Effect of Epicardial Fat Pad on Cardiac Remodeling Erika Rivera, Andres Castillo, Eli Harris, Amgad N. Makaryus and Roman Zeltser Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Nassau University Medical Center
Results
Background The epicardial fat pad (EFP) has been independently linked to increased cardiovascular risk and the development of major adverse cardiac events. The epicardial fat pad constitutes a mechanical load on the heart, which could lead to compensatory remodeling.1 Moreover, the release of adipokines from epicardial adipose tissue can locally induce cardiac remodeling. The aim of this study was to determine if reductions in EFP thickness, as seen in patients who underwent Bariatric Surgery, correlates with changes in left ventricular remodeling.
Hypothesis We predict that reductions in EFP thickness post-bariatric surgery will correlate to changes in left ventricular remodeling.
Methods
An evaluation of hospital Bariatric Surgery Registry which includes patients who had bariatric surgery, a 2-year follow up, and a pre-op and post-op echocardiography (TTE), was undertaken. The average thickness of EFP was taken from 2 TTE views with 3 measurements of each taken per heartbeat. Patients with a minimum of 3 adequate measurement qualified for the analysis. Values for left ventricular geometry were also obtained from the pre- and postoperative TTE summary reports.
n=23 Epicardial Fat Pad Thickness (cm) IVSd (cm) LVPWd (cm) LVIDd (cm) LV Mass (g) LV Mass index (g/m2) LV (EF%) LV diastolic function (0 = normal, 1 = abnormal) E/A Ratio E/e’ ratio TR Jet Velocity (m/s) RVSP (mmHg)
Future Direction
1.00 0.97 4.67 163.94 77.79
0.95 0.90 4.56 143.15 71.25
-0.05 -.07 -0.11 -20.79 -6.54
66.07 0.13
65.80 0.22
-0.27 +0.09
1.30 11.36 2.27
1.23 11.51 2.22
-0.07 +0.15 -0.05
The next step in this project is to run a bivariate Pearson correlation to assess the strength of the linear relationship between the pre and post-operative differences in EFP thickness and measurements of cardiac remodeling. By largely unknown mechanisms, EFT has been shown to be positively correlated to increased risk for CAD, unstable angina and metabolic 2 syndrome. This makes the epicardial fat pad a biomarker of cardiovascular risk and a potential therapeutic target for cardiovascular disease.3 However, it is still unknown whether a decrease in epicardial fat volume directly impacts cardiac remodeling. Determining its potential to induce cardiac remodeling may elucidate part of the pathophysiology of and progression to CAD in patients with thicker EFPs.
-3.04
Resources
Average Pre-Op Average Post-Op Difference Measurement Measurement 45.08 36.20 -8.88
28.92
25.88
Table 1. Echocardiographic variables pre and post operatively
The data suggests that there is an overall decrease, on average, in EFP thickness in patients who undergo bariatric surgery. This finding is consistent with a previous study that evaluated changes in EFP thickness in bariatric surgery. The data also points at a similar overall average decrease in most measurements of left ventricular remodeling in patients who undergo bariatric surgery.
1. Mookadam F, Goel R, Alharthi M, Jiamsripong P, and Cha S. Epicardial Fat and Its Association with Cardiovascular Risk: A CrossSectional Observational Study. 2. Tokhi B, Humphrey T, Harris E, Castillo A, Makaryus A, and Zeltser R. Effects of Bariatric Surgery on Epicardial Fat Pad Remodeling. 3. Wu Y, Zhang A, Hamilton D, and Deng T. Epicardial Fat in the Maintenance of Cardiovascular Health.