Fetal epicardial fat thickness and modified myocardial performance index in late-onset fetal growth restriction.

AIM: In our study, we aimed to investigate the value of fetal epicardial fat thickness (EFT) and modified myocardial performance index (mod-MPI) in fetal growth restriction (FGR) that develops after the 32nd week of gestation. MATERIALS AND METHODS: Fifty-six pregnant women who met the inclusion and exclusion criteria were included in the study and were divided into two groups: pregnancies diagnosed with FGR after the 32nd week of gestation (FGR group) and those without (control group). Demographic and obstetric histories, ultrasonographic and clinical characteristics, fetal EFT and mod-MPI values, and neonatal outcomes of the groups were recorded, and comparisons were made between the groups. Additionally, the diagnostic performance of fetal EFT value in late FGR was investigated. RESULTS: The FGR group had fetal EFT that was statistically significantly lower (1.11 ± 0.21 vs. 1.34 ± 0.23, p = 0.001). The FGR group had a significantly lower isovolumetric contraction time (ICT) (31.04 ± 6.88 vs. 35.14 ± 7.58, p = 0.048). The two groups' isovolumetric relaxation time (IRT), ejection time (ET), and mod-MPI values (p values 0.871, 0.55, and 0.750, respectively) were comparable. Receiver operating characteristic (ROC) analysis at a cutoff of 1.2 revealed 76.1% sensitivity and 74.2% specificity, respectively, for the diagnostic performance of the fetal EFT value in late-onset FGR. There was a positive predictive value (PPV) and negative predictive value (NPV) of 64.0% and 83.8%, respectively. CONCLUSION: We found that fetal EFT was significantly lower in FGR and may be useful in diagnosing FGR. However, we observed that mode-MPI did not change in FGR.

Negative association of apelin plasma levels with epicardial fat thickness in patients with stable angina and acute myocardial infarction: A case-control study.

Background: Apelin is one of the endogenous peptides that play a key role in the homeostasis of cardiovascular diseases. The purpose of the current study was to evaluate the correlation between apelin levels and epicardial fat thickness (EFT) in patients with stable angina and acute myocardial infarction (AMI). Materials and Methods: In a case-control study, 90 patients nominated for angiography were enrolled in the study and divided into three groups: healthy subjects without angiographic findings (Con), stable angina pectoris group (SAP), and acute AMI group. Data collected from all subjects included biochemical, echocardiographic, and angiographical parameters. The Gensini score analyzed the severity of coronary artery disease (CAD). Results: A decrease in adjusted apelin levels was evident in the AMI and SAP groups compared with healthy individuals (for both P < 0.001), especially in the AMI group. In addition, a detectable negative association was identified between apelin and Gensini score (r = -0.288, P = 0.006), Ck-MB (r = -0.300, P = 0.004), EFT (r = -0.300, P = 0.004), and troponin-T (r = -0.288, P = 0.006). Conclusion: Myocardial injury in patients with CAD appears to play a significant role in apelin concentration independent of the role of adipose tissue, which requires further studies.

Fetal epicardial fat thickness in non-severe idiopathic polyhydramnios: Its impact on fetal cardiac function and perinatal outcomes.

OBJECTIVE: This study aimed to evaluate fetal epicardial fat thickness (EFT) along with fetal myocardial performance index (MPI) and its effects on perinatal outcomes in non-severe idiopathic polyhydramnios (IP). MATERIALS AND METHODS: This prospective study included 92 participants, 32 diagnosed with non-severe IP, and 60 healthy pregnant women. Amniotic fluid indices (AFI), umbilical and middle cerebral artery Doppler, EFT, and MPI measurements were performed for all patients. RESULTS: The fetal EFT and MPI values were statistically higher in the non-severe IP group than in the control group (p = 0.0001, p = 0.014, respectively). The optimal fetal EFT cutoff value for predicting non-severe IP disease was found as 1.3 mm with a specificity of 81.7% and sensitivity of 59.4%. The EFT cutoff for predicting cesarean section in non-severe IP cases was 1.25 mm (p = 0.038). Apgar scores, neonatal intensive care unit, respiratory distress syndrome, and stillbirth rates were not different between groups. CONCLUSION: In this study, EFT and MPI were found to be higher in non-severe IP cases compared to controls. It was observed that the increase in MPI and EFT was associated with the increase in cesarean rates, but not with adverse fetal outcomes.

Effect of Smokeless Tobacco (Maras Powder) on the Epicardial Fat Thickness and Ventricular Repolarization Parameters.

Background and Objectives: Smokeless tobacco (ST) use has recently become an alternative to cigarettes, and it has been concluded that ST is at least as harmful as cigarettes. ST use is thought to play a role in the pathogenesis of arrhythmia by affecting ventricular repolarization. In this study, we aimed to examine the relationships of Maras powder (MP), one of the ST varieties, with epicardial fat thickness and new ventricular repolarization parameters, which have not previously been described. Materials and Methods: A total of 289 male individuals were included in this study between April 2022 and December 2022. Three groups, 97 MP users, 97 smokers, and 95 healthy (non-tobacco), were compared according to electrocardiographic and echocardiographic data. Electrocardiograms (ECG) were evaluated with a magnifying glass by two expert cardiologists at a speed of 50 m/s. Epicardial fat thickness (EFT) was measured by echocardiography in the parasternal short- and long-axis images. A model was created with variables that could affect epicardial fat thickness. Results: There were no differences between the groups regarding body mass index (p = 0.672) and age (p = 0.306). The low-density lipoprotein value was higher in the MP user group (p = 0.003). The QT interval was similar between groups. Tp-e (p = 0.022), cTp-e (p = 0.013), Tp-e/QT (p =0.005), and Tp-e/cQT (p = 0.012) were higher in the MP user group. While the Tp-e/QT ratio did not affect EFT, MP predicted the epicardial fat thickness (p < 0.001, B = 0.522, 95%CI 0.272-0.773). Conclusions: Maras powder may play a role in ventricular arrhythmia by affecting EFT and causing an increase in the Tp-e interval.

[Nutrition and adipose tissue distribution in low cardiovascular risk individuals, depending on the central obesity].

The low cardiovascular risk group according to SCORE in relation to the clinical and laboratory characteristics of patients is very heterogeneous, which leads to the presence of a residual risk of cardiovascular events. This category may include individuals with a family history of cardiovascular disease at a young age, with abdominal obesity (AO), endothelial dysfunction, and high levels of triglyceride-rich lipoproteins. In this regard, an active search is underway for new metabolic markers within the low cardiovascular risk group. The purpose of the study was to compare the nutrition, the adipose tissue distribution in low cardiovascular risk individuals, depending on the AO. Material and methods. The study included 86 healthy low risk (SCORE<1%) patients (mean age 42.6±2 years), who were divided into 2 groups: with AO [waist circumference (WC) >=94 cm in men and >=80 cm in women] - 44 patients (32% of men) and without AO - 42 patients (38% of men). The body composition was carried out using the bioimpedance analyzer. The distribution of ectopic fat deposits in the liver, pancreas and epicardial region was studied using ultrasound methods. A frequency questionnaire (Diet Risk Score) was used to assess nutrition. Results. In low risk patients with AO, signs of unhealthy diet are statistically significantly more common (in 52 in the main group vs 2% in the control group, p<0.01), ectopic deposition of adipose tissue in the liver (53 vs 9%, p<0.001), pancreas (56% in the main group, absent in the control group, p<0.001), epicardia l region (the epicardial fat thickness median is 4.24 mm in the main group vs 2.15 mm in the control group) compared with a control group. Conclusion. The low cardiovascular risk group is very heterogeneous. One of the markers of heterogeneity is central obesity - a marker of unhealthy diet, subclinical ectopic fat deposition and hypertriglyceridemia. Patients with AO of the low cardiovascular risk group require a more thorough examination with the obligatory determination of waist circumference, ultrasound assessment of the liver and pancreas parenchyma, and determination of the epicardial fat thickness. Using a short nutrition questionnaire allows you to quickly identify signs of unhealthy diet and discuss them with the patient.

Correlation analysis between heart rate variability, epicardial fat thickness, visfatin and AF recurrence post radiofrequency ablation.

BACKGROUND: The aim of the present study is to investigate the possible correlation between heart rate variability (HRV), epicardial fat thickness (EFT), visfatin and AF recurrence post radiofrequency ablation. METHODS: Data of 337 AF patients to whom radiofrequency ablation therapy had been initiated at our hospital over the past three years were evaluated. The patients enrolled were divided into the non-recurrence group (102 patients) and the recurrence group (235 patients) according to AF recurrence in the preceding 12 months. General data in the two groups were collected and HRV, EFT, and visfatin levels were comprehensively compared for each patients of the two groups. RESULTS: The recurrence group showed significantly higher results in rMSSD, PNN50, HF, total EFT, and visfatin but with evidently lower results in LF/HF when comparing the non-recurrence group (P < 0.05). The significantly different general variables in the general data and laboratory parameters, rMSSD, PNN50, HF, total EFT, visfatin, LF/HF were used as independent variables, and AF recurrence post radiofrequency ablation was used as dependent variables. Logistic regression analysis revealed that the risk factors of AF recurrence post radiofrequency ablation were rMSSD, PNN50, HF, total EFT, visfatin, and LF/HF, and the difference was statistically significant (P < 0.05). CONCLUSION: HRV, EFT, visfatin appear to show high association with AF recurrence post radiofrequency ablation.

Increased fetal epicardial fat thickness: A reflecting finding for GDM and perinatal outcomes.

OBJECTIVE: To study the value of fetal epicardial fat thickness (EFT) in gestational diabetes mellitus in the third trimester of pregnancy and its relationship with clinical parameters and perinatal outcomes. METHODS: A total of 80 participants, including 40 with diagnosed GDM and 40 healthy pregnant women, were included in the study. Demographic data were obtained from medical records. Sonographic examinations were performed, such as amniotic fluid value, fetal biometric measurements, and Doppler parameters of the umbilical artery. Fetal EFT values were measured at the free wall of the right ventricle using a reference line with echocardiographic methods. Correlation tests were performed to evaluate the relationship between fetal EFT and clinical and perinatal parameters. p < .05 were interpreted as statistically significant. RESULTS: The fetal EFT value was statistically higher in the GDM group than in the control group (p: .000). Spearman and Pearson correlation tests revealed statistically significant but weak positive correlations between fetal EFT value, 1-h 100-g OGTT, birth weight, and BMI (r: .198, p: .047; r: .395, p: .012; r: .360, p: .042, respectively). The optimal fetal EFT threshold for predicting GDM disease was found as 1.55 mm, with a specificity of 74.4% and sensitivity of 75.0%. Statistically significant differences between the two groups in umbilical artery Doppler resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) were not found (p: .337; p: .503; p: .155;). BMI and amniotic fluid volume were higher in the GDM group compared to the control group (p: .009; p < .01). CONCLUSION: This study demonstrated that increased fetal EFT may occur as a reflection of changes in glucose metabolism in intrauterine life. Future studies with larger series, including the study of neonatal metabolic parameters, will contribute to the understanding of the importance of fetal EFT in determining the metabolic status of the fetus.

Evaluation of the aortic velocity propagation, epicardial fat thickness, and carotid intima-media thickness in patients with subclinical hypothyroidism.

Subclinical hypothyroidism (SH) is associated with hemodynamic and metabolic abnormalities that cause endothelial dysfunction and atherosclerotic cardiovascular diseases. Aortic velocity propagation (AVP), epicardial fat thickness (EFT), and carotid intima-media thickness (CIMT) may provide additional information in SH patients. This study aimed to evaluate thyroid stimulating hormone (TSH), AVP, EFT, and CIMT in SH patients, and determine the associations among these parameters. Eighty patients with SH and 43 euthyroid (EU) individuals were enrolled. Blood samples were collected to measure laboratory parameters. Patients were divided into two groups based on their TSH values (TSH ≥10 or TSH <10 mIU/L). AVP, EFT, and CIMT were measured and compared between the study groups. A multivariate linear regression model was used for analysis of the independent predictors of AVP (beta = -0.298; 95% confidence interval = -0.946 to -0.287; p < 0.001). AVP was significantly lower in SH patients than the control group (43.7 ± 12.5 and 62.6 ± 13.8, respectively; p < 0.001). EFT values were similar between the SH and control groups (0.7 ± 0.3 and 0.6 ± 0.2, respectively; p = 0.10). SH patients had higher CIMT values than the control group (0.8 ± 0.3 and 0.5 ± 0.2, respectively; p < 0.001). In the multivariate linear analysis, TSH was an independent predictor of AVP. AVP was lower and CIMT was higher in SH patients compared to EU individuals. The increased CIMT and decreased AVP levels were significantly associated with TSH levels in SH patients.

Effect of caloric restriction with or without physical activity on body composition and epicardial fat in type 2 diabetic patients: A pilot randomized controlled trial.

BACKGROUND AND AIMS: There is debate over the independent and combined effects of caloric restriction (CR) and physical activity (PA) on reduction in fat mass and in epicardial fat thickness. We compared the impact of a similar energy deficit prescription by CR or by CR combined with PA on total fat mass, epicardial fat thickness, and cardiometabolic profile in individuals with type 2 diabetes. METHODS AND RESULTS: In this 16-week randomized controlled study, 73 individuals were randomly enrolled to receive: 1) a monthly motivational phone call (Control), 2) a caloric deficit of -700 kilocalories/day (CR), or 3) a caloric deficit of -500 kilocalories/day combined with a PA program of -200 kilocalories/day (CR&PA). Total fat mass, epicardial fat, and cardiometabolic profile were measured at baseline and after 16 weeks. While comparable weight loss occurred in both intervention groups (-3.9 ± 3.5 kg [CR], -5.1 ± 4.7 kg [CR&PA], -0.2 ± 2.9 kg [Control]), changes in total fat mass were significantly different between all groups (-2.4 ± 2.9 kg [CR], -4.5 ± 3.4 kg [CR&PA], +0.1 ± 2.1 kg [Control]; p < 0.05) as well as epicardial fat thickness (-0.4 ± 1.6 mm [CR], -1.4 ± 1.4 mm [CR&PA], +1.1 ± 1.3 mm [Control]; p < 0.05). There were no significant differences in trends for cardiometabolic parameters improvement between groups. CONCLUSIONS: For a similar energy deficit prescription and comparable weight loss, the combination of CR&PA provides a greater reduction in fat mass and epicardial fat thickness than CR alone in individuals with comparable weight loss and with a similar energy deficit prescription. These results, however, do not translate into significant improvements in cardiometabolic profiles. CLINICALTRIALS. GOV IDENTIFIER: NCT01186952.

Different clinical parameters inform epicardial fat thickness in pre- and post-menopausal women with obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is a sleep-related disorder with breathing difficulties. Previous studies revealed that epicardial fat thickness (EFT) correlates with OSA severity. Interestingly, female patients display a stronger EFT-OSA correlation than males. The purpose of this study is to investigate the relationship between EFT and different clinical characteristics in pre- and post-menopausal women diagnosed with OSA. METHODS: Patients diagnosed with OSA were divided into pre/early peri-menopausal (Group 1) and post/late peri-menopausal (Group 2) according to the menopause status. EFT was obtained from parasternal long-axis echocardiographic images. We also collected general clinical characteristics of patients involved in this study, and performed spearman correlation analysis to explore the correlations between EFT and the general clinical characteristics. We further applied Multiple stepwise linear regression analysis to explore the predictors for EFT in both groups. RESULTS: A total number of 23 and 59 patients were enrolled in Group 1 and Group 2 respectively. EFT in Group 2 was significantly higher than that of Group 1. In both groups, EFT was positively correlated with apnea-hypopnea index (AHI), percentage of total sleep time when blood oxygen saturation was less than 90% (T90), oxygen desaturation index (ODI) and glucose; while EFT was negatively correlated with mean and lowest SaO2 (oxygen saturation) levels. However, EFT was positively correlated with total cholesterol (TC) only in Group 1 and body mass index (BMI) only in Group2, respectively. Multiple stepwise linear regression analysis showed that AHI was independently associated with EFT in Group 1. However, both AHI and BMI were independent predictors of EFT in Group 2. CONCLUSION: EFT was notably correlated with menopausal status in women with OSA. AHI was the independent predictor of EFT in women with OSA. BMI was the independent predictor of EFT in post/late peri-menopausal women with OSA.

A cut-off value of epicardial fat thickness for the prediction of large for gestational age foetuses.

Estimation of foetal weight in the prenatal period is important in many respects. For this purpose, during different periods of pregnancy; mostly in the last trimester; many methods or formulas have been described, almost of them using ultrasound. Foetal epicardial adipose tissue has previously been described as a metabolic organ in studies. Foetal epicardial fat tissue thickness (EFT) measurement has been previously described in the literature and has been associated with metabolic conditions such as preeclampsia or gestational diabetes. The purpose of this study was to determine the strength and cut-off value of EFT measured by ultrasound in the second trimester in the prediction of large for gestational age (LGA) foetuses. Epicardial fat tissue thicknesses which were recorded during second trimester anomaly screening were evaluated retrospectively. Birth weights of the same cases were also obtained from the database and analysed with IBM SPSS Statistics for Windows Version 22.0 (IBM Corp., Armonk, NY, USA). LGA babies had thicker EFT measurements and we established a cut-off EFT value of 1.38 mm. Our results suggest that EFT thickness measured by ultrasound in the second trimester may be useful in predicting LGA foetuses.Impact statementWhat is already known on this subject? It is known that foetal epicardial fat tissue is an adipose tissue with metabolic functions. Previously the relationship between this tissue and prenatal complications; such as, preeclampsia, gestational diabetes and infant growth and development were investigated. We planned this study considering that a tissue with metabolic functions affecting foetal growth may also affect birth weight.What do the results of this study add? Foetal epicardial fat thickness measurement only once in the second trimester may predict the 90th percentile limit at birth which is considered as the LGA limit.What are the implications of these findings for clinical practice and/or further research? In our study, we determined that the thickness of epicardial fat tissue measured in the second tirmester could predict the 90 th percentile limit at birth and that the cut-off value for this group was 1.38 mm. We believe that this measurement may help to determine LGA babies at birth as early as the second trimester. In future studies, the 97 percentile limit can be determined from the early weeks with reaching larger groups. Thus, babies who are likely to experience birth trauma in clinical practice can be reached from early weeks.

Correlation of Serum Adipolin with Epicardial Fat Thickness and Severity of Coronary Artery Diseases in Acute Myocardial Infarction and Stable Angina Pectoris Patients.

OBJECTIVE: Adipolin/C1q/TNF-related protein-12 is a family of CTRPs highly expressed in adipose tissue with glucose-lowering and anti-inflammatory effects. Various risk factors have been suggested in the incidence of cardiovascular diseases, such as a decrease in anti-inflammatory or an increase in inflammatory factors. The purpose of the present study was to investigate the correlation of adipolin with anthropometric, angiographic, echocardiographic, and biochemical parameters. SUBJECT AND METHODS: A total of 90 patients who were candidates for angiography were included in the study and divided into 3 groups: 30 patients with acute myocardial infarction (AMI), 30 patients with stable angina pectoris (SAP), and 30 subjects as a control group with a history of chest pain but normal angiography. Anthropometric, angiographic, echocardiographic, and biochemical parameters were measured in all subjects. RESULTS: Serum adipolin levels were significantly decreased in patients with AMI compared with the SAP and control groups (p < 0.001 for both). In addition, there was a negative association between serum levels of adipolin and epicardial fat thickness (EFT) and Gensini score in CAD patients. The results of multivariate linear regression analysis revealed that EFT values were independently associated with serum adipolin levels. CONCLUSION: The current study showed an independent association of adipolin with EFT for the first time in patients with AMI. Decreased adipolin levels in patients with AMI may be involved in the process of atherosclerosis, which requires further study.

Increased epicardial fat thickness and carotid intima-media thickness in migraine patients.

BACKGROUND: Migraine is a common and debilitating neurological disorder characterized with episodic attacks. Epicardial fat is metabolically active and is an important predictor of metabolic and vascular diseases. We aimed to examine whether the echocardiographic measurement of epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) is increased in patients with episodic migraine (EM). METHODS: We studied 96 volunteers, including 48 patients with EM (mean age 40.10 ± 10 years, 41 female patients) and 48 healthy subjects (mean age 42.69 ± 10 years, gender is the same). All necessary biochemical parameters were analyzed; subsequently, EFT and CIMT were measured in all subjects. The migraine characteristics of the patients were questioned in detail. RESULTS: The patients with EM had a significantly higher EFT than the control group (5.34 ± 1.02 vs. 4.41 ± 0.68; P < 0.001) and CIMT was also found to be high (median 6.70 vs. 5.60; P < 0.001). Furthermore, there was a positive correlation between EFT and duration of disease and monthly frequency (r = 0.730; P < 0.001). EFT was significantly correlated with CIMT in the migraineurs (P < 0.001). As an optimal cut-off point, a high-risk EFT value of 5.54 mm was determined to predict EM, with 58.3% sensitivity and 96.8% specificity. CONCLUSION: We found that EFT and CIMT were significantly higher in EM patients than in healthy individuals. Increased EFT may be a new risk factor in migraine patients especially in patients with increased pain frequency.

Is epicardial fat thickness associated with acute ischemic stroke in patients with atrial fibrillation?

BACKGROUND: Atrial fibrillation (AF) is the most common etiology of acute ischemic stroke (AIS). In recent years, epicardial fat tissue (EFT) has been found to be associated with the presence and chronicity of AF. However, the potential association between EFT and AIS in AF patients has not been fully elucidated. The aim of this study was to evaluate the effectiveness of EFT on prediction of AIS in patients with AF. METHODS: This cross-sectional study has included 80 AF patients with AIS and 80 age-gender matched AF controls without AIS. Echocardiographic evaluations were performed in the first three days after hospitalization between July 2019 and December 2019 in Sakarya University Education and Research Hospital. Echocardiographic measurement of EFT was conducted according to previously published methods. RESULTS: In comparison with the control group, AF patients with AIS had significantly higher epicardial fat thickness (8.55 ± 1.08 vs 5.90 ± 1.35 mm; P < 0.0001). The multivariate regression analysis indicated that EFT independently predicts AIS in patients with AF. CONCLUSIONS: The present study showed that, EFT is an independent predictor for the development of acute ischemic stroke in patients with AF.

Fetal Epicardial Fat Thickness: Can It Serve as a Sonographic Screening Marker for Gestational Diabetes Mellitus?

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as the new onset of impairment in carbohydrate tolerance during pregnancy. The aim of the current study was to define fetal epicardial fat thickness (fEFT) changes that developed before 24 weeks of gestation, to evaluate the diagnostic effectiveness of fEFT in predicting GDM diagnosis, and to correlate fEFT values with hemoglobin A1C (HbA1C) values. METHODS: The study included a total of 60 GDM patients and 60 control subjects. A record consisted of fEFT measurements, maternal body mass index, maternal subcutaneous fat thickness, and fetal subcutaneous fat thickness during sonographic screening performed at 18-22 gestational weeks. Fetal abdominal circumference (AC) values, estimated fetal weight (EFW), and fetal gender were also recorded. RESULTS: The median fEFT measurement of the whole study population was 0.9 ± 0.21 mm; 1.05 ± 0.21 mm in the GDM patients, and 0.8 ± 0.15 mm in the control group. The median fEFT values of the GDM patients were significantly higher than those of the control group (P < 0.01). According to the correlation analysis results, a strong positive correlation was determined between the fEFT and HbA1C values (r = 0.71, P < 0.01), gestational week of the fetus (r = 0.76, P = P < 0.01), AC (r = 0.81, P < 0.01), and EFW (r = 0.71, P < 0.01). According to the receiver operating characteristic analysis results, a fEFT value of > 0.95 can predict GDM diagnosis with sensitivity of 65% and specificity of 88% (odds ratio = 13). CONCLUSION: fEFT values are increased in GDM cases, and the increase can be detected earlier than 24 weeks of gestation. fEFT values are positively correlated with HbA1C values and can serve as an early predictor for GDM diagnosis.

Is elevated urotensin II level a predictor for increased cardiovascular risk in subjects with acromegaly?

PURPOSE: Acromegaly is a rare disorder existed in the result of overproduction of growth hormone (GH). The disorder is associated with increased cardiovascular risk factors and metabolic abnormalities. Urotensin II (UII), a secreted vasoactive peptide hormone, belonging somatostatin superfamily, plays an essential role in atherosclerosis and glucose metabolism. The aim of this study was to ascertain whether circulating UII levels are altered in subjects with acromegaly, and to describe the relationship between UII and hormonal or cardiometabolic parameters. METHODS: This cross-sectional study included 41 subjects with active acromegaly, 28 subjects with controlled acromegaly, and 37 age- and BMI-matched controls without acromegaly. Hormonal and metabolic features of the subjects as well as carotid intima media thickness (cIMT) and epicardial fat thickness (EFT) were defined. Circulation of UII levels was determined via ELISA. RESULTS: Both active and controlled acromegalic subjects showed a significant elevation of circulating levels of UII with respect to controls. There was no remarkable difference in circulating levels of UII between active and controlled acromegalic groups. Both cIMT and EFT were remarkably increased in acromegaly subjects comparing to controls. UII positively correlated with cIMT, EFT, BMI, and HOMA-IR. There was no correlation between UII and GH, insulin-like growth factor-1. According to the results obtained from regression models, UII levels independently predicted cIMT and EFT. CONCLUSION: Elevated UII levels are associated with severity of cardiovascular risk factors including cIMT and EFT in acromegalic subjects.

Circulating CRP Levels Are Associated with Epicardial and Visceral Fat Depots in Women with Metabolic Syndrome Criteria.

Sexual dimorphism accounts for significant differences in adipose tissue mass and distribution. However, how the crosstalk between visceral and ectopic fat depots occurs and which are the determinants of ectopic fat expansion and dysfunction remains unknown. Here, we focused on the impact of gender in the crosstalk between visceral and epicardial fat depots and the role of adipocytokines and high-sensitivity C-reactive protein (hs-CRP). A total of 141 outward patients (both men and women) with one or more defining criteria for metabolic syndrome (MetS) were consecutively enrolled. For all patients, demographic and clinical data were collected and ultrasound assessment of visceral adipose tissue (VFth) and epicardial fat (EFth) thickness was performed. Hs-CRP and adipocytokine levels were assessed by enzyme-linked immunosorbent assay (ELISA). Men were characterized by increased VFth and EFth (p-value < 0.001 and 0.014, respectively), whereas women showed higher levels of adiponectin and leptin (p-value < 0.001 for both). However, only in women VFth and EFth significantly correlated between them (p = 0.013) and also with leptin (p < 0.001 for both) and hs-CRP (p = 0.005 and p = 0.028, respectively). Linear regression confirmed an independent association of both leptin and hs-CRP with VFth in women, also after adjustment for age and MetS (p = 0.012 and 0.007, respectively). In conclusion, men and women present differences in epicardial fat deposition and systemic inflammation. An intriguing association between visceral/epicardial fat depots and chronic low-grade inflammation also emerged. In women Although a further validation in larger studies is needed, these findings suggest a critical role of sex in stratification of obese/dysmetabolic patients.

Effect of parathyroidectomy on epicardial fat thickness as a cardiovascular risk factor in patients with primary hyperparathyroidism

Background/aim: Several studies demonstrated that primary hyperparathyroidism is related to increased risk for cardiovascular diseases (CVDs), and risk is decreased by parathyroidectomy. Epicardial fat thickness (EFT) has been postulated as a new marker of CVD risk. We evaluated the impact of parathyroidectomy on EFT in patients with primary hyperparathyroidism (PHPT). Materials and methods: Thirty-four PHPT patients (29 female, 5 male) and 28 age- and sex-matched controls (19 female, 9 male) were included in the study. Demographic, anthropometric, and biochemical data were recorded both before parathyroidectomy and 6 months after the procedure. Epicardial fat thickness was measured by transthoracic echocardiography. Results: Mean age was 53.15 ± 8.44 years. Mean preoperative EFT was higher than mean EFT in the control group (0.49 ± 0.07 cm to 0.46 ± 0.08 cm, P: 0.0005), and EFT decreased after parathyroidectomy (0.49 ± 0.07 cm to 0.44 ± 0.08 cm, P: 0.0005). Systolic blood pressure and calcium, parathormone, and hsCRP levels decreased after parathyroidectomy (P < 0.05). Vitamin D levels increased (P < 0.05). Diastolic blood pressure, body mass index, carotid intima-media thickness, and HOMA-IR, fasting plasma glucose, and phosphorus levels were unchanged after parathyroidectomy (P > 0.05). Preoperatively, EFT was correlated with SBP (r: 0.360, P: 0.0285) and age (r: 0.466, P: 0.0036). Multiple linear regression used to identify independent predictors of change in epicardial fat did not find any predictor of change in epicardial fat (P > 0.05). Conclusion: EFT was decreased by parathyroidectomy in patients with primary hyperparathyroidism.However, the decrease in EFT was not correlated with any of the cardiovascular risk factors. More comprehensive studies evaluating the potential relation between PHPT and EFT need to be conducted.

Investigation of the relationship between asthma and subclinical atherosclerosis by carotid/femoral intima media and epicardial fat thickness measurement.

OBJECTIVE: Since asthma and atherosclerosis may share similar pathophysiological mechanism, this study is planned to investigate whether epicardial fat thickness (EFT), carotid and femoral intima media thicknesses, which are markers of subclinical atherosclerosis, are increased in patients with asthma. METHODS: The study was designed as a cross-sectional study. A total of 154 participants (83 patients with asthma and 71 healthy volunteers) were enrolled into the study. Epicardial fat, carotid, and femoral intima media thicknesses were measured and recorded in both groups. The statistical difference between the two groups was examined. RESULTS: Both carotid and femoral intima media thicknesses were significantly higher in patients with asthma compared to control group (5.52 ± 0.4 mm vs. 5.36 ± 0.4 mm; p = 0.038 and 5.64 ± 0.4 mm vs. 5.46 ± 0.5 mm; p = 0.036, respectively). However, there was not a significant difference in EFT between the groups [5.9 mm (5.3-6.6; IQR = 1.3) vs. 5.6 mm (4.7-6.5; IQR = 1.8); p = 0.1]. On comparison of control group and asthma subgroups (mild, moderate, and severe), there was a statistically significant difference among these four groups in terms of carotid and femoral intima media thicknesses (p = 0.002 and p < 0.001, respectively). Subgroup analyses showed that this difference was mainly due to patients with severe asthma. CONCLUSIONS: Carotid and femoral intima media thicknesses in asthmatic patients were found to be increased compared to the normal population. As a result, the risk of subclinical atherosclerosis in asthmatic patients may be high.

Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis. METHODS AND RESULTS: Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p < 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p < 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p < 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p < 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p < 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (ß = 153, p = 0.001). CONCLUSION: Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.