Tbx18,Wt1,and Tcf21 have been identified as epicardial markers during the early embryonic stage.However,the gene markers of mature epicardial cells remain unclear.Single-cell transcriptomic analysis was performed with...Tbx18,Wt1,and Tcf21 have been identified as epicardial markers during the early embryonic stage.However,the gene markers of mature epicardial cells remain unclear.Single-cell transcriptomic analysis was performed with the Seurat,Monocle,and CellphoneDB packages in R software with standard procedures.Spatial transcriptomics was performed on chilled Visium Tissue Optimization Slides(10x Genomics)and Visium Spatial Gene Expression Slides(10x Genomics).Spatial transcriptomics analysis was performed with Space Ranger software and R software.Immunofluorescence,whole-mount RNA in situ hybridization and X-gal staining were performed to validate the analysis results.Spatial transcriptomics analysis revealed distinct transcriptional profiles and functions between epicardial tissue and non-epicardial tissue.Several gene markers specific to postnatal epicardial tissue were identified,including Msln,C3,Efemp1,and Upk3b.Single-cell transcriptomic analysis revealed that cardiac cells from wildtype mouse hearts(from embryonic day 9.5 to postnatal day 9)could be categorized into six major cell types,which included epicardial cells.Throughout epicardial development,Wt1,Tbx18,and Upk3b were consistently expressed,whereas genes including Msln,C3,and Efemp1 exhibited increased expression during the mature stages of development.Pseudotime analysis further revealed two epicardial cell fates during maturation.Moreover,Upk3b,Msln,Efemp1,and C3 positive epicardial cells were enriched in extracellular matrix signaling.Our results suggested Upk3b,Efemp1,Msln,C3,and other genes were mature epicardium markers.Extracellular matrix signaling was found to play a critical role in the mature epicardium,thus suggesting potential therapeutic targets for heart regeneration in future clinical practice.展开更多
Heart failure with preserved ejection fraction(HFpEF)is a heterogeneous syndrome with various comorbidities,multiple cardiac and extracardiac pathophysiologic abnormalities,and diverse phenotypic presentations.Since H...Heart failure with preserved ejection fraction(HFpEF)is a heterogeneous syndrome with various comorbidities,multiple cardiac and extracardiac pathophysiologic abnormalities,and diverse phenotypic presentations.Since HFpEF is a heterogeneous disease with different phenotypes,individualized treatment is required.HFpEF with type 2 diabetes mellitus(T2DM)represents a specific phenotype of HFpEF,with about 45%-50% of HFpEF patients suffering from T2DM.Systemic inflammation associated with dysregulated glucose metabolism is a critical pathological mechanism of HFpEF with T2DM,which is intimately related to the expansion and dysfunction(inflammation and hypermetabolic activity)of epicardial adipose tissue(EAT).EAT is well established as a very active endocrine organ that can regulate the pathophysiological processes of HFpEF with T2DM through the paracrine and endocrine mechanisms.Therefore,suppressing abnormal EAT expansion may be a promising therapeutic strategy for HFpEF with T2DM.Although there is no treatment specifically for EAT,lifestyle management,bariatric surgery,and some pharmaceutical interventions(anti-cytokine drugs,statins,proprotein convertase subtilisin/kexin type 9 inhibitors,metformin,glucagon-like peptide-1 receptor agonists,and especially sodium-glucose cotransporter-2 inhibitors)have been shown to attenuate the inflammatory response or expansion of EAT.Importantly,these treatments may be beneficial in improving the clinical symptoms or prognosis of patients with HFpEF.Accordingly,well-designed randomized controlled trials are needed to validate the efficacy of current therapies.In addition,more novel and effective therapies targeting EAT are needed in the future.展开更多
Diabetes mellitus(DM)is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates.Renal disease in patients with diabetes is associated with increased morbidity a...Diabetes mellitus(DM)is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates.Renal disease in patients with diabetes is associated with increased morbidity and premature mortality,particularly attributed to their very high cardiovascular risk.Since this group of patients frequently lacks specific symptomatology prior to the adverse events,a screening tool for the identification of high-risk patients is necessary.The epicardial adipose tissue(EAT)is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease.Superior to conventional cardiovascular risk factors and anthropometric measures,including body mass index and waist circumference,the EAT can early predict the development of coronary artery disease.Assessment of EAT can be performed by twodimensional echocardiography,magnetic resonance imaging or computer tomography.However,its role and significance in patients with DM and nephropathy has not been thoroughly evaluated.The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment.Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements,uncontrolled underlying disease,high body mass index and raised cardiovascular risk markers.Acknowledging the practical implications of this test,EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.展开更多
Objective:Epicardial adipose tissue(EAT)is a potential risk factor for obstructive sleep apnea(OSA).We performed a meta-analysis to assess the association of EAT with OSA.Methods:The PubMed,EMBASE,Web of Science,Cochr...Objective:Epicardial adipose tissue(EAT)is a potential risk factor for obstructive sleep apnea(OSA).We performed a meta-analysis to assess the association of EAT with OSA.Methods:The PubMed,EMBASE,Web of Science,Cochrane Library,and Wanfang databases were searched by two independent investigators for all observational studies assessing the association of EAT with OSA.Then we assessed the association of EAT thickness(EAT-t)and EAT volume(EAT-v)with OSA by a meta-analysis.Results:Ten studies were included in the fi nal analysis.Compared with that in controls,EAT-t in OSA patients was signifi cantly increased(standardized mean difference 0.88,95%confi dence interval 0.72-1.05,P=0.000).Furthermore,EAT-t was greater in OSA patients than in controls with similar BMIs.However,we did not fi nd signifi cant differences in EAT-v between OSA patients and controls(standardized mean difference 2.46,95%confi dence interval−0.36 to 5.29,P=0.088).EAT-t in the mild,moderate,and severe OSA subgroups was greater than in the controls.In addition,there were signifi cant differences in EAT-t among the mild,moderate,and severe OSA subgroups.Conclusions:EAT-t was greater in patients with OSA than in controls,and EAT-t was also associated with the severity of OSA.These fi ndings may provide a new clue for the pathogenesis and treatment of OSA.展开更多
Epicardial adipose tissue is defined as a deposit of adipocytes with pathophysiological properties similar to those of visceral fat, located in the space between the myocardial muscle and the pericardial sac. When com...Epicardial adipose tissue is defined as a deposit of adipocytes with pathophysiological properties similar to those of visceral fat, located in the space between the myocardial muscle and the pericardial sac. When compared with subcutaneous adipose tissue, visceral adipocytes show higher metabolic activity, lipolysis rates, increased insulin resistance along with more steroid hormone receptors. The epicardial adipose tissue interacts with numerous cardiovascular pathways via vasocrine and paracrine signalling comprised of pro-and anti-inflammatory cytokines excretion. Both the physiological differences be-tween the two tissue types, as well as the fact that fat distribution and phenotype, rather than quantity, affect cardiovascular function and metabolic processes, establish epicardial fat as a biomarker for cardiovascular and metabolic syndrome. Numerous studies have underlined an association of altered epicardial fat morphology, type 2 diabetes mellitus(T2 DM) and adverse cardiovascular events. In this review, we explore the prospect of using the epicardial adipose tissue as a therapeutic target in T2 DM and describe the underlying mechanisms by which the antidiabetic drugs affect the pathophysiological processes induced from adipose tissue accumulation and possibly allow for more favourable cardiovascular outcomes though epicardial fat manipulation.展开更多
Thin cap fibroatheromas(TCFAs) are thought to be the most common underlying substrate in patients suffering acute coronary thrombotic events.Recently,an interesting association between TCFAs and a particular depot of ...Thin cap fibroatheromas(TCFAs) are thought to be the most common underlying substrate in patients suffering acute coronary thrombotic events.Recently,an interesting association between TCFAs and a particular depot of visceral fat called epicardial adipose tissue(EAT) has been suggested.In this article,we discuss some basic and clinical aspects of this association and then briefly review some of the pathophysiological characteristics attributed to EAT that explain why this particular depot of fat has been attracting the attention of the cardiological scientific community in recent years.Finally we discuss the value of optical coherence tomography in the diagnosis of TCFAs and the role of multislice computed tomography to assess EAT.展开更多
AIM:To compare the predictive value of three methods of epicardial fat(EF) assessment for presence of significant coronary artery disease(CAD) [i.e.,epicardial fat volume(EFV),EFV indexed with body surface area(EFV/BS...AIM:To compare the predictive value of three methods of epicardial fat(EF) assessment for presence of significant coronary artery disease(CAD) [i.e.,epicardial fat volume(EFV),EFV indexed with body surface area(EFV/BSA) and EFV indexed with body mass index(EFV/BMI)].METHODS:The study was performed on 170 patients(85 women and 85 men) with clinical suspicion of CAD.They aged 26-89 years with a median age of 54 years.The patients were classified into three groups:Group 1:58 patients with normal coronary arteries; group 2:48 patients with non-significant CAD and group 3:64 patients with significant CAD.The three methods for assessment of epicardial fat were retrospectively studied to determine the best method to predict the presence of significant CAD.RESULTS:The three methods for epicardial fat quantification and measurements,i.e.,EFV,EFV/BSA and EFV/BMI with post- hoc analysis showed a significant difference between patients with significant coronary artery disease compared to the normal group.Receiver operating characteristic curve analysis showed no significant difference between the three methods of epicardial fat measurements,the area under curve ranging between 0.6 and 0.62.The optimal cut-off was 80.3 cm3 for EFV,2.4 cm3/m2 for EFV indexed with BMI and 41.7 cm3/(kg/m2) for EFV indexed with BSA.For this cut-off the sensitivity ranged between 0.92 and 0.94,while specificity varied from 0.31 to 0.35.CONCLUSION:Any one of the three methods for assessment of epicardial fat can be used to predict significant CAD since all have the same equivalent predictive value.展开更多
This study examined the adipocytokine-vascular interactions and link between epicardial adipose tissue and coronary artery atherosclerosis.Thirty-four patients undergoing open heart surgery were chosen randomly, and d...This study examined the adipocytokine-vascular interactions and link between epicardial adipose tissue and coronary artery atherosclerosis.Thirty-four patients undergoing open heart surgery were chosen randomly, and divided into groupⅠ(non-coronary artery disease group) and group Ⅱ(coronary artery disease group).Blood samples were taken through peripheral vein prior to surgery.Plasma levels of a panel of proteins (adiponectin, IL-10, TNF-α) were detected by using ELISA.Epicardial adipose tissue was taken near the proximal tract of the right coronary artery and subcutaneous adipose was taken from the leg before cardiopulmonary bypassing, adiponectin and CD68+ were detected by using RT-PCR and immunohistochemistry.Our results showed that plasma adiponectin level was significantly lower in the group Ⅱ as compared with group Ⅰ(P<0.05).There were no differences in plasma concentration (IL-10, TNF-α, tatal-chol, HDL-chol, LDL-chol) between group Ⅰ and group Ⅱ.The number of CD68+ cells in epicardial adipose tissue of group Ⅱ was significantly higher than that in subcutaneous adipose tissue.Adiponectin mRNA expression was 6 fold higher in subcutaneous adipose tissue than in epicardial adipose tissue of group Ⅱ (P<0.01).Furthermore, the level of adiponectin mRNA in the epicardial adipose tissue in group Ⅱ was also significantly lower than in group Ⅰ (P<0.05).We are led to conclude that inflammation that occurs locally in epicardial adipose tissue of CAD contributes to the pathogenesis of coronary artery disease.展开更多
Objective: To evaluate the relation between epicardial adipose tissue (EAT) thickness and also pericoronary fat assessed by Multidetector Computed Tomography (MDCT) with both calcium score and significance of coronary...Objective: To evaluate the relation between epicardial adipose tissue (EAT) thickness and also pericoronary fat assessed by Multidetector Computed Tomography (MDCT) with both calcium score and significance of coronary artery disease. Background: Epicardial adipose tissue (the visceral fat of the heart present under the visceral layer of the pericardium) has the same origin of abdominal visceral fat, which is known to be strongly related to the development of coronary artery atherosclerosis. Multidetector CT (MDCT) provides an accurate and reproducible quantification of EAT due to its high spatial and temporal resolution. Patients and Methods: The current study included 70 patients with low-intermediate probability of coronary artery disease. All patients were subjected to 256 Multidetectors CT to assess EAT thickness, the mean thickness of the pericoronary fat surrounding the three coronary arteries and coronary calcium score. Also coronary CT angiography was done and patients were then divided into 3 groups according to significance of coronary atherosclerosis: Group 1: No atherosclerosis (20 patients), Group 2: Non obstructive atherosclerosis (luminal narrowing less than 50% in diameter) (25 patients), Group3: Obstructive atherosclerosis (luminal narrowing ≥ 50%) (25 patients). Results: The mean EAT thickness and the mean pericoronary fat thickness were significantly higher in patients with obstructive coronary artery disease (CAD) with stenosis > 50% (group 3) compared to other groups with normal coronaries or non obstructive (CAD). ROC curve was used to define the best cut off value of the thickness of both EAT and pericoronary fat in predicting the obstructive CAD group which was ≥7.2 and 12.6 mm for epicardial and pericoronary fat respectively. Also there is a positive correlation between both epicardial adipose tissue and pericoronary fat thickness and the coronary calcium score. Conclusion: EAT thickness and pericoronary fat thickness can be used in predicting the significance of coronary artery disease.展开更多
In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rat...In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rate was 6.9% in retrograde CTO PCI.[1,2] Collateral related perforations were higher in patients with the epicardial collateral than that with the septal collateral.[3]Several techniques have been developed to deal with the collateral branch perforation.Here,we described the treatment of epicardial collateral branch perforation by absorbable suture segments embolization through microcatheter during retrograde CTO PCI.展开更多
The superior vena cava(SVC)is the main component of non-pulmonary vein(PV)ectopy in patients with atrial fibrillation(AF).Researchers have found that epicardial adipose tissue(EAT)volume is related to the AF substrate...The superior vena cava(SVC)is the main component of non-pulmonary vein(PV)ectopy in patients with atrial fibrillation(AF).Researchers have found that epicardial adipose tissue(EAT)volume is related to the AF substrate,which can be defined by the low voltage area(LVA).This study aimed to investigate the relationship between SVC-EAT and SVC-AF.Twenty-six patients with SVC-AF triggers were identified as the SVC-AF group.Other three groups were defined and included as the LVA-AF group(LVA>5%),non-LVA-AF group(LVA<5%),and physical examination(PE)group.EAT around left atrium(LA-EAT)and SVC-EAT volumes were obtained using a cardiac risk assessment module.According to the SVC/LA-EAT ratio,there are significant differences between the SVC-AF group and the three control groups(the SVC-AF group 0.092±0.041 vs.the LVA-AF group 0.054±0.026,the non-LVA-AF group 0.052±0.022,and the PE group 0.052±0.019,all P<0.001).Receiver operating characteristic curve analysis suggests the optimal cut-off point of SVC/LA-EAT ratio is 6.8%for detecting SVC-AF patients,with 81.1%sensitivity,73.1%specificity,and an area under the curve of 0.83(95%confidence interval,0.75-0.91).Those with SVC-AF have a higher SVC/LA-EAT ratio and empirical SVC isolation could be considered if the SVC/LA-EAT ratio was over 6.8%.展开更多
BACKGROUND Phrenic nerve(PN)injury is one of the recognized possible complications following epicardial ablation of ventricular tachycardia(VT).High-output pacing is a widely used maneuver to establish a relationship ...BACKGROUND Phrenic nerve(PN)injury is one of the recognized possible complications following epicardial ablation of ventricular tachycardia(VT).High-output pacing is a widely used maneuver to establish a relationship between the PN and the ablation catheter tip.An absence of PN capture is usually considered an indication that it is safe to ablate,and that successful ablation may be performed at adjacent sites.However,PN capture may impact the procedural outcome.Only a few cases have been reported in the literature that avoid PN injury by using different techniques.CASE SUMMARY Three patients with a previous history of myocarditis and one patient with ischemic cardiomyopathy underwent epicardial ablation for drug-refractory VT.Before the procedure,transthoracic echocardiogram,coronary angiogram,and cardiac magnetic resonance imaging were performed on all patients.Under general anesthesia,endo/epicardial three-dimensional anatomical and substrate maps of the left ventricle were accomplished.Before radiofrequency delivery,the course of the PN was identified by provoking diaphragmatic stimulation with high-output pacing from the distal electrode of the ablation catheter.In every case,a scar region with late potentials was mapped along the PN course.After obtaining another epicardial access,a second introducer sheath was placed,and a vascular balloon catheter was inserted into the epicardial space and inflated with saline solution to separate the PN from the epicardium.Once the absence of PN capture had been proven,radiofrequency was applied to aim for complete late potential elimination and avoid VT induction.CONCLUSION PN injury can occur as one of the complications following epicardial VT ablation procedures,and may prevent successful ablation of these arrhythmias.PN displacement by using large balloon catheters into the epicardial space seems to be feasible and reproducible,avoid procedure-related morbidity,and improve ablation success when performed in selected centers and by experienced operators.展开更多
Atrial fibrillation is the most common arrhythmia leading to cardiogenic stroke.Without membranous sructure between epicardial adipose tissue and atrial myocardium,epicardial adipose tissue directly covers the surface...Atrial fibrillation is the most common arrhythmia leading to cardiogenic stroke.Without membranous sructure between epicardial adipose tissue and atrial myocardium,epicardial adipose tissue directly covers the surface of the atrial myocardium.The formation of an epicardial adipose tissue inflammatory microenvironment,fibrosis,infiltration by epicardial adipose tissue,autonomic dysfunction and oxidative stress are important mechanisms that trigger and maintain atrial fibrillation.Those mechanisms are reviewed herein.展开更多
Background: Epicardial adipose tissue (EAT) may produce several cytokines contributed to coronary atherosclerosis. EAT was measured by transthoracic echocardiography or 3 dimensional cardiac computed tomography (CT) o...Background: Epicardial adipose tissue (EAT) may produce several cytokines contributed to coronary atherosclerosis. EAT was measured by transthoracic echocardiography or 3 dimensional cardiac computed tomography (CT) on previous studies. We aimed to evaluate the correlation between EAT thickness and cardiovascular risk factors in healthy adults. Method: We collected clinical, biochemical information from 469 subjects (371 men and 98 women) who visited our health promotion center. EAT thickness was measured by chest CT on the free wall of the right ventricle. Result: The mean EAT thickness was 2.47 ± 1.64 mm in total of 469 subjects. EAT thickness was significantly correlated to age, weight, body mass index (BMI), total body fat, systolic and diastolic blood pressure, total cholesterol, low density lipoprotein (LDL)-cholesterol, and fasting glucose in men and to age, height, weight, BMI, total body fat, systolic and diastolic blood pressure, triglycerides, C-reactive protein (CRP), and fasting glucose in women. Multivariate analysis showed that age, BMI, systolic blood pressure, fasting glucose were the variables that independently correlated to EAT thickness in men. But there was no significant independent variable in women. Conclusion: In our study, EAT thickness measured with chest CT in healthy individuals correlates with cardiovascular risk factors in men.展开更多
Background of study aims and objective:Epicardial fat thickness is a novel parameter for predicting outcome and assessment of severity of coronary artery disease. Our present study aims to establish an association bet...Background of study aims and objective:Epicardial fat thickness is a novel parameter for predicting outcome and assessment of severity of coronary artery disease. Our present study aims to establish an association between epicardial fat thickness and coronary artery disease. Materials & Methods: Patients of suspected CAD underwent coronary angiography. 100 subjects proven as confirmed cases were included in the study. Routine clinical examination, risk factor profile and anthropometric variables were also done. Severity of CAD was assessed using Gensini Score. Epicardial fat thickness was measured using 2D ECHO. For comparative analysis, 50 healthy individuals were also included in the study. Results: Epicardial fat thickness was significantly higher in cases (7.53 ± 1.79 mm) than controls (4.24 ± 1.09 mm). Female sex, hypertension, dyslipidemia, obesity were observed to affect EFT significantly. No difference in mean EFT was observed with age, diabetes, smoking, ECG changes and arterial territory involvement. BMI and Gensini scores both showed strong positive correlation with epicardial fat thickness. Conclusion: Epicardial fat thickness is associated and linearly correlates with onset and severity of CAD.展开更多
For further clarifying the mechanisms of atrial fibrillation(AF) through epicardiac mapping, we developed a "route graph" method for the analysis of epicardial mapping signal during AF. Three procedures were...For further clarifying the mechanisms of atrial fibrillation(AF) through epicardiac mapping, we developed a "route graph" method for the analysis of epicardial mapping signal during AF. Three procedures were used to construct the route graph: detecting character points and constructing isochronal maps, calculating direction vectors and finally generating activation route graph. This method was applied to five dogs during induced atrial fibrillation, Preliminary experiments show the potential of this method to study electrophysiological activity of AF.展开更多
BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evalu...BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.展开更多
基金supported by grants from the National Natural Science Foundation of China(Grant No.:82270281)Chongqing Medical University Program for Youth Innovation in Future Medicine(Grant No.:W0133)+2 种基金Senior Medical Talents Program of Chongqing for Young and Middle-aged,China(Program No.:JianlinDu[2022])Postdoctoral Research Funding of the Second Affiliated Hospital of Chongqing Medical University,China(Grant No.:rsc-postdoctor114)and Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University,China(Program No.:kryc-gg-2102).
文摘Tbx18,Wt1,and Tcf21 have been identified as epicardial markers during the early embryonic stage.However,the gene markers of mature epicardial cells remain unclear.Single-cell transcriptomic analysis was performed with the Seurat,Monocle,and CellphoneDB packages in R software with standard procedures.Spatial transcriptomics was performed on chilled Visium Tissue Optimization Slides(10x Genomics)and Visium Spatial Gene Expression Slides(10x Genomics).Spatial transcriptomics analysis was performed with Space Ranger software and R software.Immunofluorescence,whole-mount RNA in situ hybridization and X-gal staining were performed to validate the analysis results.Spatial transcriptomics analysis revealed distinct transcriptional profiles and functions between epicardial tissue and non-epicardial tissue.Several gene markers specific to postnatal epicardial tissue were identified,including Msln,C3,Efemp1,and Upk3b.Single-cell transcriptomic analysis revealed that cardiac cells from wildtype mouse hearts(from embryonic day 9.5 to postnatal day 9)could be categorized into six major cell types,which included epicardial cells.Throughout epicardial development,Wt1,Tbx18,and Upk3b were consistently expressed,whereas genes including Msln,C3,and Efemp1 exhibited increased expression during the mature stages of development.Pseudotime analysis further revealed two epicardial cell fates during maturation.Moreover,Upk3b,Msln,Efemp1,and C3 positive epicardial cells were enriched in extracellular matrix signaling.Our results suggested Upk3b,Efemp1,Msln,C3,and other genes were mature epicardium markers.Extracellular matrix signaling was found to play a critical role in the mature epicardium,thus suggesting potential therapeutic targets for heart regeneration in future clinical practice.
文摘Heart failure with preserved ejection fraction(HFpEF)is a heterogeneous syndrome with various comorbidities,multiple cardiac and extracardiac pathophysiologic abnormalities,and diverse phenotypic presentations.Since HFpEF is a heterogeneous disease with different phenotypes,individualized treatment is required.HFpEF with type 2 diabetes mellitus(T2DM)represents a specific phenotype of HFpEF,with about 45%-50% of HFpEF patients suffering from T2DM.Systemic inflammation associated with dysregulated glucose metabolism is a critical pathological mechanism of HFpEF with T2DM,which is intimately related to the expansion and dysfunction(inflammation and hypermetabolic activity)of epicardial adipose tissue(EAT).EAT is well established as a very active endocrine organ that can regulate the pathophysiological processes of HFpEF with T2DM through the paracrine and endocrine mechanisms.Therefore,suppressing abnormal EAT expansion may be a promising therapeutic strategy for HFpEF with T2DM.Although there is no treatment specifically for EAT,lifestyle management,bariatric surgery,and some pharmaceutical interventions(anti-cytokine drugs,statins,proprotein convertase subtilisin/kexin type 9 inhibitors,metformin,glucagon-like peptide-1 receptor agonists,and especially sodium-glucose cotransporter-2 inhibitors)have been shown to attenuate the inflammatory response or expansion of EAT.Importantly,these treatments may be beneficial in improving the clinical symptoms or prognosis of patients with HFpEF.Accordingly,well-designed randomized controlled trials are needed to validate the efficacy of current therapies.In addition,more novel and effective therapies targeting EAT are needed in the future.
文摘Diabetes mellitus(DM)is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates.Renal disease in patients with diabetes is associated with increased morbidity and premature mortality,particularly attributed to their very high cardiovascular risk.Since this group of patients frequently lacks specific symptomatology prior to the adverse events,a screening tool for the identification of high-risk patients is necessary.The epicardial adipose tissue(EAT)is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease.Superior to conventional cardiovascular risk factors and anthropometric measures,including body mass index and waist circumference,the EAT can early predict the development of coronary artery disease.Assessment of EAT can be performed by twodimensional echocardiography,magnetic resonance imaging or computer tomography.However,its role and significance in patients with DM and nephropathy has not been thoroughly evaluated.The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment.Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements,uncontrolled underlying disease,high body mass index and raised cardiovascular risk markers.Acknowledging the practical implications of this test,EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.
基金This work was supported by grants from the National Natural Science Foundation of China(81770251)the National Natural Science Foundation of China Youth Science Fund Project(81800254)+1 种基金the Social Undertakings and People’s Livelihood Protection Technology Innovation of Chongqing Science Commission(cstc2017shmsA130086)Chongqing City Yuzhong District Science and Technology Basic and Advanced Research Projects(20170107).
文摘Objective:Epicardial adipose tissue(EAT)is a potential risk factor for obstructive sleep apnea(OSA).We performed a meta-analysis to assess the association of EAT with OSA.Methods:The PubMed,EMBASE,Web of Science,Cochrane Library,and Wanfang databases were searched by two independent investigators for all observational studies assessing the association of EAT with OSA.Then we assessed the association of EAT thickness(EAT-t)and EAT volume(EAT-v)with OSA by a meta-analysis.Results:Ten studies were included in the fi nal analysis.Compared with that in controls,EAT-t in OSA patients was signifi cantly increased(standardized mean difference 0.88,95%confi dence interval 0.72-1.05,P=0.000).Furthermore,EAT-t was greater in OSA patients than in controls with similar BMIs.However,we did not fi nd signifi cant differences in EAT-v between OSA patients and controls(standardized mean difference 2.46,95%confi dence interval−0.36 to 5.29,P=0.088).EAT-t in the mild,moderate,and severe OSA subgroups was greater than in the controls.In addition,there were signifi cant differences in EAT-t among the mild,moderate,and severe OSA subgroups.Conclusions:EAT-t was greater in patients with OSA than in controls,and EAT-t was also associated with the severity of OSA.These fi ndings may provide a new clue for the pathogenesis and treatment of OSA.
文摘Epicardial adipose tissue is defined as a deposit of adipocytes with pathophysiological properties similar to those of visceral fat, located in the space between the myocardial muscle and the pericardial sac. When compared with subcutaneous adipose tissue, visceral adipocytes show higher metabolic activity, lipolysis rates, increased insulin resistance along with more steroid hormone receptors. The epicardial adipose tissue interacts with numerous cardiovascular pathways via vasocrine and paracrine signalling comprised of pro-and anti-inflammatory cytokines excretion. Both the physiological differences be-tween the two tissue types, as well as the fact that fat distribution and phenotype, rather than quantity, affect cardiovascular function and metabolic processes, establish epicardial fat as a biomarker for cardiovascular and metabolic syndrome. Numerous studies have underlined an association of altered epicardial fat morphology, type 2 diabetes mellitus(T2 DM) and adverse cardiovascular events. In this review, we explore the prospect of using the epicardial adipose tissue as a therapeutic target in T2 DM and describe the underlying mechanisms by which the antidiabetic drugs affect the pathophysiological processes induced from adipose tissue accumulation and possibly allow for more favourable cardiovascular outcomes though epicardial fat manipulation.
文摘Thin cap fibroatheromas(TCFAs) are thought to be the most common underlying substrate in patients suffering acute coronary thrombotic events.Recently,an interesting association between TCFAs and a particular depot of visceral fat called epicardial adipose tissue(EAT) has been suggested.In this article,we discuss some basic and clinical aspects of this association and then briefly review some of the pathophysiological characteristics attributed to EAT that explain why this particular depot of fat has been attracting the attention of the cardiological scientific community in recent years.Finally we discuss the value of optical coherence tomography in the diagnosis of TCFAs and the role of multislice computed tomography to assess EAT.
文摘AIM:To compare the predictive value of three methods of epicardial fat(EF) assessment for presence of significant coronary artery disease(CAD) [i.e.,epicardial fat volume(EFV),EFV indexed with body surface area(EFV/BSA) and EFV indexed with body mass index(EFV/BMI)].METHODS:The study was performed on 170 patients(85 women and 85 men) with clinical suspicion of CAD.They aged 26-89 years with a median age of 54 years.The patients were classified into three groups:Group 1:58 patients with normal coronary arteries; group 2:48 patients with non-significant CAD and group 3:64 patients with significant CAD.The three methods for assessment of epicardial fat were retrospectively studied to determine the best method to predict the presence of significant CAD.RESULTS:The three methods for epicardial fat quantification and measurements,i.e.,EFV,EFV/BSA and EFV/BMI with post- hoc analysis showed a significant difference between patients with significant coronary artery disease compared to the normal group.Receiver operating characteristic curve analysis showed no significant difference between the three methods of epicardial fat measurements,the area under curve ranging between 0.6 and 0.62.The optimal cut-off was 80.3 cm3 for EFV,2.4 cm3/m2 for EFV indexed with BMI and 41.7 cm3/(kg/m2) for EFV indexed with BSA.For this cut-off the sensitivity ranged between 0.92 and 0.94,while specificity varied from 0.31 to 0.35.CONCLUSION:Any one of the three methods for assessment of epicardial fat can be used to predict significant CAD since all have the same equivalent predictive value.
基金supported by a grant from the National Natural Science Foundation of China (No.30872541 C160502)fund for Doctoral Program of Ministry of Education of China (No.200804871116)
文摘This study examined the adipocytokine-vascular interactions and link between epicardial adipose tissue and coronary artery atherosclerosis.Thirty-four patients undergoing open heart surgery were chosen randomly, and divided into groupⅠ(non-coronary artery disease group) and group Ⅱ(coronary artery disease group).Blood samples were taken through peripheral vein prior to surgery.Plasma levels of a panel of proteins (adiponectin, IL-10, TNF-α) were detected by using ELISA.Epicardial adipose tissue was taken near the proximal tract of the right coronary artery and subcutaneous adipose was taken from the leg before cardiopulmonary bypassing, adiponectin and CD68+ were detected by using RT-PCR and immunohistochemistry.Our results showed that plasma adiponectin level was significantly lower in the group Ⅱ as compared with group Ⅰ(P<0.05).There were no differences in plasma concentration (IL-10, TNF-α, tatal-chol, HDL-chol, LDL-chol) between group Ⅰ and group Ⅱ.The number of CD68+ cells in epicardial adipose tissue of group Ⅱ was significantly higher than that in subcutaneous adipose tissue.Adiponectin mRNA expression was 6 fold higher in subcutaneous adipose tissue than in epicardial adipose tissue of group Ⅱ (P<0.01).Furthermore, the level of adiponectin mRNA in the epicardial adipose tissue in group Ⅱ was also significantly lower than in group Ⅰ (P<0.05).We are led to conclude that inflammation that occurs locally in epicardial adipose tissue of CAD contributes to the pathogenesis of coronary artery disease.
文摘Objective: To evaluate the relation between epicardial adipose tissue (EAT) thickness and also pericoronary fat assessed by Multidetector Computed Tomography (MDCT) with both calcium score and significance of coronary artery disease. Background: Epicardial adipose tissue (the visceral fat of the heart present under the visceral layer of the pericardium) has the same origin of abdominal visceral fat, which is known to be strongly related to the development of coronary artery atherosclerosis. Multidetector CT (MDCT) provides an accurate and reproducible quantification of EAT due to its high spatial and temporal resolution. Patients and Methods: The current study included 70 patients with low-intermediate probability of coronary artery disease. All patients were subjected to 256 Multidetectors CT to assess EAT thickness, the mean thickness of the pericoronary fat surrounding the three coronary arteries and coronary calcium score. Also coronary CT angiography was done and patients were then divided into 3 groups according to significance of coronary atherosclerosis: Group 1: No atherosclerosis (20 patients), Group 2: Non obstructive atherosclerosis (luminal narrowing less than 50% in diameter) (25 patients), Group3: Obstructive atherosclerosis (luminal narrowing ≥ 50%) (25 patients). Results: The mean EAT thickness and the mean pericoronary fat thickness were significantly higher in patients with obstructive coronary artery disease (CAD) with stenosis > 50% (group 3) compared to other groups with normal coronaries or non obstructive (CAD). ROC curve was used to define the best cut off value of the thickness of both EAT and pericoronary fat in predicting the obstructive CAD group which was ≥7.2 and 12.6 mm for epicardial and pericoronary fat respectively. Also there is a positive correlation between both epicardial adipose tissue and pericoronary fat thickness and the coronary calcium score. Conclusion: EAT thickness and pericoronary fat thickness can be used in predicting the significance of coronary artery disease.
文摘In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rate was 6.9% in retrograde CTO PCI.[1,2] Collateral related perforations were higher in patients with the epicardial collateral than that with the septal collateral.[3]Several techniques have been developed to deal with the collateral branch perforation.Here,we described the treatment of epicardial collateral branch perforation by absorbable suture segments embolization through microcatheter during retrograde CTO PCI.
文摘The superior vena cava(SVC)is the main component of non-pulmonary vein(PV)ectopy in patients with atrial fibrillation(AF).Researchers have found that epicardial adipose tissue(EAT)volume is related to the AF substrate,which can be defined by the low voltage area(LVA).This study aimed to investigate the relationship between SVC-EAT and SVC-AF.Twenty-six patients with SVC-AF triggers were identified as the SVC-AF group.Other three groups were defined and included as the LVA-AF group(LVA>5%),non-LVA-AF group(LVA<5%),and physical examination(PE)group.EAT around left atrium(LA-EAT)and SVC-EAT volumes were obtained using a cardiac risk assessment module.According to the SVC/LA-EAT ratio,there are significant differences between the SVC-AF group and the three control groups(the SVC-AF group 0.092±0.041 vs.the LVA-AF group 0.054±0.026,the non-LVA-AF group 0.052±0.022,and the PE group 0.052±0.019,all P<0.001).Receiver operating characteristic curve analysis suggests the optimal cut-off point of SVC/LA-EAT ratio is 6.8%for detecting SVC-AF patients,with 81.1%sensitivity,73.1%specificity,and an area under the curve of 0.83(95%confidence interval,0.75-0.91).Those with SVC-AF have a higher SVC/LA-EAT ratio and empirical SVC isolation could be considered if the SVC/LA-EAT ratio was over 6.8%.
基金support to Michela Grande, BEng, Abbott, Milan, Italy
文摘BACKGROUND Phrenic nerve(PN)injury is one of the recognized possible complications following epicardial ablation of ventricular tachycardia(VT).High-output pacing is a widely used maneuver to establish a relationship between the PN and the ablation catheter tip.An absence of PN capture is usually considered an indication that it is safe to ablate,and that successful ablation may be performed at adjacent sites.However,PN capture may impact the procedural outcome.Only a few cases have been reported in the literature that avoid PN injury by using different techniques.CASE SUMMARY Three patients with a previous history of myocarditis and one patient with ischemic cardiomyopathy underwent epicardial ablation for drug-refractory VT.Before the procedure,transthoracic echocardiogram,coronary angiogram,and cardiac magnetic resonance imaging were performed on all patients.Under general anesthesia,endo/epicardial three-dimensional anatomical and substrate maps of the left ventricle were accomplished.Before radiofrequency delivery,the course of the PN was identified by provoking diaphragmatic stimulation with high-output pacing from the distal electrode of the ablation catheter.In every case,a scar region with late potentials was mapped along the PN course.After obtaining another epicardial access,a second introducer sheath was placed,and a vascular balloon catheter was inserted into the epicardial space and inflated with saline solution to separate the PN from the epicardium.Once the absence of PN capture had been proven,radiofrequency was applied to aim for complete late potential elimination and avoid VT induction.CONCLUSION PN injury can occur as one of the complications following epicardial VT ablation procedures,and may prevent successful ablation of these arrhythmias.PN displacement by using large balloon catheters into the epicardial space seems to be feasible and reproducible,avoid procedure-related morbidity,and improve ablation success when performed in selected centers and by experienced operators.
基金supported primarily by the National Science Foundation of China's Major Scientific Research Instrument Development Project(81727809)Scientific Research Project of Heilongjiang Provincial Health Commission(2020-137)Harbin Medical University Innovative Scientific Research Funding Project(2021-KYYWF-0225).
文摘Atrial fibrillation is the most common arrhythmia leading to cardiogenic stroke.Without membranous sructure between epicardial adipose tissue and atrial myocardium,epicardial adipose tissue directly covers the surface of the atrial myocardium.The formation of an epicardial adipose tissue inflammatory microenvironment,fibrosis,infiltration by epicardial adipose tissue,autonomic dysfunction and oxidative stress are important mechanisms that trigger and maintain atrial fibrillation.Those mechanisms are reviewed herein.
文摘Background: Epicardial adipose tissue (EAT) may produce several cytokines contributed to coronary atherosclerosis. EAT was measured by transthoracic echocardiography or 3 dimensional cardiac computed tomography (CT) on previous studies. We aimed to evaluate the correlation between EAT thickness and cardiovascular risk factors in healthy adults. Method: We collected clinical, biochemical information from 469 subjects (371 men and 98 women) who visited our health promotion center. EAT thickness was measured by chest CT on the free wall of the right ventricle. Result: The mean EAT thickness was 2.47 ± 1.64 mm in total of 469 subjects. EAT thickness was significantly correlated to age, weight, body mass index (BMI), total body fat, systolic and diastolic blood pressure, total cholesterol, low density lipoprotein (LDL)-cholesterol, and fasting glucose in men and to age, height, weight, BMI, total body fat, systolic and diastolic blood pressure, triglycerides, C-reactive protein (CRP), and fasting glucose in women. Multivariate analysis showed that age, BMI, systolic blood pressure, fasting glucose were the variables that independently correlated to EAT thickness in men. But there was no significant independent variable in women. Conclusion: In our study, EAT thickness measured with chest CT in healthy individuals correlates with cardiovascular risk factors in men.
文摘Background of study aims and objective:Epicardial fat thickness is a novel parameter for predicting outcome and assessment of severity of coronary artery disease. Our present study aims to establish an association between epicardial fat thickness and coronary artery disease. Materials & Methods: Patients of suspected CAD underwent coronary angiography. 100 subjects proven as confirmed cases were included in the study. Routine clinical examination, risk factor profile and anthropometric variables were also done. Severity of CAD was assessed using Gensini Score. Epicardial fat thickness was measured using 2D ECHO. For comparative analysis, 50 healthy individuals were also included in the study. Results: Epicardial fat thickness was significantly higher in cases (7.53 ± 1.79 mm) than controls (4.24 ± 1.09 mm). Female sex, hypertension, dyslipidemia, obesity were observed to affect EFT significantly. No difference in mean EFT was observed with age, diabetes, smoking, ECG changes and arterial territory involvement. BMI and Gensini scores both showed strong positive correlation with epicardial fat thickness. Conclusion: Epicardial fat thickness is associated and linearly correlates with onset and severity of CAD.
文摘For further clarifying the mechanisms of atrial fibrillation(AF) through epicardiac mapping, we developed a "route graph" method for the analysis of epicardial mapping signal during AF. Three procedures were used to construct the route graph: detecting character points and constructing isochronal maps, calculating direction vectors and finally generating activation route graph. This method was applied to five dogs during induced atrial fibrillation, Preliminary experiments show the potential of this method to study electrophysiological activity of AF.
基金National Natural Science Foundation of China,No.81873887National Natural Science Foundation of China Youth Project,No.82101981Shanghai Jiao Tong University School of Medicine Double Hundred Outstanding Person Project,No.20191904。
文摘BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.
