Эпикардиальная жировая ткань как маркер висцерального ожирения и ее связь с метаболическими параметрами и ремоделированием левых отделов сердца у лиц молодого возраста с абдоминальным ожирением
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Blinova N.V., Azimova M.O., Zhernakova Y.V., et al. Epicardial adipose tissue as a marker of visceral obesity and its association with metabolic parameters and remodeling of the left chambers of the heart in young people with abdominal obesity. Therapeutic Archive. 2019; 91 (9): 68–76. DOI: 10.26442/00403660.2019.09.000334
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Материалы и методы. В исследование включено 80 пациентов с абдоминальным ожирением без сердечно-сосудистых заболеваний и сахарного диабета. Всем измеряли окружность талии, определяли индекс массы тела, метаболические параметры в крови, проводили суточное мониторирование АД, эхокардиографию, МСКТ. Для анализа сформированы 2 группы: I (n=28) – пациенты с изолированным абдоминальным ожирением, без метаболического синдрома, средний возраст которых составил 37,5±6,43 года; II (n=52) – пациенты с метаболическим синдромом, средний возраст – 38,8±5,88 года. В контрольную группу 0 вошли здоровые лица (n=13) без ожирения, средний возраст – 30,5±5,97 года.
Результаты. Выявлены корреляционные связи объема ЭКЖ с уровнем инсулина в крови (r=0,2937, р<0,05), НОМА-IR (r=0,3068, р<0,05), обратная корреляционная связь объема ЭКЖ с холестерином липопротеинов высокой плотности (r=–0,2328, р<0,05). Объем ЭКЖ коррелировал со средним диастолическим АД в ночное время (r=0,2270, р<0,05). Достоверная связь объема ЭКЖ выявлена с размером левого предсердия (r=0,3907, р<0,05), массой миокарда левого желудочка (r=0,4566, р<0,05), индексом массы миокарда левого желудочка (r=0,2700, р<0,05), относительной толщиной стенок левого желудочка (r=0,2991, р<0,05). Объем ЭКЖ коррелировал с объемом интраабдоминальной жировой ткани (r=0,6330, р<0,05), обратная корреляционная связь – с отношением объема подкожного жира к висцеральному (r=–0,4236, р<0,05).
Заключение. В представленном исследовании объем ЭКЖ ассоциировался с индексом инсулинорезистентности, метаболическими показателями и параметрами ремоделирования левых отделов сердца у лиц молодого возраста с абдоминальным ожирением. Учитывая выявленную корреляцию ЭКЖ с интраабдоминальной жировой тканью, ЭКЖ может рассматриваться как маркер висцерального ожирения.
Ключевые слова: метаболически здоровое ожирение, метаболический синдром, локальные эктопические жировые депо, эпикардиальная жировая ткань, артериальная гипертония, сердечно-сосудистый риск.
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Aim: to study the correlation of epicardial adipose tissue (EAT) with metabolic parameters, 24-hours profile of blood pressure (BP) and left ventricular remodeling, with the volume of intraabdominal adipose tissue (IAAT), measured by multislice computed tomography (MSCT) in patients with abdominal obesity and metabolic syndrome.
Materials and methods: the study included 80 participants with abdominal obesity (waist circumference > 80 cm in women and >94 cm in men) and without cardiovascular diseases and diabetes. Within this study the following examinations were performed: waist circumference and the body mass index measurement, blood sampling and measurements of lipid levels, uric acid, fasting glucose, insulin, HOMA index, 24-hour ambulatory blood pressure monitoring. Left ventricular (LV) mass index, relative wall thickness, LV mass/height index were estimated from echocardiographic data. EAT volume and IAAT was measured by MSCT. All patients was devided in two groups for analysis: 1 (n=28) – patients with isolated abdominal obesity, without metabolic syndrome, age was 37.5±6.43 years; 2 (n=52) – patients with metabolic syndrome, age – 38.8±5.88 years. The control group 0 included healthy individuals (n=13) without obesity, age was 30.5±5.97 years.
Results. A positive correlation was found between the volume of EAT with the level of insulin in the blood (r=0.2937, p<0.05), HOMA-IR (r=0.3068, p<0.05), negative correlation – with high density lipoproteins cholesterol (HDL cholesterol; r=–0.2328, p<0.05). The EAT volume correlated with mean diastolic blood pressure at night (r=0.2270, p<0.05). Quantitative analysis by cardiac parameters showed that EAT volume had correlation with the size of the left atrium (r=0.3907, p<0.05), LV mass (r=0.4566, p<0.05), the left ventricular myocardium mass index (r=0.2700, p<0.05) and relative wall thickness(r=0.2991, p<0.05). The EAT volume correlated with the volume of IAAT (r=0.6330, p<0.05), negative correlation – with the ratio of the volume of subcutaneous fat to IAAT (r=–0.4236, p<0.05).
Conclusion. In the presented study the EAT volume was associated with the insulin resistance index, metabolic parameters and remodeling parameters of the left heart in young people with abdominal obesity. EAT can be considered as a marker of visceral obesity because it strongly correlated with IAAT.
Keywords: metabolic healthy obesity, metabolic syndrome, local ectopic fat depots, epicardial adipose tissue, arterial hypertension, cardiovascular risk.
2. Carmichael J Flegal KM, Kit BK, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71-82. doi: 10.1001/jama.2012.113 905
3. Fox CS, Massaro J M, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39-48. doi: 10.1161/CIRCU LATIONAHA.106.675355
4. Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108:2460-6. doi: 10.1161/01.CIR.0000099542.57313.C5
5. Zhou L, Deng Y, Gong J. Epicardial adipose tissue volume a diagnostic study for independent predicting disorder of circadian rhythm of blood pressure in patients with essential hypertension. Cell Mol Biol (Noisy-le-grand). 2016 May 30;62(6):1-7.
6. Ueda Y, Shiga Y, Idemoto Y. Association Between the Presence or Severity of Coronary Artery Disease and Pericardial Fat, Paracardial Fat, Epicardial Fat, Visceral Fat, and Subcutaneous Fat as Assessed by Multi-Detector Row Computed Tomography. Int Heart J. 2018 Jul 31;59(4):695-704. doi: 10.1536/ihj.17-234
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8. Iacobellis G, Pellicelli AM, Sharma AM, et al. Relation of subepicardial adipose tissue to carotid intima-media thickness in patients with human immunodeficiency virus. Am J Cardiol. 2007;99:1470-2. https://doi.org/10.1016/j.amjcard.2006.12.0 82
9. Natale F, Tedesco M, Mocerino R. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiography. 2009;10(4):549-55. doi:10.1093/ejechocard/jep002
10. Nakanishi K, Fukuda S, Tanaka A. Relationships Between Periventricular Epicardial Adipose Tissue Accumulation, Coronary Microcirculation, and Left Ventricular Diastolic Dysfunction. Can J Cardiol. 2017 Nov;33(11):1489-97. doi: 10.1016/j.cjca.2017.08.001
11. Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005;47:320-32. https://doi.org/10.1016/j.pcad.2005.02.010
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16. Muscelli E, Camastra S, Gastaldelli A, et al. Influence of duration of obesity on the insulin resistance of obese nondiabetic patients. Int J Obes Relat Metab Disord. 1998;22:262-7. doi: 10.1038/sj.ijo.0800580
17. Iacobellis G, Ribaudo MC, 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 & Metabol. 2003 Nov;88(11):5163-8. https://doi.org/ 10.1210/jc.2003-030698
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1. Albu JB, Kovera AJ, Johnson JA. Fat distribution and health in obesity. Ann N Y Acad Sci. 2000;904:491-501. https://doi.org/10.1111/j.1749-6632.2000.tb06505.x
2. Carmichael J Flegal KM, Kit BK, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71-82. doi: 10.1001/jama.2012.113 905
3. Fox CS, Massaro J M, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39-48. doi: 10.1161/CIRCU LATIONAHA.106.675355
4. Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108:2460-6. doi: 10.1161/01.CIR.0000099542.57313.C5
5. Zhou L, Deng Y, Gong J. Epicardial adipose tissue volume a diagnostic study for independent predicting disorder of circadian rhythm of blood pressure in patients with essential hypertension. Cell Mol Biol (Noisy-le-grand). 2016 May 30;62(6):1-7.
6. Ueda Y, Shiga Y, Idemoto Y. Association Between the Presence or Severity of Coronary Artery Disease and Pericardial Fat, Paracardial Fat, Epicardial Fat, Visceral Fat, and Subcutaneous Fat as Assessed by Multi-Detector Row Computed Tomography. Int Heart J. 2018 Jul 31;59(4):695-704. doi: 10.1536/ihj.17-234
7. Yamashita K, Yamamoto M, Igawa W. Association of Epicardial Adipose Tissue Volume and Total Coronary Plaque Burden in Patients with Coronary Artery Disease. Int Heart J. 2018 Nov 28;59(6):1219-26. doi: 10.1536/ihj.17-709
8. Iacobellis G, Pellicelli AM, Sharma AM, et al. Relation of subepicardial adipose tissue to carotid intima-media thickness in patients with human immunodeficiency virus. Am J Cardiol. 2007;99:1470-2. https://doi.org/10.1016/j.amjcard.2006.12.0 82
9. Natale F, Tedesco M, Mocerino R. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiography. 2009;10(4):549-55. doi:10.1093/ejechocard/jep002
10. Nakanishi K, Fukuda S, Tanaka A. Relationships Between Periventricular Epicardial Adipose Tissue Accumulation, Coronary Microcirculation, and Left Ventricular Diastolic Dysfunction. Can J Cardiol. 2017 Nov;33(11):1489-97. doi: 10.1016/j.cjca.2017.08.001
11. Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005;47:320-32. https://doi.org/10.1016/j.pcad.2005.02.010
12. Kossaify A, Nicolas N. Impact of overweight and obesity on left ventricular diastolic function and value of tissue Doppler echocardiography. Clin Med Insights Cardiol. 2013;7:43-50. doi: 10.4137/CMC.S11156
13. [Chazova IE, Nedogoda SV, Zhernakova YV, et al. Recommendations for the management of patients with arterial hypertension with metabolic disorders. Kardiologicheskij Vestnik. 2014;9(1):3-57 (In Russ.)].
14. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). 2015.
15. Brochu M, Tchernof A, Dionne IJ, et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? Clin Endocrinol Metab. 2001; 86:1020-5. doi: 10.1210/ jcem. 86.3.7365
16. Muscelli E, Camastra S, Gastaldelli A, et al. Influence of duration of obesity on the insulin resistance of obese nondiabetic patients. Int J Obes Relat Metab Disord. 1998;22:262-7. doi: 10.1038/sj.ijo.0800580
17. Iacobellis G, Ribaudo MC, 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 & Metabol. 2003 Nov;88(11):5163-8. https://doi.org/ 10.1210/jc.2003-030698
18. Rabkin SW. The relationship between epicardial fat and indices of obesity and the metabolic syndrome: a systematic review and meta-analysis. Metab Syndr Relat Disord. 2014 Feb;12(1):31-42. doi: 10.1089/met.2013.0107
19. Börekçi A1, Gür M1, Şeker T2, Kalyoncu Uçar A3, Baykan AO2, Elbasan Z2, Harbalıoğlu H2, Uçar H2, Çaylı M4. Epicardial fat thickness as associated with left ventricular myocardial performance in patients with newly diagnosed hypertension. Turk Kardiyol Dern Ars. 2015 Dec;43(8):705-13. doi: 10.5543/tkda.2015. 95902
20. Iacobellis G, Ribaudo MC, Zappaterreno A, Iannucci CV, Leonetti F. Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol. 2004;94:1084-7. doi:10.1016/j.amjcard.2004.06.075
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
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N.V. Blinova 1, M.O. Azimova 1, Y.V. Zhernakova 1, E.A. Zheleznova 1, E.B. Yarovaya 1, A.A. Orlovskiy 1, M.R. Azimova 1, S.V. Dobrovolskaya 1, S.K. Ternovoy 1,2, I.E. Chazova 1
1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia