Validation of the echocardiographic assessment of epicardial adipose tissue thickness at the Rindfleisch fold for the prediction of coronary artery disease

Abstract

Background and Aim: Echocardiography is a promising technique for the assessment of epicardial adipose tissue (EAT). Increased EAT thickness is associated with different cardiac diseases, including; coronary artery disease (CAD). Since several different echocardiographic approaches have been proposed to measure EAT, the identification of a standardized method is needed. We propose the assessment of EAT maximal thickness at the Rindfleisch fold, the reproducibility of this measurement and its correlation with EAT thickness and volume assessed at cardiac magnetic resonance (CMR). Finally, we will test the predictive role of this measurement on the presence of significant CAD. Methods and Results: In 1061 patients undergoing echocardiography, EAT thickness was measured at the level of the Rindfleisch fold. In 70 patients, we tested the relationship between echo-EAT thickness and EAT thickness and volume assessed at CMR. In 499 patients with suspected CAD, undergoing coronary artery angiography, we tested the predictive value of EAT on the presence of significant CAD. Echo-EAT thickness measurements had an excellent reliability as indicated by the interobserver (ICC:0.97; 95% C.I. 0.96 to 0.98) and intra-observer (ICC:0.99; 95% C.I. 0.98 to 0.99) reliability rates. Echo-EAT thickness significantly correlated with CMR-EAT thickness and volume (p < 0.001). An EAT thickness value >10 mm discriminated patients with significant CAD at coronary angiography (p < 0.001). At multivariable analysis, including demographic data and

Epicardial Adipose Tissue and IL-13 Response to Myocardial Injury Drives Left Ventricular Remodeling After ST Elevation Myocardial Infarction

“…However, echocardiography is certainly the more simple and diffuse methodology, available in the acute settings. We previously validated the echocardiographic method for EAT thickness determination used in the present study against CMR and we reported an excellent intra and inter observer variability in CAD patients (Parisi et al, 2020c).…”

“…In this prospective study conducted on STEMI patients we evaluated changes in EAT thickness, measured at the Rindfleisch fold (Parisi et al, 2020c), at baseline and at 3 months after the event. The presence of a standardized protocol for the management of STEMI and the strictly inclusion and exclusion criteria allowed us to study in a homogeneous population both myocardial and inflammatory remodeling after the injury.…”

“…Epicardial adipose tissue thickness was obtained, as previously described and validated (Parisi et al, 2020c). EAT was visualized in parasternal long-axis view between the free wall of the right ventricle and the anterior surface of the ascending aorta.…”

“…Epicardial adipose tissue (EAT) is the visceral fat depot of the heart; in coronary artery disease (CAD), it has been described as a local source of inflammatory mediators ( Mazurek et al, 2003 ). We previously reported that EAT thickness is increased in CAD patients ( Parisi et al, 2020a , c ) and the dynamic changes of its secretory activity are important features of acute coronary syndromes, mainly ascribed to the anti-inflammatory mediators ( Parisi et al, 2020b ). Indeed, despite several pro-inflammatory cytokines have been investigated in the context of LV adverse remodeling, clinical trials failed to show benefits of their inhibition on heart failure patients ( Westman et al, 2016 ).…”

Imbalance Between Interleukin-1β and Interleukin-1 Receptor Antagonist in Epicardial Adipose Tissue Is Associated With Non ST-Segment Elevation Acute Coronary Syndrome

“…EAT was visualized in parasternal long-axis view between the free wall of the right ventricle and the anterior surface of the ascending aorta. Once visualized the EAT deposit, the maximum EAT thickness was measured at end-systole, as we have previously described (Parisi et al, 2019b). The average value from three cardiac cycles was used for the statistical analysis.…”