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JCU 2017 June;25(2) :57-62.
Published online 2017 June 30. doi:
Epicardial Fat Thickness is Correlated with Vagal Hyperactivity in Patients with Neurally-Mediated Syncope
Kyoung Im Cho, MD1, Young Soo Lee, MD2, Byong Kyu Kim, MD3, Bong Joon Kim, MD1, and Kee Sik Kim, MD2
1Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
2Division of Cardiology, Department of Internal Medicine, Catholic University of Daegu College of Medicine,Daegu, Korea
3Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
Corresponding Author: Young Soo Lee ,Tel: +82-53-650-3441, Fax: +82-53-621-3166, Email:
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.
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).
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.
Keywords: Epicardial fat · Cardiac autonomic function · Vasovagal syncope.
Volume 25, No 4
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