Increased Visceral and Epicardial Fat Mass Are Associated
With Early Diastolic dysfunction
CARDIOLOGY DEPARTMENT, VILA NOVA DE GAIA HOSPITAL, PORTUGAL
Ricardo Fontes-Carvalho, F. Sampaio, N. Bettencourt, D. Caeiro, N. Ferreira, G. Silva, O. Sousa, M. Teixeira, V. Gama Ribeiro
Results
Introduction
 Recent studies have shown that obesity (evaluated by body mass index or waist circumference) is independently
associated with heart failure risk (1) (2) (3)
Population Clinical Characterization (n=94)
Age (years)
 Visceral adipose tissue is a multi-functional endocrine organ, which can influence myocardial function inducing
“Obesity Cardiomiopathy” or “Fatty Heart” (4) (5)
 In obese patients, diastolic dysfunction is the first manifestation of cardiomyopathy and altered myocardial
function
Sex, male
CV Risk Factors
Hypertension
Type 2 Diabetes
Hyperlipidemia
Smoking
Obesity (BMI ≥ 30)
Familial History
54,8 ± 11,5 Event Characterization
80 (85%)
Previous AMI
ST-Elevation MI
45 (48%)
Revascularization (PCI)
14 (15 %)
Culprit Artery
50 (53,2%)
Anterior Descending
60 (63 %)
Circumflex
27 (28,7%)
Right coronary
11 (12%) Killip Class
Adipose Tissue can influence myocardial function by several pathophysiologic ways (3) (4):
I / II
Adipose Tissue
(Obesity)
Increased Circulating
Volume
Adipokines
Increased Cardiac
Output
Fibrosis and
EC matrix
accumulation
Apoptosis
Altered
Energy
Metabolism
Direct
Cardiotoxicity
Insulin
Resistance
Dyslipidemia
Hypertension
Metabolic
Syndrome
LV Hypertrophy
Type 2
Diabetes
Coronary
Artery Disease
Cardiac Remodeling
Association With Diastolic Dysfunction
Anthropometry
III / IV
Weigh (Kg)
77,2 ± 15
BMI (kg/m2)
27,4 ± 4,4 Peak Troponin (ng/dL)
Waist circumference
Nt-ProBNP (pg/mL)
97,6
±
10,7
Echocardiographic Characterization (n = 94)
(cm)
Left Atrium
Diastolic Function Evaluation
Diameter (mm)
40,8 ± 5,3
Area (cm2)
21,8 ± 4,2
Mitral Flow Pattern
Volume (mL)
64 ± 22
E wave velocity (cm/seg)
Volume Index
36,4 ± 9,3
A wave velocity (cm/seg)
E/A ratio
Left Ventricle
Decelaration Time
Diast. Diameter (mm)
54 ± 4,9
Sist. Diameter (mm)
ND
Tissue Doppler
Posterior Wall (mm)
10 ± 2
E/E’ septal
Septum (mm)
10 ± 2
E/E’ lateral
Mass (g/m2)
458 ± 99
E/E’ med.
Systolic Fenction
EF2D Simpson (%)
EF 3D (%)
Myocardial Dysfunction
(Heart Failure)
53,1 ± 9,1
54,1 ± 9,6
Pulmonary Vein Flow
Ard pulm – Ar mitral
8 (9 %)
56 (59,6%)
76 (81%)
Diastolic Dysfunction and Abdominal Fat Mass
Total Abdominal Fat
Visceral Fat
r = 0,23
p = 0,02
Subcutaneous Fat
r = 0,18
p = 0,09
50,6%
16,9 %
31,5 %
83% /
10,6%
0% / 6,4%
19,3 ± 77
572 ± 609
79 ± 20
69 ± 19
1,14 ± 0,48
227 ± 68
Diastolic Dysfunction and Epicardial Fat Volume
r = 0,26
p = 0,01
p = 0,02
10,2 ± 3
7,46 ± 2,9
8,6 ± 3,2
15,2 ± 32
CT Scan Parameters (n=94)
Abdominal fat:
Objectives
Medians ± IQR
Total Fat Mass Area (cm2)
Subcutaneous Fat area (cm2)
Visceral Fat Area (cm2)
 Our aims were :
1. To evaluate if systolic and diastolic function could be influenced by obesity and adipose tissue
2. To access the relative importance of visceral vs subcutaneous fat on myocardial dysfunction
3. To determine if epicardial fat could determine diastolic or systolic function.
Epicardial Fat Volume (cm2)
309,2 ± 99,7
157 ± 76,7
134 ± 67,5
 The same correlations were also significant with other diastolic function parameters, namely with septal E/Ea and mean E/Ea
After multivariate analysis by linear regression (adjustment for age, HT, 2D EF, BMI, Subcutaneous Fat, Epicardial Fat), epicardial fat volume was the only
parameter associated with diastolic dysfunction, assessed by E/Ea lat (β = 0,29;p= 0,007;)
99,6 ± 63,3
(No) Association With Systolic Function
Total Abdominal Fat
Methods
 94 patients were evaluated one month after acute myocardial infarction
r = 0,22
p = 0,03
r = 0,11
p = 0,33
Visceral Fat
r = 0,03
p = 0,33
Epicardial Fat
r = 0,11
p = 0,33
Transthoracic Echocardiography
Multidetector CT Scan
 Echocardiographic Parameters:
(64 slice CT scanner, Somaton Sensation 64, Siemens)
 Adipose Tissue Evaluation:
 Systolic function:
 Ejection fraction (2D Simpson; 3D)
 Abdominal Fat:
 Single slice CT at L4-L5 level
 CT value for body fat: -150 to -50 HU
 Total Abdominal Fat Mass Area
 Diastolic function:
Conclusions
 Doppler mitral valve flow:
E, A, E/A, DT
 In this population, increased adipose tissue was associated with more diastolic dysfunction
 Subcutaneous Fat Area
 Visceral Fat Area
 Epicardial Fat evaluation:
 After pericardium contour tracing, axial
slices (1 cm thick ) were summed, from the
pulmonary artery level to the diaphragm
 CT value for body fat: -150 to -50 HU
 Epicardial Fat Volume
 Tissue Doppler:
 E/Ea lat, sep, med
 Epicardial fat and visceral abdominal adipose tissue, but not subcutaneous fat, was associated with early diastolic
E
dysfunction
A
 There was no association between visceral, subcutaneous or epicardial adipose tissue mass measurements and
 Pulmonary vein flow:
 Ard pulm – Ad mitral
DT
E’ lat
Ad
mitral
systolic function
 Taken together with other published studies, these data seem to reinforce the role of increased visceral and epicardial
 Statistical Analysis:
adipose tissue as a cause of myocardial dysfunction, inducing early diastolic dysfunction
 Pearson’s Correlation coefficient and Mann-Whitney test, accordingly
References
(1) Kenchaiah S, et al. Obesity and the risk of heart failure. N Engl J Med 2002;347:305–13.; (2) Kenchaiah S et al. Body mass index and vigorous physical activity and the risk of heart failure among men. Circulation 2009;119:44 –52. (3) Horwich et al. Glucose, Obesity, Metabolic Syndrome, and Diabetes: Relevance to Incidence of Heart Failure. J Am Col Cardiol 2010;55:283–93; (4) Szczepaniak et al.
Forgotten but Not Gone The Rediscovery of Fatty Heart, the Most Common Unrecognized Disease in America. Circ Res. 2007;101:759-767; (5) Rosito GA et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 2008 Feb 5;117(5):605-13.