Epicardial Fat Thickness as a Diagnostic Marker of Coronary Lesions in Stable Angina Pectoris Patients
Abstract
Background: Abdominal visceral adiposity is a risk factor of cardiovascular diseases. It correlates with increasing level of pro-inflammatory adipokines and cytokines which can induce endothelial dysfunction. Epicardial adipose tissue is considered as true visceral adiposity of the heart. Epicardial adipose tissue have pivotal role than other visceral adiposity because of adjacency to the heart and coronary vessels. This study was aimed to measure the cut off point of epicardial fat thickness as a diagnostic marker for the presence of coronary lesion.
Methods: This was an observational analytic study with crossectional comparative design. Data was retrieved prospectively at the Heart Center Dr. M. Djamil Padang from August 2019 to February 2020 in stable angina pectoris patients who underwent coronary angiography. The Epicardial Fat Thickness (EFT) was measured at end-diastole from the Parasternal long axis (PLAX) views of three cardiac cycles on the free wall of the right ventricle on echocardiography examination. Bivariate analysis was used to assess epicardial fat thickness and presence of the coronary lesions using Independent Sample T test. A diagnostic test was performed based on receiver operating curve (ROC) analysis.
Results: Patients were diagnosed as CAD group group (n =150; 58,11 ± 8,24 years) and non-CAD group (n = 50; 53,16 ± 9,78 years) based on coronary angiogram result. Epicardial fat thickness was higher in subjects with coronary lesions (3,62 ± 1,03 mm) compared with subjects without coronary lesions (1,55 ± 1,10 mm) with p <0.001. Epicardial fat thickness ≥ 2.835 mm predict the presence of coronary lesion by 82% sensitivity, 86% specificity and 88.9% accuracy based on the AUC value.
Conclusions: Abnormal epicardial fat thickness ≥ 2.835 mm can be a good diagnostic marker to detect the presence of coronary lesion.
Downloads
References
2. Gaborit Bee, Sengenes C, Ancel P, Jacquier A, Dutour A. Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat? Comprehensive Physiology. 2017;11:1060-69.
3. Nagy E, Jermendy AL, Merkely B, Maurovich-Horvat P. Clinical importance of epicardial adipose tissue. Archieve of Med Science. 2016;13(4):858.
4. Eroğlu S. How do we measure epicardial adipose tissue thickness by transthoracic echocardiography? Anatolian Journal of Cardiology 2015;15:416-19.
5. Firdaus I. Angina pektoris dalam Panduan Praktik Klinis (PPK) dan Clinical Pathway (CP) Penyakit jantung dan Pembuluh darah. 1 ed. Jakarta: PERKI; 2016.
6. Cheng VY, Berman DS, Rozanski A, Dunning AM, Achenbach S, Al-Mallah M, et al. Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: results from the multinational coronary CT angiography evaluation for clinical outcomes: an international multicenter registry (CONFIRM). Circulation. 2011;124(22):2423-32, 1-8.
7. Jousilahti P, Vartiainen E, Tuomilehto J, Puska P. Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation. 1999;99(9):1165-72.
8. Shemirani H, Khoshavi M. Correlation of echocardiographic epicardial fat thickness with severity of coronary artery disease-an observational study. Anadolu Kardiyol Derg. 2012;12:200-5.
9. Demir B, Demir E, Acıksarı G, Uygun T, Utku IK, Gedikbasi A, et al. The Association between the Epicardial Adipose Tissue Thickness and Oxidative Stress Parameters in Isolated Metabolic Syndrome Patients: A Multimarker Approach. International Journal of Endocrinology. 2014;2014:954045.
10. Ambrose JA, Barua RS. The Pathophysiology of Cigarette Smoking and Cardiovascular Disease An Update. Journal of the American College of Cardiology. 2004;43(10):1731-7.
11. 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. Cardiovascular Ultrasound. 2014;12(35):1-6.
12. Kamal D, ElMoteleb AMA, Samir R, Saeed M. Epicardial fat thickness can predict severity and multivessel distribution in Egyptian patients with atherosclerotic coronary artery stenosis. The Egyptian Heart Journal. 2018;70:324-26.
13. Nabati M, Saffar N, Yazdani J, Parsaee MS. Relationship between Epicardial Fat Measured by Echocardiography and Coronary Atherosclerosis: A Single-Blind Historical Cohort Study. Echocardiography. 2013;30:506, 8-9.
14. Park J-S, Ahn S-G, Hwang J-W, Lim H-S, Choi B-J, Choi S-Y, 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. Cardiovascular Diabetology. 2010;9(29):1-8.
15. Chaowalit N, Somers VK, Pellikka PA, Rihal CS, Lopez-Jimenez F. Subepicardial adipose tissue and the presence and severity of coronary artery disease. Atherosclerosis 2006;186:354–9.
16. Faghihi S, Vasheghani-Farahani A, Parsaee M, Saedi S, Ghadrdoost B. Association Between Epicardial Fat Thickness and Premature Coronary Artery Disease: A Case Control Study. Research of Cardiovascular Medicine. 2015;4(2):1-6.
17. Eroglu S, Sade LE, Yildirir A, Bal U, Ozbicer S, Ozgul AS, et al. Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2009;19(3):211-7.
18. El-Aziz WA, Ahmed M, Badr W. Association of echocardiographic epicardial fat with the extent of coronary artery disease. Menoufia Medical Journal. 2017;30:842-9.
19. Despre´s J-P. Body Fat DIstribution and Risk of Cardiovascular Disease: An Update. Circulation. 2012;126:1301-13.
20. Willens HJ, Gomez-Marin O, Chirinos JA, Goldberg R, Lowery MH, Iacobellis G. Comparison of epicardial and pericardial fat thickness assessed by echocardiography in African American and non-Hispanic White men: a pilot study. Ethnicity & disease. 2008;18(3):311-6.
21. Adams DB, Narayan O, Munnur RK, Cameron JD, Wong DT, Talman AH, et al. Ethnic differences in coronary plaque and epicardial fat volume quantified using computed tomography. The international journal of cardiovascular imaging. 2017;33(2):241-9.
22. Fox CS, White CC, Lohman K, Heard-Costa N, Cohen P, Zhang Y, et al. Genome-wide association of pericardial fat identifies a unique locus for ectopic fat. PLoS genetics. 2012;8(5):e1002705.
23. Jain S, Mahadevaiah M, Shivanagappa M. A Comparative Study of Epicardial Fat Thickness and its Association with Abdominal Visceral Fat Thickness in Obese and Nonobese Type 2 Diabetes Subjects. Journal of Cardiovascular Echography. 2015;25(4):103-7.
PDF downloads: 1440
Copyright (c) 2021 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
