Epicardial adipose tissue deposition in patients with diabetes and renal impairment: Analysis of the literature

Kleinaki, Zoi; Agouridis, Aris P.; Zafeiri, Maria; Xanthos, Theodoros; Tsioutis, Constantinos

doi:10.4239/wjd.v11.i2.33

Cited by 4 publications

(5 citation statements)

References 66 publications

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“…The study found that a high caloric diet (HCD) led to increased epicardial fat thickness and cardiac dysfunction, which were mitigated by treatment with ezetimibe, a cholesterol absorption inhibitor. This suggested that increased oxycholesterols in the HCD group were closely related to cardiac dysfunction and epicardial fat accumulation (9). These findings collectively indicate that the amount of EAT and associated cardiac risk factors significantly impact patients' morbidity and mortality.…”

Section: Discussionmentioning

confidence: 71%

“…The processing involved several steps: data cleaning and standardization to ensure consistency and accuracy; annotation and labeling by the surgical team, who identified the full heart region and its sub-regions (Aorta, Right Ventricle Myocardium, Right Ventricle and Pulmonary Artery Epicardial Fat, and Right Atrium Appendage) using a labeling tool called LabelMe; and image segmentation techniques to isolate the heart region and identify fat deposits. The total area of fat on the anterior surface of the Right Ventricle, Pulmonary Artery, and Right Atrium was quantified using appropriate algorithms (8)(9)(10)(11). The images consisted of numerous pixels, each representing the smallest portion of an image, measured in pixel width x pixel height x channel.…”

Section: Methodsmentioning

confidence: 99%

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Quantitative Analysis of Epicardial Adipose Tissue: 120K Shades of Heart

Jan,

Ayub

et al. 2024

JHRR

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Background: Epicardial adipose tissue (EAT) is the fat deposited between the myocardium and epicardium. Due to its unique anatomical position, EAT has both protective and harmful effects on the heart, influencing conditions such as coronary artery disease, atrial fibrillation, and heart failure. This study aimed to quantify the amount of EAT by analyzing the color shades of the heart's anterior surface during coronary artery bypass grafting (CABG) procedures. Objective: To assess the number of color shades in different sub-regions of the heart and quantify EAT using real-time 2D images captured during CABG procedures, and to correlate these findings with clinical conditions and risk factors. Methods: The study was conducted at Rehman Medical Institute, Peshawar, from October 2023 to April 2024. Images were captured using an iPhone 11 with a 12-megapixel camera during CABG procedures, specifically before cannulation, after opening the pericardium, and tucking the pericardium to the skin on a beating heart. Photographs were taken at a 90-degree angle and one-foot distance during systole, including surrounding tissues and a self-retaining retractor with a ruler for measurement reference. The images from three patients were processed to form the "HEART ANTERIOR VIEW THROUGH STERNOTOMY (HATS)" dataset. The data were cleaned and standardized for consistency. The surgical team annotated and labeled the images using the LabelMe tool, identifying the full heart region and its sub-regions: Aorta, Right Ventricle (RV) Myocardium, RV and Pulmonary Artery (PA) Epicardial Fat, and Right Atrium (RA) Appendage. Image segmentation techniques isolated the heart region and identified fat deposits. The total area of fat on the anterior surface of RV, PA, and RA was quantified using appropriate algorithms. Pixel analysis was conducted to determine the color shades, with each pixel having three color channels (Red, Green, Blue) and 256 intensity values per channel. Results: The total pixel count for the full image (heart and surrounding region) was 1600x1200 for Patient 1, 480x624 for Patient 2, and 480x848 for Patient 3. The heart regions contained 218,864 pixels (Patient 1), 44,020 pixels (Patient 2), and 77,919 pixels (Patient 3). The EAT areas were found to be 158,213 pixels (Patient 1), 35,608 pixels (Patient 2), and 52,723 pixels (Patient 3). The percentage areas of the sub-regions varied, with RV and PA Epicardial Fat comprising 72.3%, 80.9%, and 67.7% of the heart regions for Patients 1, 2, and 3, respectively. The top 100 color shades were identified, with unique colors in the Aorta (23,323), Appendage (7,030), Epicardial Fat (80,257), and Myocardium (10,131). Conclusion: The study demonstrated that EAT and the color shades of heart sub-regions could be accurately quantified using advanced imaging and computational techniques. These findings provide valuable insights into the correlation between EAT and cardiac risk factors, enhancing the ability to predict postoperative morbidity and mortality and enabling early interventions to improve patient outcomes.

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Section: Discussionmentioning

confidence: 71%

Section: Methodsmentioning

confidence: 99%

Quantitative Analysis of Epicardial Adipose Tissue: 120K Shades of Heart

Jan,

Ayub

et al. 2024

JHRR

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“…Следует отметить, что тЭЖТ у больных СД 2 в данном исследовании не ассоциирована с показателями, характеризующими степень выраженности абдоминального ожирения, тогда как у недиабетических пациентов независимым маркером умеренного утолщения ЭЖТ (не более 6 мм) являлись значения ОТ. Это наблюдение свидетельствует о важности количественной оценки ЭЖТ у больных СД 2 в качестве маркера дисфункции висцеральных жировых депо и находится в соответствии с результатами недавнего метаанализа, в котором установлено, что у диабетических пациентов тЭЖТ позволяет более точно предсказать развитие неблагоприятных сердечно-сосудистых событий по сравнению с антропометрическими данными [17]. Кроме того, полученные авторами статьи данные отчетливо демонстрируют существование различий в механизмах накопления и биологического функционирования ЭЖТ и абдоминальной жировой ткани в зависимости от наличия или отсутствия диабетического статуса.…”

Section: Discussionunclassified

Metabolic, inflammatory and imaging biomarkers in evaluation of coronary atherosclerosis severity in patients with coronary artery disease and diabetes mellitus type 2

Koshelskaya

Анатольевна²,

Харитонова

et al. 2021

Terapevticheskii arkhiv

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Aim. To study interconnections between epicardial adipose tissue thickness (EATt), parameters of glucose metabolism/insulin, C-reactive protein (hsCRP), serum adipokines and severity of coronary artery disease (CAD) depending on the presence of diabetes mellitus type 2 (DM 2); to determine significant markers of CAD severity in patients with DM 2. Materials and methods. The study involved 106 patients with CAD (m/f 64/42, 60.96.8 years), including patients with DM 2 (group 1, n=35) and non-diabetic patients (group 2, n=71). Severity of CAD was evaluated according to angiography data with calculation of Gensini Score (GS). EATt was assessed via echocardiography. Serum levels of glucose/insulin metabolism parameters, lipid fractions, hsCRP and adipokines were evaluated. Clinical parameters, including GS, did not differ between groups. Results. EAT thickness median was elevated in gr.1 (5.1 mm vs. 4.4 mm in group 2), while adiponectin levels were decreased (6.55 g/ml vs. 7.71 g/ml). Linear regression of body mass index and resistin levels on EATt was revealed in gr.1; in gr.2 EATt linearly increased with waist circumference increment when EATt6 mm. Linear regression of EATt on GS was revealed in gr.1 when EATt8 mm, while linear regression in the whole GS range was obtained for HDL-C and hsCRP levels. Conclusion. Study results demonstrate differences in mechanisms of deposition and functioning of epicardial and abdominal adipose tissue depending on the presence or absence of diabetic status. Patients with DM2 are characterized by the excessive EAT deposition and decrease of serum adiponectin levels compared to non-diabetic patients in the equal conditions. Independent markers of CAD severity in DM 2 are decreased HDL-C and increased hsCRP levels, but not EATt.

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“…This, along with other myokines, could upregulate brown-like characteristics from EAT. Finally, diet-induced thermogenesis has been postulated in some literature, where dietary nitrates in green vegetables are thought to improve endothelial function and increase cyclic GMP involved in thermogenesis [ 141 , 142 ]. These are potential therapeutic routes that could be explored, but further research on EAT is warranted.…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review

Krishnan

Sharma

Yuan

et al. 2022

JCDD

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Cardiovascular diseases (CVDs) are a significant burden globally and are especially prevalent in obese and/or diabetic populations. Epicardial adipose tissue (EAT) surrounding the heart has been implicated in the development of CVDs as EAT can shift from a protective to a maladaptive phenotype in diseased states. In diabetic and obese patients, an elevated EAT mass both secretes pro-fibrotic/pro-inflammatory adipokines and forms intramyocardial fibrofatty infiltrates. This narrative review considers the proposed pathophysiological roles of EAT in CVDs. Diabetes is associated with a disordered energy utilization in the heart, which promotes intramyocardial fat and structural remodeling. Fibrofatty infiltrates are associated with abnormal cardiomyocyte calcium handling and repolarization, increasing the probability of afterdepolarizations. The inflammatory phenotype also promotes lateralization of connexin (Cx) proteins, undermining unidirectional conduction. These changes are associated with conduction heterogeneity, together creating a substrate for atrial fibrillation (AF). EAT is also strongly implicated in coronary artery disease (CAD); inflammatory adipokines from peri-vascular fat can modulate intra-luminal homeostasis through an “outside-to-inside” mechanism. EAT is also a significant source of sympathetic neurotransmitters, which promote progressive diastolic dysfunction with eventual cardiac failure. Further investigations on the behavior of EAT in diabetic/obese patients with CVD could help elucidate the pathogenesis and uncover potential therapeutic targets.

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Epicardial adipose tissue deposition in patients with diabetes and renal impairment: Analysis of the literature

Cited by 4 publications

References 66 publications

Quantitative Analysis of Epicardial Adipose Tissue: 120K Shades of Heart

Quantitative Analysis of Epicardial Adipose Tissue: 120K Shades of Heart

Metabolic, inflammatory and imaging biomarkers in evaluation of coronary atherosclerosis severity in patients with coronary artery disease and diabetes mellitus type 2

The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review

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