Echocardiographic association of epicardial fat thickness with aortic velocity propagation and carotid intima-media thickness in patients with type 2 diabetes mellitus
ZHANG Hong1, DING Qin2, NING Ning2, LV Jiannan1, WU Xiaowei1
1.Department of Ultrasound Imaging, 2.Department of Endocrinology and Hematology, Characteristic Medical Center of the Chinese People's Armed Police Force, Tianjin 300162, China
Abstract:Objective To find out whether the parameters of epicardial fat thickness (EFT)are associated with aortic velocity propagation (AVP) and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM).Methods Forty-one cases of T2DM who were over 18 years old, left their coronary heart disease undiagnosed but were treated in the Department of Endocrinology and Hematology between November 2019 and June 2020 were selected as the T2DM group,while another 37 non-diabetic patients were enrolled as the control group. EFT and AVP of all these subjects were determined using the echocardiographic method and CIMT was calculated ultrasonographically.Results EFT [(8.41±1.62)mm] and CIMT[(0.93±0.21)mm] in the T2DM group was significantly higher than in the control group [(6.32±2.19)mm, (0.53±0.11)mm],while AVP[ (28.21±16.03)mm] was significantly lower[(58.12±17.49)mm].Correlation analysis showed that EFT was negatively correlated with AVP (r=-0.339, P=0.001), but positively with CIMT (r=0.415, P<0.001). AVP was negatively correlated with CIMT (r=-0.629, P<0.001). Stepwise linear regression analysis showed that CIMT was an independent predictor of EFT(β1=3.255, 95% CI:1.775-4.739, P=0.001) and AVP (β2=-30.868, 95% CI:-45.805--15.932, P< 0.001). ROC curve analysis showed that EFT 7.2 mm and CIMT 0.66 mm were effective cut-off points of subclinical atherosclerosis in diabetic patients, with a sensitivity of 75.8% and 92.5%, and a specificity of 71.1% and 78.2%, respectively.Conclusions The levels of EFT and CIMT are higher while that of AVP is lower in T2DM patients. EFT and AVP are significantly correlated with CIMT, respectively. EFT and CIMT can be used as reliable indicators for evaluation of subclinical atherosclerosis in T2DM patients.
Li Y, Liu B, Li Y, et al. Epicardial fat tissue in patients with diabetes mellitus: a systematic review and meta-analysis [J]. Cardiovasc Diabetol, 2019, 18(1): 3.
[2]
Iacobellis G, Bianco A C. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features [J]. Trends Endocrinol Metab,2011,22(11):450-457.
[3]
Gorter P M, Van Lindert A S R, De Vos A M, et al. Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease[J]. Atherosclerosis, 2008, 197(2): 896-903.
[4]
Kim B J, Kim B S, Kang J H. Echocardiographic epicardial fat thickness is associated with arterial stiffness[J]. Int J Cardiol, 2013, 167(5): 2234-2238.
[5]
Christensen R H, Von Scholten B J, Lehrskov L L, et al. Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes?[J]. Ther Adv Endocrinol Metab, 2020, 11: 2042018820928824.
[6]
Lusis A J. Atherosclerosis[J]. Nature, 2000, 407(6801): 233-241.
[7]
Naqvi T Z, Lee M S. Carotid intima-media thickness and plaque in cardiovascular risk assessment[J]. JACC Cardiovasc Imaging, 2014, 7(10):1025-1038.
[8]
Ghaderi F, Samim H, Keihanian F, et al. The predictive role of aortic propagation velocity for coronary artery disease [J]. BMC Cardiovasc Disord, 2018, 18(1):121.
[9]
AsoGlu R, ÖzdemÍr M, AladaG N, et al. Evaluation of epicardial adipose tissue by echocardiography and its correlation with aortic velocity propagation and carotid intima-media thickness in patients of type 2 diabetes mellitus[J]. An Acad Bras Cienc, 2020, 92(4): e20191457.
Iacobellis G, Malavazos A E, Corsi M M. Epicardial fat: from the biomolecular aspects to the clinical practice[J]. Int J Biochem Cell Biol, 2011,43(12):1651-1654.
[12]
Roumeliotis A, Roumeliotis S, Panagoutsos S, et al. Carotid intima-media thickness is an independent predictor of all-cause mortality and cardiovascular morbidity in patients with diabetes mellitus type 2 and chronic kidney disease[J]. Ren Fail, 2019, 41(1): 131-138.
[13]
Wang Z, Zhang Y, Liu W, et al. Evaluation of epicardial adipose tissue in patients of type 2 diabetes mellitus by echocardiography and its correlation with intimal medial thickness of carotid artery[J]. Exp Clin Endocrinol Diabetes, 2017, 125(9): 598-602.
[14]
Talman A H, Psaltis P J, Cameron J D, et al. Epicardial adipose tissue: far more than a fat depot[J]. Cardiovasc Diagn Ther, 2014, 4(6): 416-429.
[15]
Ansaldo A M, Montecucco F, Sahebkar A, et al. Epicardial adipose tissue and cardiovascular diseases[J]. Int J Cardiol, 2019, 278: 254-260.
[16]
Kim H M, Kim K J, Lee H J, et al. Epicardial adipose tissue thickness is an indicator for coronary artery stenosis in asymptomatic type 2 diabetic mellitus patients: its assessment by cardiac magnetic resonance[J]. Cardiovasc Diabetol, 2012, 11: 83.
[17]
Hirata Y, Kusunose K, Yamada H, et al. Detection of coronary artery stenosis by epicardial adipose tissue thickness in type 2 diabetes mellitus [J]. Circulation, 2017, 136(Supp11): A17288.
[18]
Kumar P V, Kannan K, Kumar S R, et al. Epicardial adipose tissue thickness, carotid intima-media thickness and total cholesterol/HDL ratio-A combined cut off for detecting coronary artery disease[J]. J In Coll Cardiol, 2018, 8(2): 73-79.
[19]
Mandal P K, Pramanik S, Mondal K, et al. Epicardial fat thickness and carotid intima-media thickness in patients with type 2 diabetes mellitus[J]. Asian J Med Sci, 2016, 7(6): 1-5.
[20]
Cetin M, Cakici M, Polat M, et al. Relation of epicardial fat thickness with carotid intima-media thickness in patients with type 2 diabetes mellitus [J]. Int J Endocrinol, 2013, 2013: 769175.
[21]
Mahfouz B H, Elnoamany M. Impact of type 2 diabetes mellitus on aortic elastic properties in normotensive diabetes: Doppler tissue imaging study [J]. J Am Soc Echocardiogr, 2006, 19(12): 1471-1481.