Accumulation of epicardial fat rather than visceral fat is an independent risk factor for left ventricular diastolic dysfunction in patients undergoing peritoneal dialysis
- Equal contributors
1 Division of Cardiology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
2 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
3 Department of Clinical Pathology & Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
4 Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
5 Department of Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
6 Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
7 Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital No. 7, Chung-Shan South Road Taipei 100, Taipei, Taiwan
8 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Cardiovascular Diabetology 2013, 12:127 doi:10.1186/1475-2840-12-127Published: 30 August 2013
Symptoms of heart failure with preserved left ventricular systolic function are common among patients undergoing peritoneal dialysis (PD). Epicardial fat (EpF) is an ectopic fat depot with possible paracrine or mechanical effects on myocardial function. The aim of our current study is to assess the association between EpF and Left ventricular diastolic dysfunction (LVDD) in patients undergoing PD and to clarify the relationships among EpF, inflammation, and LVDD in this population.
This was a cross-sectional study of 149 patients with preserved left ventricular systolic function who were undergoing PD. LVDD was diagnosed (according to the European Society of Cardiology guidelines) and EpF thickness measured by echocardiography. The patients without LVDD were used as controls. The serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) was measured. The location and amount of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra.
Subjects with LVDD had higher levels of hsCRP, more visceral and peritoneal fat, and thicker EpF (all p < 0.001) than controls. Visceral adipose tissue, hsCRP, and EpF all correlated significantly (p < 0.05) with LVDD. Multivariate regression analysis rendered the relationship between visceral adipose tissue and LVDD insignificant, whereas EpF was the most powerful determinant of LVDD (odds ratio = 2.41, 95% confidence interval = 1.43–4.08, p < 0.01). EpF thickness also correlated significantly with the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e’; r = 0.27, p < 0.01).
EpF thickness is significantly independently associated with LVDD in patients undergoing PD and may be involved in its pathogenesis.