Impact of Gender on the Association of Epicardial Fat Thickness, Obesity, and Circadian Blood Pressure Pattern in Hypertensive Patients

Shim, In Kyong; Cho, Kyoung-Im; Kim, Hyun-Su; Heo, Jung-Ho; Joon, Tae

doi:10.1155/2015/924539

Cited by 28 publications

(23 citation statements)

References 32 publications

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“…Left atrial volume was measured by prolate ellipse methods. Echocardiographic assessments of EFT, defined as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium, were measured perpendicularly from the free wall of the right ventricle at end-systole in three cardiac cycles as previously described 4). Because one of the critical issues in EFT measurement is the inconsistency in measurement location, the mean EFT was averaged from images of the parasternal long axis, parasternal short axis, and apical 4-chamber view.…”

Section: Methodsmentioning

confidence: 99%

“…Although the association between intra-abdominal fat and CV risk has been well-studied, epicardial fat tissue is a newly identified CV risk factor that reflects visceral adiposity 3). There is an association between epicardial adipose tissue and hypertension, and echocardiographic epicardial fat thickness (EFT) is increased in the non-dipper pattern 4)5)…”

Section: Introductionmentioning

confidence: 99%

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Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

Kim

Cho

Choi

et al. 2016

J Cardiovasc Ultrasound

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BackgroundIn this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension.MethodsA total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group.ResultsThe mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors.ConclusionEFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

Kim

Cho

Choi

et al. 2016

J Cardiovasc Ultrasound

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“…Echocardiographic assessments of EFT, defined as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium, were measured perpendicularly from the free wall of the right ventricle at the end-systole in three cardiac cycles according to the method we previously described (Fig. 1 ) [ 20 ]. Because one of the critical issues in EFT measurement is the inconsistency in the measurement location, and mean EFT was averaged from the images of the parasternal long axis, parasternal short axis and apical 4 chamber view.…”

Section: Methodsmentioning

confidence: 99%

Association among epicardial fat, heart rate recovery and circadian blood pressure variability in patients with hypertension

Kim

Cho

et al. 2015

Clin Hypertens

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BackgroundEpicardial fat tissue is known to have an unique endocrine function which affect the cardiac autonomic system. Heart rate recovery (HRR) is a simple non-invasive measurement that assesses autonomic nervous system dysfunction. We aimed to investigate the association among epicardial fat thickness (EFT), HRR and circadian blood pressure (BP) variation in patients with hypertension.MethodsA total of 358 consecutive patients who underwent both 24-hour ambulatory BP monitoring (ABPM) and a treadmill test were enrolled. Echocardiographic EFT and HRR, defined as peak heart rate minus heart rate after a 1-min recovery time, were measured. Patients were classified according to the ABPM; 147 patients with hypertension with a dipping pattern at night (dippers), 140 patients with hypertension with a non-dipping pattern at night (non-dippers) and 71 normotensive controls.ResultsEFT was significantly higher in hypertensive patients, especially in the non-dipper group, compared to the controls (non-dippers, 7.5 ± 2.9 mm; dippers, 6.6 ± 1.6 mm; controls, 5.5 ± 2.1 mm; p < 0.001). HRR was significantly lower in both hypertensive groups as compared to the control group and was the lowest in the non-dipper group (non-dipper, 26.6 ± 18.6; dipper, 29.5 ± 21.5; control, 71.4 ± 19.8; p < 0.001). EFT was significantly correlated with age, body mass index, 24-hour mean systolic BP and 24 h mean BP variability, whereas exercise duration, metabolic equivalents (METs) and HRR were inversely correlated with EFT. Furthermore, EFT > 6.7 mm was associated with a blunted HRR with 76 % sensitivity and 61 % specificity (ROC area under curve: 0.71, 95 % confidence interval, CI = 0.65–0.76, p < 0.001). In a multivariate analysis, EFT (odds ratio, OR = 3.53, 95 % CI = 1.20–10.37, p = 0.022) and 24-hour mean BP variability (OR = 1.09, 95 % CI = 1.03–1.16, p = 0.005) were independent predictors of a blunted HRR defined as HRR ≤ 12 beats (n = 63) in patients with hypertension.ConclusionEFT and HRR were significantly correlated with circadian BP variability in patients with hypertension. EFT and circadian BP variability were independent predictors of blunted HRR, which suggests a link between epicardial fat and autonomic dysregulation in hypertension.

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“…EF differs from other fat depots (omental, visceral/abdominal, or subcutaneous) by having significantly larger number of smaller adipocytes, a different fatty acid and protein composition, as well as different lipid metabolism (increased fatty acid synthesis and fatty acid breakdown) [17]. Several recent human studies have shown an association between obesity and increases in EF mass [37, 38]. Clinical studies have also shown that EF expresses increased inflammatory cytokines (TNFα and IL6) compared to other adipose depots in patients with coronary artery disease and other diseases [2, 18].…”

Section: Introductionmentioning

confidence: 99%

Sexual dimorphism in obesity-related genes in the epicardial fat during aging

et al. 2016

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Aging increases the risk of cardiovascular disease and metabolic syndrome. Alterations in epicardial fat play an important pathophysiological role in coronary artery disease and hypertension. We investigated the impact of normal aging on obesity-related genes in epicardial fat. Sex-specific changes in obesity-related genes with aging in epicardial fat (EF) were determined in young (6 months) and old (30/36 months) female and male, Fischer 344 × Brown Norway hybrid (FBN) rats, using a rat obesity RT2 PCR Array. Circulating sex hormone levels, body and heart weights were determined. Statistical significance was determined using two-tailed Student’s t test and Pearson’s correlation. Our results revealed sex-specific differences in obesity-related genes with aging. Dramatic changes in the expression profile of obesity-related genes in EF with aging in female, but not in male, FBN rats were observed. The older (30 months) female rats had more significant variations in the abundance of obesity-related genes in the EF compared to that seen in younger female rats or both age groups in male rats. A correlation of changes in obesity-related genes in EF to heart weights was observed in female rats, but not in male rats with aging. No correlation was observed to circulating sex hormone levels. Our findings indicate a dysfunctional EF in female rats with aging compared to male rats. These findings, with further functional validation, might help explain the sex differences in cardiovascular risk and mortality associated with aging observed in humans.

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Impact of Gender on the Association of Epicardial Fat Thickness, Obesity, and Circadian Blood Pressure Pattern in Hypertensive Patients

Cited by 28 publications

References 32 publications

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

Association among epicardial fat, heart rate recovery and circadian blood pressure variability in patients with hypertension

Sexual dimorphism in obesity-related genes in the epicardial fat during aging

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