Diastolic dysfunction in patients with acute coronary pathology in the presence of an increase in epicardial adipose tissue

DOI: https://doi.org/10.29296/25877305-2022-09-09
Issue: 
9
Year: 
2022

A. Davydova(1); Professor V. Nikiforov(2), MD; Professor Yu. Khalimov(3), MD
1-A.S. Lukashevsky Kamchatka Territorial Hospital, Petropavlovsk-Kamchatsky
2-I.I. Mechnikov North-Western State Medical University, Ministry of Health
of Russia, Saint Petersburg
3-S.M. Kirov Military Medical Academy, Ministry of Defense of Russia;
Saint Petersburg

Objective. To evaluate diastolic disturbances in patients with unstable angina (UA) in the presence of an increase in epicardial adipose tissue (EAT). Subjects and methods. The investigation involved 64 men and 38 women (mean age, 61.2±7.6 years) with UA treated in the emergency cardiology unit. The patients were examined; standard laboratory parameters were determined, coronary angiography (CAG) and stenting of one or more coronary arteries were performed on days 1–3 of hospitalization. Echocardiography (EchoCG) with measurement of EAT thickness (EATT) was done at 2–4 days after CAG. EAT was measured from the parasternal position along the long and short axes of the left ventricle (LV) at the end of systole during 3 cardiac cycles; the average of three successive values was taken as the EATT value. According to EATT, the patients were divided into 2 groups: 1) 46 patients who had an EATT of ≤7.6 mm; 2) 56 patients who had an EATT of >7.6 mm. Results. Analysis of anamnestic and anthropometric data showed no significant differences between the groups, with the exception of waist-to-hip ratio (higher in Group 1; p=0.0026). EchoCG revealed heart failure with preserved LV ejection fraction (EF); however, LV EF had lower values in Group 2 than in Group 1 (55 [51–59]% versus 58 [53–60]%; p=0.031). There was a significant decrease in the following indicators of diastolic function (DF) in Group 2 compared to Group 1: lateral Em was 6.5 (4.2–8.1) versus 9.3 (6.5–11.1) cm/s (p

Keywords: 
cardiology
diastolic dysfunction
acute coronary syndrome
unstable angina
epicardial adipose tissue
obesity
echocardiography



References: 
  1. Barbarash O.L., Duplyakov D.V., Zateischikov D.A. et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021; 26 (4): 4449 (in Russ.). DOI: 10.15829/1560-4071-2021-4449
  2. Collet J.P., Thiele H., Barbato E. et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021; 42 (14): 1289–367. DOI: 10.1093/eurheartj/ehaa575
  3. Shao C., Wang J., Tian J. et al. Coronary Artery Disease: From Mechanism to Clinical Practice. Adv Exp Med Biol. 2020; 1177: 1–36. DOI: 10.1007/978-981-15-2517-9_1
  4. Davydova A.V., Nikiforov V.S, Khalimov Yu.S. Thickness of epicardial adipose tissue as a predictor of cardiovascular risk. Consilium Medicum. 2018; 20 (10): 91–4 (in Russ.). DOI: 10.26442/2075-1753_2018.10.91-94
  5. Iacobellis G., Willens H. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr. 2009; 22 (12): 1311–9; quiz 1417–8. DOI: 10.1016/j.echo.2009.10.013
  6. Iacobellis G., Assael F., Ribaudo M. et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res. 2003; 11 (2): 304–10. DOI: 10.1038/oby.2003.45
  7. Villasante Fricke A., Iacobellis G. Epicardial Adipose Tissue: Clinical Biomarker of Cardio-Metabolic Risk. Int J Mol Sci. 2019; 20 (23): 5989. DOI: 10.3390/ijms20235989
  8. Nikiforov V.S., Novikov V.I., Chekina N.M. et al. Echocardiographic assessment of systolic and diastolic heart functions. SPb: KultInformPress, 2017; 36 p. (in Russ.).
  9. Jadhav S.N., Radchenko V.G., Seliverstov P.V. et al. Importance of insulin resistance in patients with nonalcoholic fatty liver disease and diastolic dysfunction of the heart. Preventive and clinical medicine. 2019; 2 (71): 52–9.
  10. Khabibulina M. Therapy for cardiac remodeling in young men with hypertension, androgen deficiency, and dyslipidemia. Vrach. 2019; 30 (3): 44–9. DOI: 10.29296/25877305-2019-03-09
  11. Koepp K., Obokata M., Reddy Y. et al. Hemodynamic and Functional Impact of Epicardial Adipose Tissue in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail. 2020; 8 (8): 657–66. DOI: 10.1016/j.jchf.2020.04.016
  12. Dedov D.V., Ivanov A.P., Elgardt I.A. Electro-mechanical heart remodelling and atrial fibrillation development in patients with coronary heart disease and arterial hypertension. Russian Journal of Cardiology. 2011; 4: 13–8 (in Russ.).
  13. Russo R., Di Iorio B., Di Lullo L. et al. Epicardial adipose tissue: new parameter for cardiovascular risk assessment in high-risk populations. J Nephrol. 2018; 31 (6): 847–53. DOI: 10.1007/s40620-018-0491-5
  14. Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol. 2015; 11 (6): 363–71. DOI: 10.1038/nrendo.2015.58
  15. Vural M., Talu A., Sahin D. et al. Evaluation of the relationship between epicardial fat volume and left ventricular diastolic dysfunction. Jpn J Radiol. 2014; 32 (6): 331–9. DOI: 10.1007/s11604-014-0310-4
  16. Nakanishi K., Fukuda S., Tanaka A. et al. Relationships Between Periventricular Epicardial Adipose Tissue Accumulation, Coronary Microcirculation, and Left Ventricular Diastolic Dysfunction. Can J Cardiol. 2017; 33 (11): 1489–97. DOI: 10.1016/j.cjca.2017.08.001