Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-09-2015 | Original Article

The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function

Authors: M. J. Bakkum, I. Danad, M. A. J. Romijn, W. J. A. Stuijfzand, R. M. Leonora, I. I. Tulevski, G. A. Somsen, A. A. Lammertsma, C. van Kuijk, A. C. van Rossum, P. G. Raijmakers, P. Knaapen

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2015

Abstract

Purpose

Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function.

Methods

A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [¹⁵O]H₂O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow.

Results

Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg×ml⁻¹×min⁻¹×g⁻¹, p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR.

Conclusion

EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors.

Available only for authorised users

Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561–6.PubMedCrossRef

Friberg P, Allansdotter-Johnsson A, Ambring A, Ahl R, Arheden H, Framme J, et al. Increased left ventricular mass in obese adolescents. Eur Heart J 2004;25:987–92.PubMedCrossRef

Turkbey EB, McClelland RL, Kronmal RA, Burke GL, Bild DE, Tracy RP, et al. The impact of obesity on the left ventricle: the Multi-Ethnic Study of Atherosclerosis (MESA). JACC Cardiovasc Imaging 2010;3:266–74.PubMedCentralPubMedCrossRef

Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, 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;117:605–13.PubMedCrossRef

Rabkin SW. Epicardial fat: properties, function and relationship to obesity. Obes Rev 2007;8:253–61.PubMedCrossRef

Iacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011;22:450–7.PubMedCrossRef

Cherian S, Lopaschuk GD, Carvalho E. Cellular cross-talk between epicardial adipose tissue and myocardium in relation to the pathogenesis of cardiovascular disease. Am J Physiol Endocrinol Metab 2012;303:E937–49.PubMedCrossRef

Iacobellis G, Ribaudo MC, Zappaterreno A, Iannucci CV, Leonetti F. Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol 2004;94:1084–7.PubMedCrossRef

Alam MS, Green R, de Kemp R, Beanlands RS, Chow BJ. Epicardial adipose tissue thickness as a predictor of impaired microvascular function in patients with non-obstructive coronary artery disease. J Nucl Cardiol 2013;20:804–12.PubMedCrossRef

10.

Tok D, Ҫaǧli K, Kadife I, Turak O, Özcan F, Başar FN, et al. Impaired coronary flow reserve is associated with increased echocardiographic epicardial fat thickness in metabolic syndrome patients. Coron Artery Dis 2013;24:191–5.PubMedCrossRef

11.

Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol 2001;37:451–7.PubMedCrossRef

12.

Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300:1350–8.PubMedCrossRef

13.

Danad I, Raijmakers PG, Harms HJ, Heymans MW, van Royen N, Lubberink M, et al. Impact of anatomical and functional severity of coronary atherosclerotic plaques on the transmural perfusion gradient: a [15O]H2O PET study. Eur Heart J 2014;35:2094–105.PubMedCrossRef

14.

Danad I, Raijmakers PG, Appelman YE, Harms HJ, de Haan S, van den Oever ML, et al. Coronary risk factors and myocardial blood flow in patients evaluated for coronary artery disease: a quantitative [15O]H2O PET/CT study. Eur J Nucl Med Mol Imaging 2012;39:102–12.PubMedCentralPubMedCrossRef

15.

Chen WJ, Danad I, Raijmakers PG, Halbmeijer R, Harms HJ, Lammertsma AA, et al. Effect of type 2 diabetes mellitus on epicardial adipose tissue volume and coronary vasomotor function. Am J Cardiol 2014;113:90–7.PubMedCrossRef

16.

Harms HJ, Nesterov SV, Han C, Danad I, Leonora R, Raijmakers PG, et al. Comparison of clinical non-commercial tools for automated quantification of myocardial blood flow using oxygen-15-labelled water PET/CT. Eur Heart J Cardiovasc Imaging 2014;15:431–41.

17.

Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975;51:5–40.PubMedCrossRef

18.

Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42.PubMedCrossRef

19.

Knaapen P, Camici PG, Marques KM, Nijveldt R, Bax JJ, Westerhof N, et al. Coronary microvascular resistance: methods for its quantification in humans. Basic Res Cardiol 2009;104:485–98.PubMedCentralPubMedCrossRef

20.

Danad I, Uusitalo V, Kero T, Saraste A, Raijmakers RG, Lammertsma AA, et al. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease: cutoff values and diagnostic accuracy of quantitative [(15)O]H2O PET imaging. J Am Coll Cardiol 2014;64:1464–75.PubMedCrossRef

21.

Corradi D, Maestri R, Callegari S, Pastori P, Goldoni M, Luong TV, et al. The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts. Cardiovasc Pathol 2004;13:313–6.PubMedCrossRef

22.

Després JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation 2012;126:1301–13.PubMedCrossRef

23.

Canoy D, Boekholdt SM, Wareham N, Luben R, Welch A, Bingham S, et al. Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: a population-based prospective study. Circulation 2007;116:2933–43.PubMedCrossRef

24.

Coutinho T, Goel K, Corrĕa de Sá D, Carter RE, Hodge DO, Kragelund C, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of “normal weight central obesity”. J Am Coll Cardiol 2013;61:553–60.PubMedCrossRef

25.

Simone DG, Izzo R, De Luca N, Gerdts E. Left ventricular geometry in obesity: is it what we expect? Nutr Metab Cardiovasc Dis 2013;23:905–12.PubMedCrossRef

26.

Mazurek T, Zhang L, Zalewski A, Zalewski A, Mannion JD, Diehl JT, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 2003;108(20):2460–6.PubMedCrossRef

27.

Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005;2:536–43.PubMedCrossRef

28.

Hua N, Chen Z, Phinikaridou A, Pham T, Qiao Y, LaValley MP, et al. The influence of pericardial fat upon left ventricular function in obese females: evidence of a site-specific effect. J Cardiovasc Magn Reson 2014;16:37.PubMedCentralPubMedCrossRef

29.

Iacobellis G, Singh N, Wharton S, Sharma AM. Substantial changes in epicardial fat thickness after weight loss in severely obese subjects. Obesity (Silver Spring) 2008;16:1693–7.CrossRef

30.

Alpert MA, Omran J, Mehra A, Ardhanari S. Impact of obesity and weight loss on cardiac performance and morphology in adults. Prog Cardiovasc Dis 2014;56:391–400.PubMedCrossRef

31.

Kardassis D, Bech-Hanssen O, Schönander M, Sjöström L, Karason K. The influence of body composition, fat distribution, and sustained weight loss on left ventricular mass and geometry in obesity. Obesity (Silver Spring) 2012;20:605–11.CrossRef

32.

Iwayama T, Nitobe J, Watanabe T, Ishino M, Tamura H, Nishiyama S, et al. The role of epicardial adipose tissue in coronary artery disease in non-obese patients. J Cardiol 2013;63(5):344–9.PubMedCrossRef

33.

Park JS, Ahn SG, Hwang JW, Lim HS, Choi BJ, Choi SY, et al. Impact of body mass index on the relationship of epicardial adipose tissue to metabolic syndrome and coronary artery disease in an Asian population. Cardiovasc Diabetol 2010;9:29.PubMedCentralPubMedCrossRef

34.

Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J, et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 2010;31:737–46.PubMedCentralPubMedCrossRef

35.

Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol 2014;63:1345–54.PubMedCrossRef

36.

Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med 2007;356:830–40.PubMedCrossRef

37.

Yudkin JS, Eringa E, Stehouwer CD. “Vasocrine” signalling from perivascular fat: a mechanism linking insulin resistance to vascular disease. Lancet 2005;365:1817–20.PubMedCrossRef

38.

Sade LE, Eroglu S, Bozbaş H, Ozbiçer S, Hayran M, Haberal A, et al. Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. Atherosclerosis 2009;204:580–5.PubMedCrossRef

39.

Eroglu S, Sade LE, Bozbas H, Haberal A, Ozbicer S, Demir O, et al. Association of serum adiponectin levels and coronary flow reserve in women with normal coronary angiography. Eur J Cardiovasc Prev Rehabil 2009;16:290–6.PubMedCrossRef

40.

Gaborit B, Kober F, Jacquier A, Moro PJ, Flavian A, Quilici J, et al. Epicardial fat volume is associated with coronary microvascular response in healthy subjects: a pilot study. Obesity (Silver Spring) 2012;20:1200–5.CrossRef

41.

Bucci M, Joutsiniemi E, Saraste A, Kajander S, Ukkonen H, Saraste M, et al. Intrapericardial, but not extrapericardial, fat is an independent predictor of impaired hyperemic coronary perfusion in coronary artery disease. Arterioscler Thromb Vasc Biol 2011;31:211–8.PubMedCrossRef

42.

Brinkley TE, Jerosch-Herold M, Folsom AR, Carr JJ, Hundley WG, Allison MA, et al. Pericardial fat and myocardial perfusion in asymptomatic adults from the Multi-Ethnic Study of Atherosclerosis. PLoS One 2011;6:e28410.PubMedCentralPubMedCrossRef

43.

Girerd N, Scridon A, Bessière F, Chauveau S, Geloen A, Boussel L, et al. Periatrial epicardial fat is associated with markers of endothelial dysfunction in patients with atrial fibrillation. PLoS One 2013;8:e77167.PubMedCentralPubMedCrossRef

44.

Houghton JL, Frank MJ, Carr AA, von Dohlen TW, Prisant LM. Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease. J Am Coll Cardiol 1990;15:43–51.PubMedCrossRef

Title: The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function
Authors: M. J. Bakkum
I. Danad
M. A. J. Romijn
W. J. A. Stuijfzand
R. M. Leonora
I. I. Tulevski
G. A. Somsen
A. A. Lammertsma
C. van Kuijk
A. C. van Rossum
P. G. Raijmakers
P. Knaapen
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3087-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2015

Test–retest repeatability of myocardial blood flow and infarct size using 11C-acetate micro-PET imaging in mice

Focal impairment in myocardial fatty acid imaging in the left anterior descending artery area, a strong predictor for cardiac death in hemodialysis patients without obstructive coronary artery disease

Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity

Test–retest reproducibility of the metabotropic glutamate receptor 5 ligand [18F]FPEB with bolus plus constant infusion in humans

Amyloid PET in European and North American cohorts; and exploring age as a limit to clinical use of amyloid imaging

Metabolic patterns in prion diseases: an FDG PET voxel-based analysis