Pericardial fat, insulin resistance, and left ventricular structure and function in morbid obesity
Section snippets
Subjects
From November 2010 to December 2012 a total of 121 consecutive patients with morbid obesity (mean age 43 ± 13 years, 35% men, 43.9 ± 7 kg/m2) were referred to the Unit of Internal Medicine, Angiology and Atherosclerosis of Perugia University for a comprehensive cardiovascular and metabolic assessment. All of them were potential candidates for bariatric surgery according to the National Institutes of Health Consensus Development criteria [16].
We excluded from the study patients with known
Results
Clinical, anthropometric and echocardiographic characteristics of the study population (n = 80) are reported in Table 1. Fifty-three patients (66%) had a BMI above 40 kg/m2, and 43 (54%) were hypertensive. Average systolic/diastolic BP was 136/84 ± 18/11 mmHg. A sizeable proportion of the population (64%) had HOMA-IR values ≥2.6.
Discussion
Results from our study show that in a population of middle-aged subjects with morbid obesity, pericardial and epicardial fat thicknesses at echocardiography were differently related to measures of adiposity, insulin sensitivity and measures of cardiac structure and function. While both epicardial and pericardial fat thicknesses were associated with BMI and waist circumference, only pericardial fat thickness showed a relationship with insulin resistance. The relationship of pericardial fat
Funding source
None.
Potential conflict of interest
None.
References (38)
Increases in morbid obesity in the USA: 2000-2005
Public Health
(2007)- et al.
Effect of diabetes and hypertension on obesity-related mortality
Surgery
(2005) - et al.
Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data
J Am Coll Cardiol
(2011) - et al.
Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries
Atherosclerosis
(2009) - et al.
The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA)
Am J Clin Nutr
(2009) - et al.
Relation between epicardial adipose tissue and left ventricular mass
Am J Cardiol
(2004) - et al.
Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk
J Am Coll Cardiol
(1995) - et al.
Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy
Am J Cardiol
(1976) - et al.
Subclinical left ventricular dysfunction in systemic hypertension and the role of 24-hour blood pressure
Am J Cardiol
(2000) - et al.
Proinflammatory cytokines and cardiac abnormalities in uncomplicated obesity: relationship with abdominal fat deposition
Nutr Metab Cardiovasc Dis
(2007)
Impact of obesity on cardiac geometry and function in a population of adolescents: the Strong Heart Study
J Am Coll Cardiol
Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study
J Am Coll Cardiol
Pericardial rather than epicardial fat is a cardiometabolic risk marker: an MRI vs echo study
J Am Soc Echocardiogr
Inappropriate left ventricular mass in normotensive and hypertensive patients
Am J Cardiol
Health, United States
General and abdominal adiposity and risk of death in Europe
N Engl J Med
Ectopic fat depots and cardiovascular disease
Circulation
Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham heart study
Obesity (Silver Spring)
Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: relationship to metabolic profile, cardiac function and visceral fat
Int J Obes (Lond)
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2016, Journal of Nutritional BiochemistryCitation Excerpt :We reported that ectopic fat tissue volume and macrophage and cytokine/adipocytokine signals in ectopic fat tissue are strongly correlated with human coronary artery diseases, suggesting that ectopic fat tissue volume and adipocytokine imbalances are strongly linked to human coronary atherosclerosis. [31]. Meanwhile, it has been reported that paracardial fat thickness is associated with inappropriately high LV mass and LV systolic dysfunction in obese individuals [32]. Pericardial fat includes both epicardial (located within or deep in the pericardium) and paracardial fat (located superficial to the pericardium) [15], and our data may suggest that epicardial fat, not paracardial fat, is closely related to LV morphology and cardiac function.
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