Epicardial fat thickness is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

BACKGROUND: Although the relationship between epicardial fat thickness (EFTh) and coronary atherosclerosis is well established, this relation in the early periods of atherosclerosis has not been fully demonstrated. On the other hand, thoracic aortic intima-media thickness (IMT) rather than carotid IMT was reported as an earlier marker of preclinical atherosclerosis. OBJECTIVE: We aimed to assess the relationship between thoracic aortic IMT and EFTh in patients undergoing transesophageal echocardiography (TEE) examination for different indications. METHODS: We included 104 patients (mean age 38±11.4 years), who underwent TEE for various indications. The patients were divided into two groups according to the median thoracic aortic IMT values (IMT normal group<10 mm and IMT abnormal group≥10 mm). EFTh was obtained using two-dimensional transthoracic echocardiography on the right ventricular free wall during systole and diastole. RESULTS: The highest EFTh values (3.3±0.96 mm vs. 4.51±0.66 mm, P<.001) were observed in the abnormal aortic IMT group. Multivariate linear regression analysis showed that aortic IMT was independently correlate with EFTh (ß=0.423, P<.001). Moreover, EFTh was found to be associated with history of transient ischemic attack (r=.403, P<.001) and abnormal IMT (r=.643, P<.001) in bivariate analysis. CONCLUSION: Epicardial fat thickness is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increase in EFTh may be crucial marker for initial atherosclerosis.

Defining the prognosis of chronic total occlusions during primary percutaneous coronary intervention.

BACKGROUND: The influence of coexisting collateral circulation between chronic total occlusion (CTO) and infarct-related artery (IRA) in patients with acute ST segment elevation myocardial infarction (STEMI) remains unclear. We aimed to investigate the impact of coexisting collateral circulation between CTO and IRA on early clinical outcomes in patients with acute STEMI. METHODS: A total of 1488 consecutive acute STEMI patients who underwent primary percutaneous coronary intervention were prospectively included in the study. After restoration of antegrade flow, the patients who had coexisting CTO and collateral supply from IRA were defined as the CTO-IRA-related (CIR) group (n=56). Patients with coexisting CTO but with no collateral supply from IRA were defined as the CTO-IRA-unrelated (CIUR) group (n=104). Patients without coexisting CTO were defined as the non-CTO group (n=1328). RESULTS: Compared with the CIUR and non-CTO groups, the CIR group was significantly associated with higher Killip class of at least 2 (P<0.001) at presentation, a lower rate of postprocedural thrombolysis in myocardial infarction 2/3 flow (P<0.001), and myocardial perfusion grade 3 (P<0.001). Moreover, the CIR group had significantly higher in-hospital (P<0.001) and 30-day mortality (P<0.001). On multivariate regression analysis, the CIR group (odds ratio=15.96, 95% confidence interval=4.94-51.54; P<0.001) as well as age, post-PCI TIMI, Killip and NT-proBNP levels were independently associated with 30-day mortality. However, the CIUR group was not an independent predictor of early clinical outcomes. CONCLUSION: After restoration of antegrade flow, coexisting CTO supplied by IRA collaterals has unfavourable effects on procedural success, enzymatic infarct size and postprocedural haemodynamic conditions. These collaterals are also independent predictors of 30-day mortality in acute STEMI patients.

Aortic stiffness increases in proportion to the severity of apnoea-hypopnea index in patients with obstructive sleep apnoea syndrome.

BACKGROUND AND AIMS: Obstructive sleep apnoea syndrome (OSA) and aortic stiffness are associated with an increased risk of cardiovascular morbidity and mortality. Although aortic stiffness increased in patients with OSA, the relationship between severity of OSA indicated with apnoea-hypopnea index (AHI) and aortic stiffness was not investigated in previous studies. The aim of this study is to investigate the relationship between the severity of OSA and aortic stiffness. METHODS: In the present study, 90 consecutive OSA patients definite diagnosed with sleep test were prospectively included (mean age 54.5 ± 11.6 years). Aortic pulse wave velocity (PWV) and augmentation index (AIx) were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. Aortic distensibility (AD) was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Overnight full-laboratory polysomnography examination was conducted on each subject. Patients were classified into two groups according to their median AHI values (AHIlow and AHIhigh groups). RESULTS: PWV values were higher and AD values were lower in AHIhigh group compared with AHIlow group (P < 0.05, for all). AHI was associated with body mass index (BMI), systolic blood pressure, pulse pressure, aortic diameter, AD, AIx and PWV in bivariate analysis (P < 0.05, for all). Multivariate linear regression analysis showed that AHI was independently associated with BMI (ß = 0.175, P = 0.047), PWV (ß = 0.521, P < 0.001) and aortic distensibility (ß = -0.223, P = 0.020). CONCLUSIONS: Aortic stiffness is associated both with the presence and the severity of OSA.