May hepatic steatosis be associated with gynecomastia and epicardial fat? A retrospective study of 599 male patients

Objective There is no study in the literature investigating the association of hepatic steatosis with both gynecomastia and epicardial fat thickness together. We aimed to determine the correlations between hepatic steatosis through liver density, gynecomastia and epicardial fat thickness in patients undergoing CT scans due to suspected COVID-19 symptoms. Methods A total of 599 male patients who underwent chest CT scans due to a presumed diagnosis of COVID-19 in our radiology clinic were included in the study. Patients’ age, diameters of the subareolar glandular tissues of the right and left breasts, the right retroareolar fatty tissue, liver and spleen density, epicardial fat thickness and biochemical parameters were recorded and analyzed. The laboratory analyses were performed according to the standard methods. Results The mean age of the patients was 47.21±15.00 years. The left subareolar tissue thickness and the right retroareolar fatty tissue thickness that are used to indicate the presence of gynecomastia were found to be significantly correlated with liver density in negative direction (r=-.137, p<0.001; r=-.172, p<0.001; respectively). Epicardial fat thickness was statistically significantly correlated with right subareolar tissue thickness (r=.085, p=0.037), left subareolar tissue thickness (r=.101, p=0.014) and right retroareolar fatty tissue thickness (r=.148, p<0.001). Conclusion The results of this study showed that gynecomastia was significantly correlated with both age and hepatic steatosis. Epicardial fat thickness was also associated with liver steatosis. We demonstrated the significant correlations between epicardial fat thickness and gynecomastia for the first time. Nevertheless, our results need to be confirmed by further comprehensive studies.

Correlation between epicardial fat thickness with intima–media thickness and ankle–brachial index in patients with metabolic syndrome

Background An increase in epicardial fat thickness (EFT) has been associated with increased cardiovascular risk and the development of atherosclerosis. Transthoracic echo-cardiography provides a reliable measurement of EFT. We evaluated the relationship of EFT with carotid intima–media thickness (CIMT) and ankle–brachial index (ABI), in patients with metabolic syndrome. Methods We assessed 80 patients with metabolic syndrome who underwent echocardiography; EFT was measured by two cardiologists. The CIMT (B-mode colour imaging of extracranial carotid arteries using high-resolution ultrasound) was also measured by a certified ultrasonographer, and ABI was measured by the main researcher. Results We did not find any correlation between ABI with EFT (r=0.0103, p=0.93) or with CIMT (r=–0.1625, p=0.15). However, we found a significant correlation between EFT and CIMT (r=0.2718, r2=0.074, p=0.015). When we evaluated the risk for a CIMT >0.9 mm in patients with an EFT >3 mm, we found a statistically significant association (p=0.039). Interestingly, only 1 patient with an EFT <3 mm had a CIMT >0.9 mm. Conclusion We found that the EFT correlates with CIMT in patients with metabolic syndrome, which explains, at least in part, the higher risk of atherosclerosis in them. Measurement of EFT should be part of the cardiovascular risk evaluation in patients with metabolic syndrome.

Epicardial adipose tissue and nonvalvular atrial fibrillation

Background Several studies revealed the relationship between epicardial fat tissue (EF) and development of atrial fibrillation (AF). Though pathophysiological mechanisms are not clear enough, the anatomy and location EF as a part of visceral adiposity tissue could lead to proinflammatory and fibrotic changes in atrial myocardium. Purpose To evaluate the paracrine effects of EF and detect the association of tissue Doppler imaging (TDI) parameters, EF thickness by cardiac magnetic resonance tomography (CMR) and biochemical markers of fibrosis and inflammation in patients with nonvalvular AF without concomitant coronary artery disease. Methods Thirty-nine patients with idiopathic paroxysmal AF, normal or slightly enlarged left atria (LA) (mean LA diameter 4,5±0,6cm) were included. The mean age was 50,8±13,9 y.o., 19 (49%) were men. The absence of coronary lesions was confirmed by angiography in all cases. Besides standard ECG and ECHO, all patients underwent TDI and CMR with late gadolinium enhancement. EP thickness at anterior left ventricular (LV) wall was estimated by CMR. The myocardial fibrotic and proinflammatory biomarkers levels - matrix metalloproteinases (MMP-2, MMP-9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were estimated. Kendall rank correlation coefficient was used. If the |τ| &gt;Tcr, the correlation ranked as statistically significant. Results The epicardial fat thickness was associated with TIMP-1 plasma level (τ=0,71; Tcr=0,18) and MMP-9 (τ=0,65; Tcr=0,16). Among clinical factors weight was slightly associated with fat thickness (τ=0,33; Tcr=0,26). Besides, we found correlation of MMP-9, TIMP-1 with E/e' by TDI (τ=0,65; Tcr=0,16 and τ=0,56; Tcr=0,21, relatively); and with maximal systolic strain of lateral LV wall (τ=−0,37; Tcr=0,18 and τ=−0,44; Tcr=0,16, relatively) and interventricular septum (τ=−0,36; Tcr=0,18 and τ=−0,44; Tcr=0,16, relatively). Conclusion The epicardial fat thickness by CMR is significantly associated with myocardial fibrosis markers (MMP-9, TIMP-1) in patients with AF without structural heart disease. The increasing levels of MMP-9 and TIMP-1 are associated with LV local contractility disturbances by TDI in patients with AF. This association demonstrates the paracrine effect of EF, which could lead to atrial remodeling and formation AF substrate even in patients without valvular and ischemic heart disease and with normal or slightly enlarged LA FUNDunding Acknowledgement Type of funding sources: None.

Optimization of change in epicardial fat thickness for obese patients who lost weight via the bariatric surgery method using central composite and Box-Behnken experimental designs

Background The aim of this study was to detect the optimal values for Age, Body Mass Index (BMI) and HOMA-IR of obese patients prior to surgery that results in a maximal decrease of visceral fat mass 6 months after bariatric surgery. Method In this study, 33 experimental set-ups were designed. This study was approved by Baskent University Medical and Health Sciences Research Board (Approval number: KA16/281). The study data consisted of 40 obese patients who lost weight through the bariatric surgery between February 2015 and December 2016. The values of BMI, Age and HOMA for the obese patients who lost weight through the bariatric surgery were evaluated in three categories and at three levels; the response variable was determined as the Change in Epicardial Fat Thickness (ΔEFT). Results As a result of CCD analysis, the optimum ΔEFT = 2.571 was determined when Age = 30.52, BMI = 45.30, and HOMA = 34.62. As a result of the BBD analysis, the optimum ΔEFT = 3.756 was determined, when Age = 38.36, BMI = 63.18, and HOMA = 14.95. The optimum ΔEFT was modeled with Contour and Response Surface plots. Conclusion Based on the two surface response models used in our study, the maximal decrease of visceral fat mass as assessed by measuring echography images of epicardial fat thickness can be obtained by bariatric surgery of persons who are between 31 and 38 year old, have a BMI between 45 and 63 kg/m2 and have a HOMA-IR 34 between 15 and 35. Central Composite Design and a Box-Behnken Design of suitable patient data predicted 35 optimal settings of independent variables for the maximal clinical response of an intervention.

Epicardial fat thickness in infants of diabetic mothers

BACKGROUND: Epicardial fat thickness (EFT) in adults and children has been related to the metabolic syndrome and other cardiovascular risk factors; however, scarce studies have evaluated it in infants of diabetic mothers (IDM) in whom, alterations in the thickness of the interventricular septum have been reported. This study compares the EFT in IDM versus infants of non-diabetic mothers (INDM) and its association with others echocardiographic parameters. METHODS: We performed a cross sectional study in 93 infants (64 IDM and 29 INDM). To evaluate EFT dimensions, an echocardiogram was performed within the first 24h of extrauterine life in both groups. In diabetic mothers, HbA1c was also determined. RESULTS: There was no significant difference in birth weight between the groups although gestational age was lower in IDM. The EFT (3.6 vs. 2.5 mm, p < 0.0001), the interventricular septum thickness (IVST) (6.2 vs. 5.2 mm, p < 0.0001) and the IVST / left ventricle posterior wall (1.3 vs. 1.1, p = 0.001) were higher in the IDM; while the left ventricular expulsion fraction [LVFE] (71.1 vs. 77.8; p < 0.0001) was lower than in the INDM, respectively. We found a positive correlation between EFT with IVST (r = 0.577; p = 0.0001), LVPW (r = 0.262; p = 0.011), IVST/LVPW index (r = 0.353; p = 0.001), and mitral integral early velocity (r = 0.313; p = 0.002), while a negative correlation with LVFE was observed (r = –0.376; p = 0.0001). CONCLUSIONS: The EFT is higher in IDM than in INDM. It was positively related with echocardiographic parameters of left ventricular thickness and negatively with left ventricular ejection function.

Association of epicardial fat thickness with left ventricular diastolic function parameters in a community population

Background We examined the relationship between epicardial fat thickness (EFT) measured by echocardiography and left ventricular diastolic function parameters in a Beijing community population. Methods We included 1004 participants in this study. Echocardiographic parameters including E and A peak velocity, the early diastolic velocities (e′) of the septal and lateral mitral annulus using tissue doppler imaging, E/e′, and EFT were measured. EFT1 was measured perpendicularly on the right ventricular free wall at end diastole in the extension line of the aortic root. EFT2 was the maximum thickness measured perpendicularly on the right ventricular free wall at end diastole. Multivariable linear regression was used to analyze the relationship between EFT and the mean e′ and E/e′. Results The mean age of the participants was 63.91 ± 9.02 years, and 51.4% were men. EFT1 and EFT2 were negatively correlated with lateral e′, septal e′, and mean e′ (p < 0.05), and the correlation coefficient for EFT1 and EFT2 and mean e′ was − 0.138 and − 0.180, respectively. EFT1 and EFT2 were positively correlated with lateral E/e′, septal E/e′, and mean E/e′ (p < 0.05), and the correlation coefficient for EFT1 and EFT2 and mean e′ was 0.100 and 0.090, respectively. Multivariable egression analysis showed that EFT2 was independently and negatively associated with e′ mean (β = − 0.078 [95% confidence interval = − 0.143, − 0.012, p = 0.020]). There were no interactions between EFT2 and any covariates, including age or heart groups, sex, BMI, or presence of hypertension, diabetes, or coronary heart disease, in relation to left ventricular diastolic dysfunction. Conclusions EFT2 was negatively and independently associated with e′ mean, which suggests that more attention to this type of adipose fat is required for cardiovascular disease therapy.

Biomarkers of inflammation, parameters characterizing obesity and cardiac remodeling in patients with atrial fibrillation and metabolic syndrome

Aim. To determine the blood level of inflammatory markers, parameters characterizing obesity and cardiac remodeling in patients with atrial fibrillation (AF) in combination with metabolic syndrome (MS).Material and methods. This single-stage case-control study included 677 subjects aged 35 to 65 years: patients with MS (n=407), of which 128 patients with AF; comparison group — patients with AF without MS (n=75); control group — practically healthy subjects without cardiovascular diseases and metabolic disorders (n=195).Results. It was found that the blood concentration of circulating pro-inflammatory biomarkers in patients with AF and MS is higher than in patients with AF without MS: C-reactive protein (CRP) (4,43 (2,68-4,98) and 2,33 (1,08-4,7) mg/L, p<0,0001), interleukin-6 (IL-6) (2,5 (1,28-5,13) and 1,27 (0,68-2,7) pg/ml, p<0,0001) and tumor necrosis factor-α (TNF-α) (5,18 (2,63-7,32) and 3,42 (2,115,48) pg/ml, p<0,0001). The serum CRP concentration positively correlates with left (ρ=0,451, p<0,0001) and right atrial (ρ=0,412, p<0,000) volumes, as well as with the waist circumference (ρ=0,503, p<0,001) and epicardial fat thickness (ρ=0,550, p<0,001). Plasma IL-6 and serum TNF-α levels correlated to a lesser extent with parameters characterizing atrial remodeling, but had a strong positive relationship with epicardial fat thickness. According to multivariate analysis, it was found that an increase in the epicardial fat thickness had a greater effect on an increase in blood concentration of CRP, IL-6 and TNF-α, in contrast to other parameters characterizing obesity, such as body mass index and waist circumference.Conclusion. An increase in the blood concentration of proinflammatory biomarkers CRP, IL-6, and TNF-α is associated with cardiac remodeling and epicardial fat thickness in patients with MS and probably has a pathogenetic role in increasing the AF risk in this cohort of patients.