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
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
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
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
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
Background:Recent studies have reported circular RNA(circRNA)expression profiles in various tissue types;however,circRNA expression profile in human epicardial adipose tissue(EAT)remains undefined.This work aimed to c...Background:Recent studies have reported circular RNA(circRNA)expression profiles in various tissue types;however,circRNA expression profile in human epicardial adipose tissue(EAT)remains undefined.This work aimed to compare circRNA expression patterns in EAT between the heart failure(HF)and non-HF groups.Methods:RNA-sequencing was carried out to compare circRNA expression patterns in EAT specimens from coronary artery disease cases between the HF and non-HF groups.Quantitative real-time polymerase chain reaction was performed for validation.Comparisons of patient characteristics between the two groups were using t test,Mann-Whitney U test,and Chi-squared test.Results:A total of 141 circRNAs substantially different between the HF and non-HF groups(P<0.05;fold change>2)were detected,including 56 up-regulated and 85 down-regulated.Among them,hsa_circ_0005565 stood out,for it had the highest fold change and was significantly increased in HF patients in quantitative real-time polymerase chain reaction validation.The top highly expressed EAT circRNAs corresponded to genes involved in cell proliferation and inflammatory response,including GSE1,RHOBTB3,HIPK3,UBXN7,PCMTD1,N4BP2L2,CFLAR,EPB41L2,FCHO2,FNDC3B,and SPECC1.The top enriched Gene Ontology term and Kyoto Encyclopedia of Genes and Genomes pathway were positive regulation of metabolic processes and insulin resistance,respectively.Conclusion:These data indicate EAT circRNAs may contribute to the pathogenesis of metabolic disorders causing HF.展开更多
Background Epicardial adipose tissue(EAT)is a unique visceral adipose tissue that is located between the myocardium and the visceral layer of the pericardium.Physiologically,EAT can produce heat and protect the heart....Background Epicardial adipose tissue(EAT)is a unique visceral adipose tissue that is located between the myocardium and the visceral layer of the pericardium.Physiologically,EAT can produce heat and protect the heart.Under pathological conditions,EAT is involved in the development of diastolic heart failure(DHF)by secreting a variety of pro-inflammatory cytokines.More and more studies have shown that EAT plays an important role in the inflammatory mechanism and myocardial remodeling of DHF.Exercise,weight loss and drug therapy can significantly reduce the thickness/volume of EAT and its functional disorder.In recent years,research on EAT and DHF has made new progress.This article reviewed the mechanism and treatment of EAT in the development of DHF.展开更多
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.
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.
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.
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.
基金a grant from the Natural Science Foundation of China(No.81800304)。
文摘Background:Recent studies have reported circular RNA(circRNA)expression profiles in various tissue types;however,circRNA expression profile in human epicardial adipose tissue(EAT)remains undefined.This work aimed to compare circRNA expression patterns in EAT between the heart failure(HF)and non-HF groups.Methods:RNA-sequencing was carried out to compare circRNA expression patterns in EAT specimens from coronary artery disease cases between the HF and non-HF groups.Quantitative real-time polymerase chain reaction was performed for validation.Comparisons of patient characteristics between the two groups were using t test,Mann-Whitney U test,and Chi-squared test.Results:A total of 141 circRNAs substantially different between the HF and non-HF groups(P<0.05;fold change>2)were detected,including 56 up-regulated and 85 down-regulated.Among them,hsa_circ_0005565 stood out,for it had the highest fold change and was significantly increased in HF patients in quantitative real-time polymerase chain reaction validation.The top highly expressed EAT circRNAs corresponded to genes involved in cell proliferation and inflammatory response,including GSE1,RHOBTB3,HIPK3,UBXN7,PCMTD1,N4BP2L2,CFLAR,EPB41L2,FCHO2,FNDC3B,and SPECC1.The top enriched Gene Ontology term and Kyoto Encyclopedia of Genes and Genomes pathway were positive regulation of metabolic processes and insulin resistance,respectively.Conclusion:These data indicate EAT circRNAs may contribute to the pathogenesis of metabolic disorders causing HF.
基金supported by the Jining City Science and Technology Key Research and Development Program(No.2018SMNS006)the 2018 Shandong Province professional degree graduate case teaching project(No.SDYAL18100)。
文摘Background Epicardial adipose tissue(EAT)is a unique visceral adipose tissue that is located between the myocardium and the visceral layer of the pericardium.Physiologically,EAT can produce heat and protect the heart.Under pathological conditions,EAT is involved in the development of diastolic heart failure(DHF)by secreting a variety of pro-inflammatory cytokines.More and more studies have shown that EAT plays an important role in the inflammatory mechanism and myocardial remodeling of DHF.Exercise,weight loss and drug therapy can significantly reduce the thickness/volume of EAT and its functional disorder.In recent years,research on EAT and DHF has made new progress.This article reviewed the mechanism and treatment of EAT in the development of DHF.
