title: Epicardial adipose tissue in long-term hemodialysis patients: its association with vascular calcification and long-term development.
abstract: BACKGROUND
  Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) in the general population. EAT is suggested to promote CAD by paracrine mechanisms and local inflammation. We evaluated whether in chronic hemodialysis (HD) patients EAT associates with CAD, how the amount of EAT develops over time, and if EAT independently predicts the mortality risk.
  
  
  METHODS
  Post-hoc analysis of a prospective study in 59 chronic HD patients who underwent non-enhanced multi-slice computed tomography (MSCT) at baseline. Thirty-seven patients underwent another MSCT after 24 ± 5 months. We measured EAT volume (cm³) and Agatston calcification scores of coronary arteries (CAC) and aortic valves (AVC). All-cause mortality was assessed after a follow-up of 88 months (IQR 52-105).
  
  
  RESULTS
  Baseline EAT was 128.2 ± 60.8 cm³ and significantly higher than in a control group of non-renal patients (94 ± 46 cm³; p < 0.05). Median Agatston score for CAC was 329 (IQR 23-1181) and for AVC was 0 (IQR 0-25.3) in HD patients. We observed significant positive correlations between baseline EAT and age (r = 0.386; p = 0.003), BMI (r = 0.314; p = 0.016), CAC (r = 0.278; p = 0.03), and AVC (r = 0.282; p = 0.03). In multivariate analysis, age, BMI and AVC remained as significant predictors of EAT (p < 0.01). Calcification scores significantly increased over 2 years; in contrast EAT change was not significant (+11 %, IQR -10 to 24 %; p = 0.066). The limited patient number in the present study precludes analysis of the EAT impact upon survival.
  
  
  CONCLUSIONS
  EAT correlated significantly with cardiovascular calcification in long-term HD patients. Mean EAT did not significantly change over 2 years.
authors.affiliation: Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany. xoabaf@hotmail.com.|Department of Nephrology, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain. xoabaf@hotmail.com.
authors.forename: Xoana
authors.initials: X
authors.lastname: Barros
authors.affiliation: Department of Radiology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Dirrichs
authors.affiliation: Department of Cardiology, Städtische Kliniken Mönchengladbach GmbH, Elisabeth-Krankenhaus Rheydt, Rheydt, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Koos
authors.affiliation: Department of Radiology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Reinartz
authors.affiliation: Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Kaesler
authors.affiliation: Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: Rafael
authors.initials: R
authors.lastname: Kramann
authors.affiliation: Dialysis Center, Kuratorium für Heimdialyse (KfH), Würselen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gladziwa
authors.affiliation: Department of Nephrology, Klinikum Coburg, Coburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Ketteler
authors.affiliation: Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.affiliation: Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.affiliation: Department of Nephrology, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain.
authors.forename: José V
authors.initials: JV
authors.lastname: Torregrosa
authors.affiliation: Department of Medical Informatics, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: András
authors.initials: A
authors.lastname: Keszei
authors.affiliation: Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Brandenburg
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010496:Pericardium / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality
keywords: Coronary artery calcification; Epicardial adipose tissue; Hemodialysis; Survival