Correlation between epicardial fat thickness with intima-media thickness and ankle-brachial index in patients with metabolic syndrome.

Background An increase in epicardial fat thickness (EFT) has been associated with increased cardiovascular risk and the development of atherosclerosis. Transthoracic echo-cardiography provides a reliable measurement of EFT. We evaluated the relationship of EFT with carotid intima-media thickness (CIMT) and ankle-brachial index (ABI), in patients with metabolic syndrome. Methods We assessed 80 patients with metabolic syndrome who underwent echocardiography; EFT was measured by two cardiologists. The CIMT (B-mode colour imaging of extracranial carotid arteries using high-resolution ultrasound) was also measured by a certified ultrasonographer, and ABI was measured by the main researcher. Results We did not find any correlation between ABI with EFT (r=0.0103, p=0.93) or with CIMT (r=-0.1625, p=0.15). However, we found a significant correlation between EFT and CIMT (r=0.2718, r2=0.074, p=0.015). When we evaluated the risk for a CIMT >0.9 mm in patients with an EFT >3 mm, we found a statistically significant association (p=0.039). Interestingly, only 1 patient with an EFT <3 mm had a CIMT >0.9 mm. Conclusion We found that the EFT correlates with CIMT in patients with metabolic syndrome, which explains, at least in part, the higher risk of atherosclerosis in them. Measurement of EFT should be part of the cardiovascular risk evaluation in patients with metabolic syndrome.

Prehypertension is associated with peripheral arterial disease and low ankle-brachial index.

Patients with prehypertension suffer endothelial dysfunction and are at increased cardiovascular risk. Ankle-brachial index (ABI) constitutes an efficient tool for diagnosing peripheral arterial disease; but also an ABI<0.9 is an independent and positive predictor of endothelial dysfunction and is associated with increased cardiovascular risk and mortality. THE AIM: of this study was testing whether ABI was decreased in prehypertensive patients when compared with normotensive subjects. METHODS: We included 70 prehypertensive patients older than 19 years, in whom the ABI was registered with a 5 megahertz Doppler (Summit Doppler L250, Life Dop., USA). The highest ankle systolic pressure was divided by the highest brachial systolic pressure. We also included 70 normotensive subjects in whom the ABI was registered in the same way. The measurements were performed by the same physician who was blinded about the study. Statistical analysis was performed with odds ratio and student t-test. RESULTS: The ABI values in normotensive subjects were 1.023±0.21, whereas prehypertensive patients significantly had lower ABI (0.90±0.14p=0.00012). We found ABI <0.9 in 30 prehypertensive patients (42.85%) and 13 normotensive patients (18.5%). The odds ratio of ABI <0.90 in prehypertensive patients was 3.288 (IC95 1.5-7.0, p=0.0023). A regression analysis failed to show any independent association between ABI values and any other clinical parameter. CONCLUSIONS: Prehypertensive patients had lower ABI and higher prevalence of peripheral artery disease when compared with normotensive subjects; this fact increases their cardiovascular risk. ABI must be included in global evaluation of prehypertensive subjects.

Diferencias en el grosor de la grasa epicárdica en pacientes con diabetes mellitus tipo 2, prediabetes y sujetos no diabéticos / Differences in the epicardial fat thickness in patients with diabetes mellitus 2, prediabetes and nondiabetic subjects

Resumen OBJETIVO Evaluar si hay diferencias en el grosor de la grasa epicárdica en pacientes con diabetes mellitus 2, prediabetes y sujetos no diabéticos. MATERIAL Y MÉTODO Estudio en el que de enero a agosto de 2017 se evaluaron sujetos divididos en tres grupos: sujetos con diabetes mellitus 2, sujetos con prediabetes y sujetos no diabéticos. En todos se midió el grosor de la grasa epicárdica por ecocardiografía, siguiendo la técnica descrita por Iacobelis, con un equipo Aloka alfa 6, usando un transductor de 3.5 MHz, por dos ecocardiografistas que desconocían los datos clínicos de los pacientes. El método estadístico usado fue ANOVA. RESULTADOS Se incluyeron en el estudio 120 pacientes divididos en los tres grupos (40 pacientes cada grupo); se encontró grosor de la grasa epicárdica de 5.63 mm en el grupo de diabetes mellitus, de 4.43 mm en el grupo de prediabetes y de 4.0 mm en el grupo sin diabetes. No hubo diferencia en el grosor de la grasa epicárdica entre los grupos sin diabetes y prediabéticos (p = 0.09). Sin embargo, sí encontramos diferencia significativa entre el grupo de diabetes mellitus y los grupos prediabetes y sin diabetes (p = 0.00017). CONCLUSIÓN Los pacientes diabéticos tipo 2 tienen mayor grosor de la grasa epicárdica que los prediabéticos y los sujetos no diabéticos, lo que apoya la relación entre grasa visceral y diabetes mellitus tipo 2.

Abstract OBJECTIVE To evaluate the differences in epicardial fat thickness in subjects with type-2 diabetes, prediabetes or non-diabetic. MATERIAL AND METHOD A study was done from January to August 2017 evaluating subjects divided into 3 groups: group with type-2 diabetic patients, group with subjects with prediabetes and group with nondiabetic subjects. In all of them the epicardial fat thickness was measured with an Aloka alfa 6 equipment, by 2 cardiologists who were unaware of the clinical data. Statistical analysis was performed with ANOVA. RESULTS There were included 120 patients divided into three groups of 40 patients each. Epicardial fat thickness was of 5.63 mm in diabetes mellitus group, 4.43 mm in prediabetes group and 4 mm in nondiabetic group. We did not find difference in epicardial fat thickness between nondiabetes and prediabetes groups (p = 0.09). However, we found significantly differences in epicardial fat thickness between diabetes group and groups of prediabetes and nondiabetes (p = 0.00017). CONCLUSION Type-2 diabetic patients have greater nondiabetes than prediabetic and nondiabetic subjects; this fact supports the relationship between visceral fat and the risk of type-2 diabetes.