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The predictive value of the epicardial adipose thickness in the rate of expansion of the aortic root

Dicke des epikardialen Fettgewebes als Prädiktor für die Ausdehnung der Aortenwurzel

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Abstract

Background

Epicardial adipose tissue (ECAT) is metabolically active and is involved in the development of atherosclerosis. The thickness of ECAT has been positively correlated with the dimensions of the ascending aorta. We aimed to examine whether ECAT thickness predicted the expansion of the aortic dimensions.

Methods

The imaging results of patients who had undergone transthoracic echocardiographic (TTE) examinations more than twice during the period 2005–2015 were surveyed. We included adult patients who had undergone TTE examinations at least 1 year apart. The ECAT was measured in the parasternal long-axis view from the index TTE study. End-diastolic dimensions in three consecutive beats were averaged for all measurements. The annulus, root, and sinotubular junction (STJ) were also measured. The amount of increase (if any) in aortic dimensions per year was calculated and the correlation of this increase with the initial thickness of the ECAT was analyzed.

Results

In total, 429 examinations were performed with 197 patients (17 females), from which 394 examinations were analyzed. The ECAT thickness was 8.6 ± 3.6 mm. In the initial examinations, the annulus, STJ, and root measured 23 ± 4, 28 ± 4, and 34 ± 4 mm, respectively. In univariate analysis, for every 1 mm of ECAT thickness, the STJ expanded 0.056 (95% CI: 0.001–0.112 mm/year; p = 0.030) and the aortic root expanded 0.088 mm/year (p < 0.001). In multivariate analysis, ECAT thickness remained an independent predictor of the aortic root expansion. For every 1‑mm increase in ECAT thickness, the aortic root expanded by 0.036 mm (95% CI: 0.010–0.062) per year (p = 0.007).

Conclusion

The thickness of the ECAT is a predictor of more rapid increases in the dimensions of the aortic root. Further studies of patients with established aortic aneurysm are warranted.

Zusammenfassung

Hintergrund

Epikardiales Fettgewebe („epicardial adipose tissue“ [ECAT]) ist metabolisch aktiv und an der Entwicklung der Atherosklerose beteiligt. Die Dicke des ECAT korreliert positiv mit den Abmessungen der Aorta ascendens. In der vorliegenden Arbeit wurde untersucht, ob die ECAT-Dicke ein Prädiktor für die aortalen Abmessungen ist.

Methoden

Betrachtet wurden die Ergebnisse der Bildgebung von Patienten, die im Zeitraum 2005–2015 mehr als 2‑mal einer transthorakalen Echokardiographie (TTE) unterzogen worden waren. Eingeschlossen wurden erwachsene Patienten, bei denen mindestens ein Jahr zwischen den TTE-Untersuchungen lag. Das ECAT wurde in Aufnahmen der parasternalen Langachse aus der TTE-Ausgangsuntersuchung vermessen. Für alle Messungen wurden die enddiastolischen Abmessungen bei 3 aufeinanderfolgenden Schlägen gemittelt. Ebenfalls vermessen wurden der Anulus, die Aortenwurzel und der sinutubuläre Übergang. Die Zunahme (soweit gegeben) in den Abmessungen der Aorta pro Jahr wurde berechnet und die Korrelation dieser Zunahme mit der ECAT-Dicke in der Ausgangsmessung analysiert.

Ergebnisse

Insgesamt wurden 429 Untersuchungen bei 197 Patienten (17 weiblich) durchgeführt, 394 dieser Untersuchungen wurden analysiert. Die ECAT-Dicke betrug 8,6 ± 3,6 mm. In den Ausgangsmessungen maßen der Anulus, der sinutubuläre Übergang und die Aortenwurzel 23 ± 4, 28 ± 4 bzw. 34 ± 4 mm. In der univariaten Analyse nahm der sinutubuläre Übergang mit jedem Millimeter der ECAT-Dicke um 0,056 mm/Jahr (95%-Konfidenzintervall [KI]: 0,001–0,112 mm/Jahr; p = 0,030) und die Aortenwurzel um 0,088 mm/Jahr zu (p < 0,001). In der multivariaten Analyse blieb die ECAT-Dicke ein unabhängiger Prädiktor für die Ausdehnung der Aortenwurzel. Mit jeder Zunahme der ECAT-Dicke um 1 mm vergrößerte sich die Aortenwurzel um 0,036 mm/Jahr (95%-KI: 0,010–0,062 mm/Jahr; p = 0,007).

Schlussfolgerung

Die ECAT-Dicke ist ein Prädiktor für die schnellere Zunahme der Abmessungen der Aortenwurzel. Es sollten Studien an Patienten mit gesichertem Aortenaneurysma durchgeführt werden.

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Authors and Affiliations

  1. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Leili Pourafkari MD, FACC, FASE, Carlos M. Li MD & Nader D. Nader MD, PhD

  2. Roger Williams Medical Center, Boston University, Boston, RI, USA

    Ata O. Hassani-Afshar MD

  3. Brandon Regional Hospital, Brandon, FL, USA

    Matthew Umholtz DO

  4. Rajaie Echocardiography Research Center, Iran University of Medical Sciences, Tehran, Iran

    Anita Sadeghpour MD, FACC, FASE

  5. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Arezou Tajlil MD

  6. Veterans Affairs Western New York Healthcare System (VAWNY), Buffalo, NY, USA

    Carlos M. Li MD & Nader D. Nader MD, PhD

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  1. Leili Pourafkari MD, FACC, FASE
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Correspondence to Nader D. Nader MD, PhD.

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Conflict of interest

N.D. Nader, L. Pourafkari, A.O. Hassani-Afshar, M. Umholtz, A. Sadeghpour, A. Tajlil, and C.M. Li declare that they have no competing interests.

This was a retrospective study conducted at the VA Western New York Medical Center. The institutional ethics committee reviewed and approved the study protocol and the study was exempted from informed consent because of its retrospective design. The study was conducted in accordance to the ethical standards of the Helsinki Declaration of 1975 and patient privacy was maintained.

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Pourafkari, L., Hassani-Afshar, A., Umholtz, M. et al. The predictive value of the epicardial adipose thickness in the rate of expansion of the aortic root. Herz 46 (Suppl 1), 48–53 (2021). https://doi.org/10.1007/s00059-019-04865-3

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  • DOI: https://doi.org/10.1007/s00059-019-04865-3

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