярной профилактике. Журнал Кардиоваскулярная терапия и профилактика. 2011;10 (6):1–64.
  19. Рекомендации экспертов ВНОК по диагностике и лечению артериальной гипертензии (4‑й пересмотр). Журнал Системные гипертензии. 2010;3:5–26.
  20. Conroy RM, Pyorala K, Fitzgerald AP et al. Estimation of ten-year risk of fatal cardiovascular disease in EUROPE; the SCORE pro­ject. Eur Heart J. 2003;24 (11):987–1003.
  21. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10‑year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002;105 (3):310–315.
  22. Рекомендации экспертов ВНОК по диагностике и лечению МС (2‑й пересмотр). Журнал Кардиоваскулярная терапия и профилактика. 2009; 7 (6).
  23. Pignoli P, Tremoli E, Poli A et al. Intimal plus medial thickness of the arterial wall: a direct measurements with ultrasound imaging. Circulation. 1986;74 (6):1399–1406
  24. Рекомендации экспертов ВНОК по диагностике и коррекции нарушений липидного обмена. Журнал Кардиоваскулярная терапия и профилактика. 2009; 8 (6).
  25. Stein JH, Korcarz CE, Hurst RT et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21 (2):93–111.
  26. Моисеева Н. М, Пономарев Ю. А, Сергеева М. В, Рогоза А. Н. Оценка показателей ригидности магистральных артерий по данным бифункционального суточного мониторирования АД и ЭКГ прибором BPLab. Журнал Артериальная гипертензия. 2007;13 (1):34–38.
  27. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in men. Anatomic validation of the method. Circulation. 1977;55 (4):613–618.
  28. Dubois D, Dubois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med. 1916; 17:863–871.
  29. Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18 (12):1440–1463.
  30. Rosito G, Massaro J, Hoffmann U et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 2008;117 (5):605–613.
  31. Alexopoulos N, McLean DS, Janik M et al. Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis. 2010;210 (1):150–154.
  32. Alberto C, Magliano S, Augusto C et al. Epicardial Fat Measured to the Echocardiogram is correlated to Carotid Atheromathosis. Revista brasileira de ecocardiografia e imagem cardiovascular. 2011;24 (2):16–22.
  33. Iacobellis G, Pellicelli AM, Sharma AM et al. Relation of subepicardial adipose tissue to carotid intima-media thickness in patients with human immunodeficiency virus. Am J Cardiol. 2007;99 (10):1470–1472.
  34. Natale F, Tedesco MA, Mocerino R et al. 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 (4):549–555.
  35. Elsayed Z, Ding J, Hsu F at al. Association between carotid intima-media thickness and pericardial fat in the Multi-Ethnic Study of Atherosclerosis (MESA). J Stroke Cerebrovasc Dis. 2010;19 (1):58–65.
  36. Davy K, Hall J. Obesity and hypertension: two epidemics or one? Am J Physiol Regul Integr Comp Physiol. 2004;286 (5):R803–813.
  37. Bloomgarden Z. Adiposity and Diabetes. Diabetes Care. 2002;25 (12):2342–2349.
  38. Shin SY, Yong HS, Lim HE et al. Total, interatrial epicardial adipose tissues are independently associated with left atrial remode­ling in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22 (6):647–655.
  39. Iacobellis G, Willens HJ, Barbaro G, Sharma AM. Òhreshold va­lues of high-risk echocardiographic epicardial fat thickness. Obesity. 2008;16 (4):887–892.
Druzhilov M. A., Otmakhov V. V., Beteleva Yu. E. et al. Epicardial fat pad and rates of cardiovascular remodeling in normotensive patients with abdominal obesity. Russian Heart Failure Journal. 2013;14 (1):22-28

To access this material please log in or register

Register Authorize
Ru En