THE ROLE OF EPICARDIAL OBESITY IN THE DEVELOPMENT OF STRUCTURAL AND FUNCTIONAL REMODELING OF THE HEART

Aim. To perform the comparison of the heart structural and functional parameters in abdominal obesity patients depending on the presence epicardial fat tissue verified by echocardiographically defined thickness of the fat deposition.

Material and methods. Totally, 108 normotensive males included, with no clinical signs of cardiovascular diseases, age 46-55 y. o. (mean age 48,7±2,0 y. o.), with abdominal obesity (waist circumference >94 cm). The assessment included lipid profile and glycemia, echocardiography, bifunctional ambulatory blood pressure monitoring with the assessment of pulse wave velocity (PWV) in aorta, and augmentation index.

Results. Epicardial obesity patients had higher left ventricle (LV) myocardial mass index (119,4±8,9 g/m2 vs 100,4±15,9 g/m2, р<0,001, 47,9±5,3 g/m2,7 vs 39,2±6,7 g/m2,7, р<0,001), index of the relative LV walls thickness (0,42±0,03 vs 0,39±0,04, р<0,01), index of the left atrium volume (22,3±3,4 mL/m2 vs 20,1±2,2 mL/m2, р<0,01), PWV in aorta (8,4±0,4 m/s vs 7,6±0,4 m/s, р<0,001) and augmentation index (-39,4±12,2% vs -46,3±10,6%, р<0,01). In the group of epicardial obesity patients there was more prevalentLV hypertrophy (25,9% (33,3%) vs 6,2% (7,4%), р<0,01) and echo signs of diastolicLV dysfunction (74,8% vs 11,1%, р<0,01).

Conclusion. The association revealed, of the epicardial obesity defined by echo assessment of epicardial fat thickness, with parameters of structural and functional remodeling of the heart. Epicardial obesity patients have higher indexed values ofLV myocardial mass and left atrium volume, more prevalent hypertrophy and diastolicLV dysfunction, which does, probably, underlie the development of chronic heart failure and rhythm disorders.

1. Finucane M, Stevens G, Cowan M et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9,1 million participants. Lancet 2011; 377:557–67.

2. Kim S, Despres J, Koh K. Obesity and cardiovascular disease: friend or foe? European Heart Journal 2016; 37:3560–8.

3. Chumakova GA, Veselovskaya NG, Kozarenko AA. Heart morphology, structure, and function in obesity. Russ J Cardiol 2012; 4(96):93–9. Russian (Чумакова Г.А., Веселовская Н.Г., Козаренко А.А. Особенности морфологии, структуры и функции сердца при ожирении. Российский кардиологический журнал 2012; 4(96):93–9).

4. Neeland I, Gupta S, Ayers C et al. Relation of regional fat distribution to left ventricular structure and function. Circ Cardiovasc Imaging 2013; 6:800–7.

5. Iacobellis G, Willens Н. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009; 23:1311–9.

6. Salazar J, Luzardo E, Mejías J et al. Epicardial fat: physiological, pathological, and therapeutic implications. Cardiology Research and Practice 2016. http://dx.doi.org/10.1155/2016/1291537.

7. Iacobellis G, Bianco А. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends in Endocrinology and Metabolism 2011; 22(11):450–7.

8. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Hypertension 2013; 31:1281–357.

9. Lang R, Badano L, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1–39.

10. Aurigemma G, De Simone G, Fitzgibbons T. Cardiac Remodeling in Obesity. Circ Cardiovasc Imaging 2013; 6:142–2.

11. Nazare J, Smith J, Borel A et al. Usefulness of measuring both body mass index and waist circumference for the estimation of visceral adiposity and related cardiometabolic risk profile (from the INSPIRE ME IAA study). Am J Cardiol 2015; 115:307–15.

12. Matloch Z, Kotulak T, Haluzik M. The Role of Epicardial Adipose Tissue in Heart Disease. Physiol Res 2016; 65:23–32.

13. Malavazos A, Di Leo G, Secchi F et al. Relation of echocardiographic epicardial fat thickness and myocardial fat. Am J Cardiol 2010; 105:1831–5.

14. Morelli M, Gaggini M, Daniele G et al. Ectopic fat: the true culprit linking obesity and cardiovascular disease? Thromb Haemost 2013; 110:651–60.

15. Druzhilov MA, Kuznetsova TYu. Visceral obesity as risk factor of early vascular aging. Cardiologiia 2016; 2(56):52–6. Russian (Дружилов М.А., Кузнецова Т.Ю. Висцеральное ожирение как фактор риска раннего сосудистого старения. Кардиология 2016; 2(56):52–6).