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Published on: April 13, 2015
Relationship between epicardial fat tissue, endothelial function, and coronary flow reserve in coronary microvascular
Mengjiao Li1, Yingying Huang1, Linghui Bai1
1Department of Cardiac Ultrasound, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Insights
Epicardial fat thickness (EFT) and flow-mediated dilation (FMD) show promise for diagnosing coronary microvascular disease (CMVD) in patients with ischemia with non-obstructive coronary arteries (INOCA). EFT is an independent predictor of CMVD.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Biology
Background:
- Coronary microvascular disease (CMVD) significantly impacts patients with ischemia with non-obstructive coronary arteries (INOCA), characterized by reduced coronary flow reserve (CFR).
- Current imaging modalities for CMVD assessment remain limited, highlighting the need for novel diagnostic tools.
Purpose of the Study:
- To investigate the associations between epicardial fat thickness (EFT), endothelial function (flow-mediated dilation, FMD), and CFR in INOCA patients.
- To evaluate the predictive value of EFT and FMD for diagnosing CMVD.
Main Methods:
- Coronary flow reserve (CFR) measured via regadenoson stress echocardiography.
- Epicardial fat thickness (EFT) and flow-mediated dilation (FMD) assessed using transthoracic echocardiography and vascular ultrasound, respectively.
- Multivariable logistic regression and receiver operating characteristic (ROC) analysis performed on 66 INOCA subjects.
Main Results:
- Patients with decreased CFR (<2.0) exhibited significantly higher EFT (P=0.003) and lower FMD (P=0.011) compared to those with normal CFR (≥2.0).
- EFT emerged as an independent predictor of CMVD (OR: 5.084, P=0.009), with a cut-off >5.51 mm showing 90% sensitivity and 71% specificity.
- FMD was not an independent predictor but indicated CMVD with 60% sensitivity and 83% specificity at <4.65%.
Conclusions:
- Epicardial fat thickness (EFT) and flow-mediated dilation (FMD) represent potential non-invasive markers for evaluating CMVD in INOCA patients.
- EFT is a significant independent predictor of CMVD, offering valuable clinical diagnostic insights.
- FMD provides complementary value for risk stratification, aiding in improved management of patients with microvascular dysfunction.
Background:
Coronary microvascular disease (CMVD) is a major cause of hospitalization for a considerable number of patients with ischemia with non-obstructive coronary arteries (INOCA), with coronary flow reserve (CFR) reduction being the main feature of CMVD. However, imaging methods for CMVD evaluation are still lacking. This study aimed to investigate associations among epicardial fat thickness (EFT), endothelial function assessed by flow-mediated dilation (FMD), and CFR in patients with CMVD, and to evaluate their predictive value for CMVD diagnosis.
Methods:
CFR was measured by regadenoson stress echocardiography, while EFT and FMD were measured by transthoracic echocardiography and brachial artery vascular ultrasound in 66 subjects with INOCA. Multivariable logistic regression and receiver operating characteristic analysis were performed.
Results:
Twenty-nine patients were categorized into the CFR decreased group (CFR < 2.0), and thirty-seven patients were separated into the CFR normal group (CFR ≥ 2.0). EFT was significantly higher in the CFR decreased group (6.063 ± 1.732 mm vs. 5.95 ± 1.718 mm, P = 0.003), while FMD was significantly lower in the CFR decreased group [4.05 (3.10, 5.40) vs. 5.30 (4.85, 7.30), P = 0.011]. EFT was an independent predictor for CMVD [odds ratio: 5.084, 95% confidence interval: 1.498-17.251, P = 0.009]. A cut-off value of EFT > 5.51 mm predicted CMVD with 90% sensitivity and 71% specificity. FMD was not an independent predictor for CMVD, but when FMD < 4.65%, it predicted CMVD with 60% sensitivity and 83% specificity.
Conclusions:
EFT and FMD may serve as potential evaluation methods for CMVD in patients with INOCA. EFT was independently associated with the presence of CMVD in this cohort, offering significant clinical diagnostic insights. EFT is a novel independent predictor of CMVD in this specific population, while FMD provides complementary diagnostic value for risk stratification. These non-invasive markers may help to improve risk stratification in patients with microvascular dysfunction.
