title: Impact of body mass index on the relationship of epicardial adipose tissue to metabolic syndrome and coronary artery disease in an Asian population.
abstract: BACKGROUND
  In a previous study, we demonstrated that the thickness of epicardial adipose tissue (EAT), measured by echocardiography, was increased in patients with metabolic syndrome (MS) and coronary artery disease (CAD). Several studies on obese patients, however, failed to demonstrate any relationship between EAT and CAD. We hypothesized that body mass index (BMI) affected the link between EAT and MS and CAD.
  
  
  METHODS
  We consecutively enrolled 643 patients (302 males, 341 females; 59 +/- 11 years), who underwent echocardiography and coronary angiography. The EAT thickness was measured on the free wall of the right ventricle at the end of diastole. All patients were divided into two groups: high BMI group, > or = 27 kg/m2 (n = 165), and non-high BMI group, < 27 kg/m2 (n = 478).
  
  
  RESULTS
  The median and mean EAT thickness of 643 patients were 3.0 mm and 3.1 +/- 2.4 mm, respectively. In the non-high BMI group, the median EAT thickness was significantly increased in patients with MS compared to those without MS (3.5 vs. 1.9 mm, p < 0.001). In the high BMI group, however, there was no significant difference in the median EAT thickness between patients with and without MS (3.0 vs. 2.5 mm, p = 0.813). A receiver operating characteristic (ROC) curve analysis predicting MS revealed that the area under the curve (AUC) of the non-high BMI group was significantly larger than that of the high BMI group (0.659 vs. 0.506, p = 0.007). When compared to patients without CAD, patients with CAD in both the non-high and high BMI groups had a significantly higher median EAT thickness (3.5 vs. 1.5 mm, p < 0.001 and 4.0 vs. 2.5 mm, p = 0.001, respectively). However, an ROC curve analysis predicting CAD revealed that the AUC of the non-high BMI group tended to be larger than that of the high BMI group (0.735 vs. 0.657, p = 0.055).
  
  
  CONCLUSIONS
  While EAT thickness was significantly increased in patients with MS and CAD, the power of EAT thickness to predict MS and CAD was stronger in patients with BMI < 27 kg/m2. These findings showed that the measurement of EAT thickness by echocardiography might be especially useful in an Asian population with a non-high BMI, less than 27 kg/m2.
authors.affiliation: Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jin-Sun
authors.initials: JS
authors.lastname: Park
authors.forename: Sung-Gyun
authors.initials: SG
authors.lastname: Ahn
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Lim
authors.forename: Byoung-Joo
authors.initials: BJ
authors.lastname: Choi
authors.forename: So-Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Myeong-Ho
authors.initials: MH
authors.lastname: Yoon
authors.forename: Gyo-Seung
authors.initials: GS
authors.lastname: Hwang
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Joon-Han
authors.initials: JH
authors.lastname: Shin
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D050154:Adiposity / Q000208:ethnology*; D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000208:ethnology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007723:Korea; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging / Q000208:ethnology / Q000503:physiopathology*; D008875:Middle Aged; D016017:Odds Ratio; D010496:Pericardium; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography