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Epicardial fat thickness is correlated with vagal hyperactivity in patients with neurally-mediated syncope
Kyoung Im Cho1, Young Soo Lee2*, Byong Kyu Kim3, Bong Joon Kim1, Kee Sik Kim2
1Kosin University College of Medicine
2Catholic University of Daegu Cardiology
3Dongguk University College of Medicine
Corresponding Author: Young Soo Lee ,Email: mdleeys@cu.ac.kr
ABSTRACT
Background:
Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. The head-up tilt table 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 855 consecutive patients (mean age 26.5 years, male: 46.9%) 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, and symptomatic arrhythmias. We divided patients into two groups based on the HUTT (positive versus negative).
Results:
There were 363 patients (42.5%) with a negative HUTT result and 492 patients (57.5%) with a positive result. The HUTT-positive patients showed a significantly lower waist circumference and systolic and diastolic blood pressure, although a significantly higher EFT as compared to the HUTT-negative patients (HUTT-positive, 5.7 ± 1.8 mm vs. HUTT-negative 5.3 ± 1.6 mm, p < 0.001). EFT >5.4 mm was associated with a positive HUTT result with 52% sensitivity and 63% specificity (p < 0.001) on receiving operator characteristic analysis. Multivariate Cox regression analysis revealed that EFT >5.4 mm (hazard ratio, HR: 2.23; 95% CI: 1.43–3.48, p < 0.001) was an independent predictor of HUTT positivity.
Conclusion:
EFT was significantly correlated with positive HUTT, which suggests an association between EFT and autonomic dysregulation.
Keywords: Epicardial fat, Cardiac autonomic function, Vasovagal syncope
Volume 25, No 3
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