THE “EXTRA-MEDIA” THICKNESS OF CAROTID ARTERIES AS A NOVEL MARKER OF PERIVASCULAR VISCERAL ADIPOUS TISSUE: ACCENT ON THE RELATION WITH VASCULAR REMODELLING PARAMETERS

Aim. To perform ultrasound assessment of the “extra-media” thickness (EMT) of carotid arteries and to analyze its association with vascular stiffness and sonographical indexes of carotid arteries condition in patients with abdominal obesity.

Material and methods. Totally, 84 normotensive men assessed, non-sympthomatic by cardiovascular diseases and with non high risk by SCORE (mean age 44,7±4,2 y.) with abdominal obesity. We performed triplex scanning of brachiocephalic arteries with measurement of carotid EMT, echocardiographical measurement of epicardial fat and ultrasound assessment of abdominal visceral fat tissue; bifunctional 24-hour monitoring of blood pressure.

Results. Carotid EMT was from 0,3 mm to 0,8 mm (mean 0,43±0,12 mm). Linear correlation coefficient of the parameter was 0,49 for the age (p<0,001), for body mass index 0,47 (p<0,001), for waist circumference 0,32 (p<0,01), for epicardial fat 0,71 (p<0,001), for abdominal visceral fat 0,48 (p<0,001), for fasting glucose 0,35 (p<0,001), for high-sensitive C-reactive protein of blood 0,42 (p<0,001), for carotid intima-media 0,41 (p<0,001), for aortic pulse wave velocity 0,56 (p<0,001). Significantly higher EMT of carotid arteries were found in patients with carotid atherosclerosis (0,63±0,08 mm vs 0,39±0,08 mm, р<0,001), increase of carotid “intima-media” thickness (0,49±0,12 mm vs 0,41±0,12 mm, р<0,01) and high levels of pulse wave velocity in aorta (0,51±0,12 mm vs 0,38±0,10 mm, р<0,001).

Conclusion. The EMT correlation revealed, for carotid arteries with the age, indirect and direct markers of visceral obesity, metabolic risk factors, vascular remodeling parameters. Carotid atherosclerosis patients, with intima-media hypertrophy, increased vessel stiffness had higher levels of this perivascular visceral fat tissue marker.

1. Pischon T, Boeing H, Hoffmann K. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359:2105–20.

2. Almabrouk T, Ewart M, Salt I et al. Perivascular fat, AMP-activated protein kinase and vascular diseases. British Journal of Pharmacology 2014; 171:595–617.

3. Thalmann S, Meier C. Local adipose tissue depots as cardiovascular risk factors. Cardiovascular Research 2007; 75:690–701.

4. Verhagen S, Buijsrogge M, Vink A et al. Secretion of adipocytokines by perivascular adipose tissue near stenotic and non-stenotic coronary artery segments in patients undergoing CABG. Atherosclerosis 2014; 233:242–7.

5. Lehman S, Massaro J, Schlett C et al. Peri-aortic fat, cardiovascular disease risk factors, and aortic calcification: the Framingham Heart Study. Atherosclerosis 2010; 210:656–61.

6. Skilton M, Sérusclat A, Sethu A et al. Noninvasive measurement of carotid extra-media thickness: associations with cardiovascular risk factors and intima-media thickness. JACC Cardiovasc Imaging 2009; 2(2):176–82.

7. Falk E, Thim T, Kristensen I. Atherosclerotic Plaque, Adventitia, Perivascular Fat, and Carotid Imaging. JACC Cardiovasc Imaging 2009; 2(2):183–6.

8. Haberka M, Sosnowski M, Zuziak-pruska J et al. Extra-media thickness and epicardial fat: Comparison of a novel carotid artery ultrasound index and a well-established cardiac magnetic resonance fat quantification method. Nutr Metab Cardiovasc Dis 2015; 25(8):763–70.

9. Haberka M, Gąsior Z. Carotid extra-media thickness in obesity and metabolic syndrome: a novel index of perivascular adipose tissue: extra-media thickness in obesity and metabolic syndrome. Atherosclerosis 2015; 239(1):169–77.

10. 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.

11. Iacobellis G, Ribaudo M, Assael F et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003; 88(11):5163–68.

12. Vlachos I, Hatziioannou A, Perelas A et al. Sonographic Assessment of Regional Adiposity. American Journal of Roentgenology 2007; 189:1545–53.

13. Posokhov IN. Pulse wave velocity 24-hour monitoring with one-site measurements by oscillometry. Medical Devices: Evidence and Research 2013; 6:11–5.

14. Sugawara J, Hayashi K, Tanaka H et al. Carotid–femoral pulse wave velocity: Impact of different arterial path length measurements. Artery Research 2010; 4:27–31.

15. Druzhilov MA, Beteleva YuE, Kuznetsova TYu. Epicardial adipose tissue thickness – an alternative to waist circumference as a stand-alone or secondary main criterion in metabolic syndrome diagnostics? Russ J Cardiol 2014; 3(107):76–81. Russian (М.А. Дружилов, Ю.Е. Бетелева, Т.Ю. Кузнецова. Толщина эпикардиального жира – альтернатива окружности талии как самостоятельный или второй основной критерий для диагностики метаболического синдрома? Российский кардиологический журнал 2014; 3(107):76–81).