scholarly journals Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction – a meta-analysis on over 6600 patients and rationale for the EPIC-ACS study

Medicine ◽  
2021 ◽  
Vol 100 (52) ◽  
pp. e28060
Author(s):  
Stefanie Hendricks ◽  
Iryna Dykun ◽  
Bastian Balcer ◽  
Matthias Totzeck ◽  
Tienush Rassaf ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Adipose Tissue ◽  
Epicardial Adipose Tissue ◽  
Meta Analysis ◽  
Increased Risk

P6429Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction, a meta-analysis on over 6.600 patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Hendricks ◽  
I Dykun ◽  
B Balcer ◽  
T Rassaf ◽  
A A Mahabadi
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Adipose Tissue ◽  
Patient Management ◽  
Epicardial Adipose Tissue ◽  
Meta Analysis ◽  
Free Text ◽  
Emergency Setting ◽  
3 Dimensional ◽  
Coronary Events

Abstract Background Epicardial adipose tissue surrounds the heart and the coronary arteries. Endocrine and paracrine activity is accredited to EAT. Studies descripted the association between increased EAT and traditional cardiovascular risk factors as well as coronary events. While computed tomography is the gold standard for the assessment of 3-dimensional EAT-volume, echocardiography based EAT thickness is an easy accessible alternative in particular in an emergency setting. So far, little is known, how quantification of EAT in patients presenting with chest pain could alter patient management. Purpose To perform a meta-analysis on existing studies, comparing EAT in patients with and without myocardial infarction, stratifying by imaging technique. Methods We performed a systematic search using the Pubmed, Cochrane, SCOPUS, and Web of Science databases for studies, describing EAT in patients with and without myocardial infarction. Manuscripts, published until 1st of October 2018, were included. We made our search specific and sensitive using Medical Subject Headings terms and free text and considered studies published in English language. Search terms used were “epicardial adipose tissue” or “pericardial adipose tissue” and “myocardial infarction”, “coronary events”, or “acute coronary syndrome”. For comparability, EAT measures were normalized to mean values for patients without myocardial infarction for each study separately. Random effect models were calculated. All analyses were performed using Review Manager 5.3. Results Overall, 6.641 patients (mean aged 58.9 years, 53% male) from 7 studies were included. Patients with myocardial infarction had 37% higher measures of EAT compared to patients without myocardial infarction (95% CI: 21–54%, Figure A). Comparing studies using echocardiography for assessment of EAT thickness with studies using computed tomography based EAT volume, similar relative differences in EAT with wide overlap of confidence intervals were observed (Echo measures: 40 [4–76]%, CT measures: 36 [16–57]%, Figure B and C). No relevant heterogeneity and inconsistency between groups was present in all analyses (detailed data not shown). Figure 1 Conclusion EAT is increased in patients with myocardial infarction. Our data suggests that quantification of EAT thickness using echocardiography distinguishes equally between patients with and without myocardial infarction as compared to 3-dimensional EAT volume from computed tomography. Therefore, it may be an easy accessible alternative in clinical settings. However, further studies are warranted to determine, whether quantification of EAT may lead to improved patient management.

Correction to: The impact of epicardial adipose tissue in patients with acute myocardial infarction

2021 ◽  
Author(s):  
Christoph Fisser ◽  
Stefan Colling ◽  
Kurt Debl ◽  
Andrea Hetzenecker ◽  
Ulrich Sterz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adipose Tissue ◽  
Epicardial Adipose Tissue ◽  
The Impact

scholarly journals The Association of Epicardial Adipose Tissue and High Risk Plaque Characteristics: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 26 ◽  
pp. S272
Author(s):  
N. Nerlekar ◽  
A. Brown ◽  
R. Muthalaly ◽  
A. Talman ◽  
J. Laggoune ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adipose Tissue ◽  
High Risk ◽  
Epicardial Adipose Tissue ◽  
Meta Analysis

Epicardial Adipose Tissue and Postoperative Atrial Fibrillation

2021 ◽  
Author(s):  
Petraglia Laura ◽  
Conte Maddalena ◽  
Comentale Giuseppe ◽  
Cabaro Serena ◽  
Campana Pasquale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Epicardial Adipose Tissue ◽  
Perioperative Period ◽  
Postoperative Atrial Fibrillation ◽  
Serum Samples ◽  
Monocyte Chemoattractant Protein 1 ◽  
Elective Cardiac Surgery ◽  
Increased Risk

Abstract Background. Atrial fibrillation (AF) often occurs after cardiac surgery and is associated to increased risk of stroke and mortality. Several evidence support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an exalted production of inflammatory mediators from EAT.Methods. The study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.Results. Forty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p = < 0.001; 322.4 pg/ml vs. 153.4 pg/ml; p = 0.028 respectively). EAT levels of IL-6 were significantly increased in POAF patients compared to those in sinus rhythm (126.3 pg/ml vs. 23 pg/ml; p = < 0.005).ConclusionHigher EAT levels of IL6 and MCP1 are significantly associated with the occurrence of POAF. Statin therapy seems to play a role in preventing POAF. These results might pave the way for a targeted use of these drugs in the perioperative period.

P960Association of peri-procedural intravenous morphine use on clinical outcomes in ST-elevation myocardial infarction treated by percutaneous coronary intervention: systematic review and meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Batchelor ◽  
D Liu ◽  
J Bloom ◽  
S Noaman ◽  
W Chan
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background Morphine analgesia may affect absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of peri-procedural intravenous (IV) morphine administration on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is not well defined. Purpose To conduct a systematic review and meta-analysis exploring clinical outcomes with peri-procedural IV morphine in patients undergoing PPCI for STEMI. Methods Analysis of the electronic databases MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI IV morphine use with myocardial infarction (MI) and mortality. Primary and secondary outcomes were in-hospital or 30-day MI and all-cause mortality respectively. Results Eleven studies (1 randomised controlled trial; 10 cohort studies) were included for systematic review. Five studies, including 3,748 patients were included in meta-analysis of the primary outcome. Of 3,748 patients, 2,239 were treated concurrently with ticagrelor, 1,256 treated with clopidogrel and 253 with prasugrel. As shown in the Figure, there was a trend towards increased risk of myocardial infarction with IV morphine (odds ratio 1.88; 95% CI 0.87–4.09, I2 0%). Across seven studies and 6585 patients, no increased risk of mortality at the same composite time endpoint was evident (odds ratio 0.70, 95% CI 0.40–1.23, I2 19%). Figure 1. MI in hospital or at 30 days Conclusion Based on current literature, evidence of an association between IV morphine and myocardial infarction in patients undergoing PPCI for STEMI is limited by observational methodology and conflicting results. There is no evidence of an association between intravenous peri-procedural morphine and mortality. Clinical trial evidence with strong documentation of adverse events data is required to demonstrate association or causality. Acknowledgement/Funding None

30Machine learning to predict the long-term risk of myocardial infarction and cardiac death based on clinical risk, coronary calcium and epicardial adipose tissue: a prospective study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F C Commandeur ◽  
P J Slomka ◽  
M Goeller ◽  
X Chen ◽  
S Cadet ◽  
...  
Keyword(s):  
Machine Learning ◽  
Myocardial Infarction ◽  
Adipose Tissue ◽  
Cardiac Death ◽  
Epicardial Adipose Tissue ◽  
Long Term Follow Up ◽  
Ascvd Risk ◽  
Asymptomatic Subjects

Abstract Background/Introduction Machine learning (ML) allows objective integration of clinical and imaging data for the prediction of events. ML prediction of cardiovascular events in asymptomatic subjects over long-term follow-up, utilizing quantitative CT measures of coronary artery calcium (CAC) and epicardial adipose tissue (EAT) have not yet been evaluated. Purpose To analyze the ability of machine learning to integrate clinical parameters with coronary calcium and EAT quantification in order to improve prediction of myocardial infarction (MI) and cardiac death in asymptomatic subjects. Methods We assessed 2071 consecutive subjects [1230 (59%) male, age: 56.049.03] from the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) trial with long-term follow-up after non-enhanced cardiac CT. CAC (Agatston) score, age-and-gender-adjusted CAC percentile, and aortic calcium scores were obtained. EAT volume and density were quantified using a fully automated deep learning method. Extreme gradient boosting, a ML algorithm, was trained using demographic variables, plasma lipid panel measurements, risk factors as well as CAC, aortic calcium and EAT measures from CAC CT scans. ML was validated using 10-fold cross validation; event prediction was evaluated using area-under-receiver operating characteristic curve (AUC) analysis and Cox proportional hazards regression. Optimal ML cut-point for risk of MI and cardiac death was determined by highest Youden's index (sensitivity + specificity – 1). Results At 152 years' follow-up, 76 events of MI and/or cardiac death had occurred. ML obtained a significantly higher AUC than the ASCVD risk and CAC score in predicting events (ML: 0.81; ASCVD: 0.76, p<0.05; CAC: 0.75, p<0.01, Figure A). ML performance was mostly driven by age, ASCVD risk and calcium as shown by the variable importance (Figure B); however, all variables with non-zero gain contributed to the ML performance. ML achieved a sensitivity and specificity of 77.6% and 73.5%, respectively. For an equal specificity, ASCVD and CAC scores obtained a sensitivity of 61.8% and 67.1%, respectively. High ML risk was associated with a high risk of suffering an event by Cox regression (HR: 9.25 [95% CI: 5.39–15.87], p<0.001; survival curves in Figure C). The relationships persisted when adjusted for age, gender, CAC, CAC percentile, aortic calcium score, and ASCVD risk score; with a hazard ratio of 3.42 for high ML risk (HR: 3.42 [95% CI: 1.54–7.57], p=0.002). Conclusion(s) Machine learning used to integrate clinical and quantitative imaging-based variables significantly improves prediction of MI and cardiac death in asymptomatic subjects undergoing CAC assessment, compared to standard risk assessment methods. Acknowledgement/Funding NHLBI 1R01HL13361, Bundesministerium für Bildung und Forschung (01EX1012B), Dr. Miriam and Sheldon G. Adelson Medical Research Foundation

scholarly journals Updating insights into rosiglitazone and cardiovascular risk through shared data: individual patient and summary level meta-analyses

BMJ ◽  
2020 ◽  
pp. l7078 ◽  
Author(s):  
Joshua D Wallach ◽  
Kun Wang ◽  
Audrey D Zhang ◽  
Deanna Cheng ◽  
Holly K Grossetta Nardini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systematic Review ◽  
Cardiovascular Risk ◽  
Meta Analysis ◽  
Odds Ratios ◽  
Level Data ◽  
Increased Risk ◽  
Meta Analyses ◽  
Analytical Approaches

AbstractObjectivesTo conduct a systematic review and meta-analysis of the effects of rosiglitazone treatment on cardiovascular risk and mortality using multiple data sources and varying analytical approaches with three aims in mind: to clarify uncertainties about the cardiovascular risk of rosiglitazone; to determine whether different analytical approaches are likely to alter the conclusions of adverse event meta-analyses; and to inform efforts to promote clinical trial transparency and data sharing.DesignSystematic review and meta-analysis of randomized controlled trials.Data sourcesGlaxoSmithKline’s (GSK’s) ClinicalStudyDataRequest.com for individual patient level data (IPD) and GSK’s Study Register platforms, MEDLINE, PubMed, Embase, Web of Science, Cochrane Central Registry of Controlled Trials, Scopus, and ClinicalTrials.gov from inception to January 2019 for summary level data.Eligibility criteria for selecting studiesRandomized, controlled, phase II-IV clinical trials that compared rosiglitazone with any control for at least 24 weeks in adults.Data extraction and synthesisFor analyses of trials for which IPD were available, a composite outcome of acute myocardial infarction, heart failure, cardiovascular related death, and non-cardiovascular related death was examined. These four events were examined independently as secondary analyses. For analyses including trials for which IPD were not available, myocardial infarction and cardiovascular related death were examined, which were determined from summary level data. Multiple meta-analyses were conducted that accounted for trials with zero events in one or both arms with two different continuity corrections (0.5 constant and treatment arm) to calculate odds ratios and risk ratios with 95% confidence intervals.Results33 eligible trials were identified from ClinicalStudyDataRequest.com for which IPD were available (21 156 patients). Additionally, 103 trials for which IPD were not available were included in the meta-analyses for myocardial infarction (23 683 patients), and 103 trials for which IPD were not available contributed to the meta-analyses for cardiovascular related death (22 772 patients). Among 29 trials for which IPD were available and that were included in previous meta-analyses using GSK’s summary level data, more myocardial infarction events were identified by using IPD instead of summary level data for 26 trials, and fewer cardiovascular related deaths for five trials. When analyses were limited to trials for which IPD were available, and a constant continuity correction of 0.5 and a random effects model were used to account for trials with zero events in only one arm, patients treated with rosiglitazone had a 33% increased risk of a composite event compared with controls (odds ratio 1.33, 95% confidence interval 1.09 to 1.61; rosiglitazone population: 274 events among 11 837 patients; control population: 219 events among 9319 patients). The odds ratios for myocardial infarction, heart failure, cardiovascular related death, and non-cardiovascular related death were 1.17 (0.92 to 1.51), 1.54 (1.14 to 2.09), 1.15 (0.55 to 2.41), and 1.18 (0.60 to 2.30), respectively. For analyses including trials for which IPD were not available, odds ratios for myocardial infarction and cardiovascular related death were attenuated (1.09, 0.88 to 1.35, and 1.12, 0.72 to 1.74, respectively). Results were broadly consistent when analyses were repeated using trials with zero events across both arms and either of the two continuity corrections was used.ConclusionsThe results suggest that rosiglitazone is associated with an increased cardiovascular risk, especially for heart failure events. Although increased risk of myocardial infarction was observed across analyses, the strength of the evidence varied and effect estimates were attenuated when summary level data were used in addition to IPD. Because more myocardial infarctions and fewer cardiovascular related deaths were reported in the IPD than in the summary level data, sharing IPD might be necessary when performing meta-analyses focused on safety.Systematic review registrationOSF Home https://osf.io/4yvp2/.

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