Epicardial fat thickness and biomarkers of inflammation in patients with stable coronary artery disease: correlation with the severity of coronary atherosclerosis

Aim. To study the relationship between the epicardial fat thickness (EFT), biomarkers of inflammation and metabolic dysfunction in patients with coronary artery disease (CAD) and various severity of coronary atherosclerosis.

Material and methods. The study consisted of 89 patients (47 men and 42 women) with stable CAD at the age of 62,2±6,5 years, who assessed the presence and severity of coronary atherosclerosis according to angiography with the calculation of the Gensini Score (GS). We conducted an ultrasonic evaluation of the EFT. We determined the content of glucose, lipid fractions, apoproteins, pro-inflammatory cytokines and adipokines, C-reactive protein by a highly sensitive method (hsCRP).

Results. In the total sample of patients, the median GS index was 13,5 (3,5; 43) points, the median EFT was 4,93 (3,95; 6,0) mm, the median hsCRP was 2,1 (1,02; 3,65) mg/l. There were no correlation relationships between the GS index and the body mass index, waist circumference, EFT, hsCRP, lipid and carbohydrate metabolism in the general group of patients. In the course of linear regression analysis, an independent contribution of hsCRP >2,1 mg/l to the formation of the first two tertiles of a sample of GS values was established (0≤ GS ≤28, paired linear regression hsCRP at GS β=0,55, p=0,0221), whereas in patients with GS values from the third tertile (GS >28 points), the growth of this parameter had an independent association with an increase in the EFT (estimation of the coefficient of paired linear regression of the EFT on GS β=0,56, p=0,0015). The range of hsCRP changes did not affect the value of the β coefficient in paired linear regression models in patients with GS >28 points (n=29) and in the subgroup of patients with GS >28 and hsCRP >2,1 mg/l (n=18).

Conclusion. The absence of an independent association between EFT and minor or moderate severity of atherosclerotic lesions of the coronary arteries (for GS ≤28 points) in patients with CAD, while an independent marker of GS index increase is higher than 2,1 mg/l. An independent contribution to the formation of a severe coronary atherosclerosis (with a GS value of >28 points) is equally made by thickening of EFT, and a moderately elevated level of hsCRP.

1. Jacobellis G. Local and systemic effect of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol.2015;11(6):363-71. doi:10.1038/nrendo.2015.58.

2. Chumakova GA, Veselovskaya NG. Clinical significance of visceral obesity. Moscow: GEOTAR-Media, 2016. p. 200. (In Russ.) ISBN 978-5-9704-3988-3.

3. Meenakshi K, Rajendran M, Srikumar S, et al. Epicardial fat thickness: A surrogate marker of coronary artery disease — Assessment by echocardiography. Indian Heart J.2016;68(3):336-41. doi:10.1016/j.ihj.2015.08.005.

4. Ansari AM, Mohebati M, Pousadegh F, et al. Is echocardiographic epicardial fat thickness increased in patients with coronary artery disease? A systematic review and metaanalysis. Electronic Physician. 2018;10(9):7249-58. doi:10.19082/7249.

5. Habib SS, Al Masri A. Relationship of high sensitivity C-reactive protein with presence and severity of coronary artery disease. J Clin Sci Res.2012;3:126-30. doi:10.15380/2277-5706.jcsr.12.021.

6. Razban MM, Eslami M, Bagherzaden A. The relationship between serum levels of hs-CPR and coronary lesion severity. Clujul Medical. 2016;89(3):352-64. doi:10.15386/cjmed-633.

7. Eltoft A, Arntzen KA, Hansen JB, et al. C-reactive protein in atherosclerosis — A risk marker but not a causal factor? A 13-year population-based longitudinal study: The Tromsø study. Atherosclerosis. 2017;263:293-300. doi:10.1016/j.atherosclerosis.2017.07.001.

8. Lai YH, Yun CH, Yang FS, et al. Epicardial adipose tissue relating to anthropometrics, metabolic derangements and fatty liver disease independently contributes to serum high-sensitivity C-reactive protein beyond body fat composition: a study validated with computed tomography. J Am Soc Echocardiogr. 2012;25(2):234-41. doi:10.1016/j.echo.2011.09.018.

9. Russian experts’ consensus on metabolic syndrome problem in the Russian Federation: definition, diagnostic criteria, primary prevention, and treatment. Cardiovascular Therapy and Prevention. 2010;9(5):4-11. (In Russ.)

10. Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res. 2003;11:304-10. doi:10.1038/oby.2003.45.

11. Caselli C, De Graaf MA, Lorenzoni V, et al. HDL cholesterol, leptin and interleukin-6 predict high risk coronary anatomy assessed by CT angiography in patients with stable chest pain. Atherosclerosis. 2015;241:55-61. doi:10.1016/j.atherosclerosis.2015.04.811.

12. Iwayama T, Nitobe J, Watanabe T, et al. The role of epicardial adipose tissue in coronary artery disease in non-obese patients. J. of Cardiol. 2014;63:344-9. doi:10.1016/j.jjcc.2013.10.002.

13. Chechi K, Blanchard PG, Mathieu P, et al. Brown fat like gene expression in the epicardial fat depot correlates with circulating HDL-cholesterol and triglycerides in patients with coronary artery disease. Int J Cardiol. 2013;167(5):2264-70. doi:10.1016/j.ijcard.2012.06.008.

14. Maimaituxun G, Shimabukuro M, Salim HM, et al. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery. PLoS ONE. 2017;12(6):e0177170. doi:10.1371/journal.pone.0177170.

15. Kologrivova IV, Vinnitskaya IV, Koshelskaya OA, Suslova TE. Visceral obesity and cardiometabolic risk: features of hormonal and immune regulation. Obesity and metabolism. 2017;14(3):3-10. (In Russ.) doi:10/14341/OMET201733-10.