Accumulation of epicardial fat rather than visceral fat is an independent risk factor for left ventricular diastolic dysfunction in patients undergoing peritoneal dialysis

Abstract

BackgroundSymptoms of heart failure with preserved left ventricular systolic function are common among patients undergoing peritoneal dialysis (PD). Epicardial fat (EpF) is an ectopic fat depot with possible paracrine or mechanical effects on myocardial function. The aim of our current study is to assess the association between EpF and Left ventricular diastolic dysfunction (LVDD) in patients undergoing PD and to clarify the relationships among EpF, inflammation, and LVDD in this population.MethodsThis was a cross-sectional study of 149 patients with preserved left ventricular systolic function who were undergoing PD. LVDD was diagnosed (according to the European Society of Cardiology guidelines) and EpF thickness measured by echocardiography. The patients without LVDD were used as controls. The serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) was measured. The location and amount of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra.ResultsSubjects with LVDD had higher levels of hsCRP, more visceral and peritoneal fat, and thicker EpF (all p < 0.001) than controls. Visceral adipose tissue, hsCRP, and EpF all correlated significantly (p < 0.05) with LVDD. Multivariate regression analysis rendered the relationship between visceral adipose tissue and LVDD insignificant, whereas EpF was the most powerful determinant of LVDD (odds ratio = 2.41, 95% confidence interval = 1.43–4.08, p < 0.01). EpF thickness also correlated significantly with the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e’; r = 0.27, p < 0.01).ConclusionEpF thickness is significantly independently associated with LVDD in patients undergoing PD and may be involved in its pathogenesis.

Alteration of Cardiovascular Structure and Function in Patients Undergoing Peritoneal Dialysis

“…In the present study, the linear regression analysis revealed that hemoglobin levels, diuresis and diabetes mellitus type 2 were independent predictors of poor diastolic function (E/A ratio). Our results are similar to previous studies [22,23]. …”

The effect of epicardial adipose tissue thickness on left ventricular diastolic functions in patients with normal coronary arteries

“…In another study, Börekci et al [19] investigated the relationship between EAT and tissue Doppler myocardial performance index (TD-MPI), which incorporates both systolic and diastolic LV function, in newly diagnosed hypertension patients. Lin et al [20] also showed that EAT is significantly independently associated with LVDD in patients undergoing peritoneal dialysis. Although the main limitation of all of the above studies is that the authors did not objectively assess the presence of CAD in their study populations, we well know that the association of CAD with LVDD was studied before, and it was shown that CAD is an independent risk factor for LVDD [21].…”

Nonparallel Progression of Left Ventricular Structure and Function in Long-Term Peritoneal Dialysis Patients

“…Our findings are consistent with these studies. Previous studies reported that age, hypertension, systemic inflammation, and increased visceral fat were risk factors for LVDD in patients undergoing PD [21,22]. Moreover, 1 study demonstrated that CKD-related anemia, hyperphosphatemia, hyperparathyroidism, and oxidative stress decreased LV compliance, which was a central pathophysiological feature of LVDD [23].…”