Importance of cardiac imaging assessment of epicardial adipose tissue after a first episode of myocardial infarction

Abstract

BackgroundOver the past years, information about the crosstalk between the epicardial adipose tissue (EAT) and the cardiovascular system has emerged. Notably, in the context of acute myocardial infarction (AMI), EAT might have a potential role in the pathophysiology of ventricular structural changes and function, and the clinical evolution of patients. This study aims to assess the impact of EAT on morpho-functional changes in the left ventricle (LV) and the outcome of patients after an AMI.MethodsWe studied prospectively admitted patients to our hospital with a first episode of AMI. All patients underwent percutaneous coronary intervention (PCI) during admission. Transthoracic echocardiography (TTE) was performed within 24–48 h after PCI, as well as blood samples to assess levels of galectin-3 (Gal-3). Cardiac magnetic resonance (CMR) was performed 5–7 days after PCI. Clinical follow-up was performed at 1 and 5 years after MI.ResultsMean age of our cohort (n = 41) was 57.5 ± 10 years, and 38 (93%) were male. Nine patients had normal BMI, 15 had overweight (BMI 25–30), and 17 were obese (BMI > 30). Twenty three patients (56%) had ≥ 4 mm thickness of EAT measured with echo. In these patients, baseline left ventricular ejection fraction (LVEF) after AMI was significantly lower, as well as global longitudinal strain. EAT thickness ≥ 4 m patients presented larger infarct size, higher extracellular volume, and higher T1 times than patients with EAT < 4 mm. As for Gal-3, the median was 16.5 ng/mL [12.7–25.2]. At five-year follow-up 5 patients had major cardiac events, and all of them had EAT ≥ 4 mm.ConclusionsPatients with EAT >4 mm have worse LVEF and GLS, larger infarct size and longer T1 values after a MI, and higher levels of Gal-3. EAT >4 mm was an independent predictor of MACE at 5-year follow-up. EAT thickness is a feasible, noninvasive, low-cost parameter that might provide important information regarding the chronic inflammatory process in the myocardium after an infarction.

Impact of Epicardial Adipose Tissue on Infarct Size and Left Ventricular Systolic Function in Patients with Anterior ST-Segment Elevation Myocardial Infarction

“…The relationship between pre-existing EAT at the time of acute coronary occlusion and resulting IS has been controversial. Concurring with our results, Islas et al [15], Mohamed et al [16], Fisser et al [11], and Toya et al [17]. reported larger infarctions in patients with high EAT; however, Bière et al [18] and Gohbara et al [12] detected the opposite.…”

“…(ii) EAT is a biologically active tissue closely connected with the myocardium [5]. Parallel to the response detected in the myocardium itself, in the acute post-infarction period EAT can also undergo a deregulated pro-inflammatory response which can ultimately contribute to an undesirable expansion of structural damage [4][5][6]15].…”

The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration

“…The EAT thickness measured in transthoracic echocardiography in subjects with MI corresponded positively with ST-segment resolution, reduction in LVEF, reduction in LV end-diastolic and end-systolic volume, and larger infarct size [171,179]. Furthermore, thick EAT was correlated with the presence of coronary collateral vessels (CCVs) in patients presenting with ACS.…”

“…It also appeared to be an independent risk factor of NSTEMI, unstable angina pectoris [167], and restenosis after PCI [168]. Additionally, the EAT thickness in echocardiography occurred to be significantly predictive of adverse cardiovascular events in patients presenting with AF [169] and ACS during short-term and long-term follow-up [170,171]. Moreover, individuals with high echocardiographic EAT thickness were more likely to require target vessel revascularization.…”

The role of epicardial adipose tissue dysfunction in cardiovascular diseases: an overview of pathophysiology, evaluation, and management

“…reported that acute myocardial infarction patients with EAT >4 mm have worse left ventricular systolic function and have large infarct size. EAT >4 mm is an independent predictor of major adverse cardiovascular events at 5-year follow-up ( 30 ).…”