Relationship of Epicardial Adipose Tissue Thickness with Early Indicators of Atherosclerosis and Cardiac Functional Changes in Obese Adolescents with Metabolic Syndrome

Abstract

Objective: Epicardial adipose tissue thickness (EATT) is suggested as a new cardiometabolic risk factor. Carotid intima-media thickness (IMT) is a potential indicator of subclinical atherosclerosis in patients with metabolic syndrome (MS). We investigated the association of EATT with carotid IMT and cardiac functional changes in obese adolescents with MS.Methods: One hundred thirty-eight obese adolescents and 63 lean subjects were enrolled in the study. The obese subjects were divided into two subgroups based on the presence or absence of MS (MS group and non-MS group). All subjects underwent transthoracic echocardiographic examination for determination of left ventricular (LV) function, LV mass index (LVMI), and myocardial performance index (MPI). EATT and carotid IMT were also measured during echocardiography.Results: The average LVMI measurements were higher in both MS and non-MS obese patients in comparison with the lean children. The MS group had significantly higher LVMI measurements than the non-MS and lean groups (88.5±23.0, 67.5±24.8 g/m2, and 62.4±18.2 g/m2, respectively; p<0.01). Carotid IMT was higher in both the MS and non-MS obese patients in comparison with the lean group. The MS group had significantly higher carotid IMT measurements than the non-MS and lean groups (0.91±0.23, 0.78±0.18, and 0.52±0.08 mm, respectively; p<0.01). The EATT was also increased significantly in patients with MS compared to lean adolescents (7.42±1.55 vs. 4.28±0.79mm; p=0.001). EATT was positively correlated with body mass index-SDS, waist circumference, fasting glucose, insulin, homeostasis model assessment-insulin resistance, triglyceride levels, LV thickness, LVMI, and MPI in the MS obese group. EATT was the only independent predictor of carotid IMT in the multivariate analysis (β= 0.69, p<0.001).Conclusion: The findings of the present study demonstrate a close relationship of EATT with carotid IMT and early cardiac dysfunction in obese adolescents with MS. Assessment of EATT and carotid IMT in routine echocardiographic examinations is suggested as a feasible and reliable method for the evaluation of obesity with MS and its related cardiovascular risks in children and adolescents. Conflict of interest:None declared.

Evaluation oF Epicardial Fat and Carotid Intima-Media Thickness in Obese Children

“…In our study, there was a significant correlation between EATT and the following laboratory measures; fasting insulin, insulin resistance, triglyceride, and high sensitivity C-reactive protein. Our findings are in agreement of Akyol et al 2013 ( 25 ). In the present study, there is positive correlation between EATT and homeostasis model assessment index of insulin resistance.…”

“…EATT has been suggested as a new cardiometabolic risk factor as it reflects visceral fat tissue and obesity. Similar results were reported by Akyol et al ( 25 ). Carotid IMT is a noninvasive, feasible, reliable and inexpensive marker of subclinical atherosclerosis.…”

“…In MetS obese patients, there were significant correlations between EATT and hypertension, echocardiographic parameters such as left ventricular thickness, left ventricular mass index, myocardial performance index and carotid IMT. Similar findings were reported by Ozdmir et al (2010), Akyol et al (2013), Boyraz et al (2013), and Eren et al (2014) ( 3 , 20 , 21 , 25 ). Until now, magnetic resonance imaging has been accepted as the gold standard for measuring EATT.…”

Epicardial Fat: Physiological, Pathological, and Therapeutic Implications

“…In accordance with the age group, Fernández Muñoz et al [ 149 ] showed similar findings in Mexican postmenopausal patients, but the sample sizes of these studies preclude the generalization of results. Also Akyol et al [ 151 ] have observed in teenagers with obesity and MS a close relationship between EAT, the thickness of the carotid intima, and early cardiac dysfunction parameters showing the predictive role of lipid accumulation for the adult and elderly population ( Table 2 ).…”

‘Browning’ the cardiac and peri-vascular adipose tissues to modulate cardiovascular risk

“…In obese adolescents with metabolic syndrome EAT thickness (EATT) was raised and positively correlated with fasting plasma glucose and triglycerides, HOMA-IR, carotid IMT and a range of parameters of cardiac dysfunction including left ventricular mass and myocardial performance index [47]. Similar results between lean and obese adolescents were shown by Boyraz et al [48] who further divided the obese group into mild–moderate and severe obesity where EAT was only positively correlated with the majority of metabolic and clinical parameters in the latter group.…”