J Cardiovasc Ultrasound.  2017 Jun;25(2):57-62. 10.4250/jcu.2017.25.2.57.

Epicardial Fat Thickness is Correlated with Vagal Hyperactivity in Patients with Neurally-Mediated Syncope

• Cho KI
• Lee YS
• Kim BK
• Kim BJ
• Kim KS

• KMID: 2385076
• DOI: http://doi.org/10.4250/jcu.2017.25.2.57

Abstract

BACKGROUND
Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. The head-up tilt test (HUTT) is a simple non-invasive measurement that assesses autonomic nervous system dysfunction. We investigated the association between epicardial fat thickness (EFT) and autonomic neural tone, such as vagal tone.
METHODS
A total of 797 consecutive patients (mean age 46.5 years, male: 45.7%) who underwent HUTT and echocardiography between March 2006 and June 2015 were enrolled. EFT was measured during the diastolic phase of the parasternal long axis view. We excluded patients with prior percutaneous coronary intervention, old age (* 70 years old), valvular heart disease, symptomatic arrhythmias and diabetes. We divided patients into two groups based on the HUTT (positive vs. negative).
RESULTS
There were 329 patients (41.3%) with a negative HUTT result and 468 patients (58.7%) with a positive result. The HUTT-positive patients showed a significantly lower waist circumference, body mass index and systolic and diastolic blood pressure, although a significantly higher EFT as compared to the HUTT-negative patients (HUTT-positive, 5.69 ± 1.76 mm vs. HUTT-negative, 5.24 ± 1.60 mm; p < 0.001). EFT > 5.4 mm was associated with a positive HUTT result with 51.7% sensitivity and 63.8% specificity (p < 0.001) on receiving operator characteristic analysis. Multivariate Cox regression analysis revealed that EFT (hazard ratio: 1.02, 95% confidence interval: 1.01-1.30, p = 0.004) was an independent predictor of HUTT-positivity. CONCLSION: EFT was significantly correlated with positive HUTT, which suggests an association between EFT and autonomic dysregulation.

Keyword

Epicardial fat; Cardiac autonomic function; Vasovagal syncope

MeSH Terms

Arrhythmias, Cardiac
Autonomic Nervous System
Blood Pressure
Body Mass Index
Echocardiography
Heart Valve Diseases
Humans
Male
Percutaneous Coronary Intervention
Sensitivity and Specificity
Syncope*
Syncope, Vasovagal
Waist Circumference

Figure

• 

  Fig. 1 Comparison of epicardial fat thickness (EFT) according to the head-up tilt test (HUTT). EFT was significantly higher in HUTT-positive patients compared to HUTT-negative patients (A). However, there were no significant differences among the three hemodynamic types of syncope groups with respect to EFT (B).

• 

  Fig. 2 On the receiving operator characteristic analysis, epicardial fat thickness > 5.4 mm was associated with a positive head-up tilt test (HUTT) result with 51.7% sensitivity and 63.8% specificity (area under curve: 0.578, 95% confidence interval = 0.54–0.61, p < 0.001).

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