Epicardial Adipose Tissue is Related to Arterial Stiffness in Patients with Cardio-metabolic Disease

Background: Epicardial adipose tissue (EAT) is an emerging cardio-metabolic risk factor and has been shown to be correlated with several cardiac comorbidities including coronary artery disease and left ventricular dysfunction. The underlying pathophysiology of this link is not well understood. It has been suggested that EAT can exert local effects on the coronary arteries and the myocardium through paracrine secretion of pro-inflammatory cytokines. However, EAT is also a metabolically active endocrine organ and could potentially exert harmful effects systemically. Arterial stiffness is implicated in both coronary artery disease and in heart failure pathophysiology. In this study, we have examined the relationship between EAT and arterial stiffness measured by pulse wave velocity (PWV) in a cross sectional study of patients with cardio-metabolic disease and healthy controls.Methods: One hundred and forty five participants from the SUMMIT project underwent cardiac MR (CMR) and were categorised into one of four groups: (1) type 2 diabetes mellitus (T2DM) with cardiovascular disease (CVD); (2) T2DM without CVD; (3) CVD without T2DM; (4) healthy controls. Measurements were performed on 4 chamber CMR images to define EAT as fat within the visceral pericardium. Arterial stiffness was assessed by carotid-femoral PWV.Results: 145 participants completed the study protocol-61.4 % male, with mean age of 63.86 ± 8.057 years. EAT measurements in the 4 groups were 15.89±5.49cm² in T2DM with CVD, 13.55±3.48cm² in T2DM without CVD, 15.09±4.27cm² in CVD without T2DM and 11.82±4.14cm² healthy controls (P<0.05). Mean-PWV measurements in the 4 groups were 11.43±2.95m/sec inT2DM with CVD, 11.12±2.69m/s in T2DM, 11.07±2.38m/s in CVD and 9.87±2.36m/s in healthy controls. There was a significant correlation between PWV and EAT (R= 0.28, p=0.002).Conclusions: EAT showed an association with arterial stiffness which is pathophysiologically linked to both coronary artery disease and heart failure