title: The Influence of Epicardial Fat and Nonalcoholic Fatty Liver Disease on Heart Rate Recovery in Metabolic Syndrome.
abstract: Epicardial adipose tissues reflecting visceral fat accumulations of the heart are associated with metabolic syndrome (MetS) and can be a predictor of other cardiometabolic diseases. It can adversely influence autonomic nervous system (ANS) of heart. Heart rate recovery (HRR) is an easy method for measuring ANS dysfunction. The purpose of this study was to determine whether epicardial fat thickness (EFT) and nonalcoholic fatty liver disease (NAFLD) are related to HRR in patients with MetS.
  
  
  
  We enrolled 772 consecutive patients from a health-screening center who underwent abdominal ultrasonography, treadmill test, and cardiac echocardiography. EFT using echocardiography and HRR by symptom-limited exercise testing was assessed. According to the presence of MetS and NAFLD, patients were classified into the four groups.
  
  
  
  In NAFLD patients, EFT was higher and HRR was lower, especially in patients with MetS and NAFLD, compared to non-MetS participants without NAFLD (MetS with NAFLD, EFT 7.5 ± 4.4 mm, HRR 31.9 ± 12.7; MetS without NAFLD, EFT 4.9 ± 3.0 mm, HRR 39.5 ± 11.1; non-MetS with NAFLD, EFT 5.9 ± 3.6 mm, HRR 36.6 ± 12.7; and non-MetS without NAFLD, EFT 4.4 ± 3.5 mm, HRR 43.4 ± 14.5, p < 0.001). Patients with severe liver steatosis (LS) showed significantly higher EFT than those with moderate LS (14.2 ± 2.0 vs. 7.5 ± 3.1 mm, P < 0.001), and EFT was positively correlated with severity of LS (r = 0.431, P < 0.001). HRR was significantly correlated with EFT (r = -0.386, P < 0.001) and severity of LS (r = -0.324, P < 0.001).
  
  
  
  EFT and NAFLD were significantly correlated with HRR in patients with MetS and they may be highly related to increased cardiovascular risk. These results suggest a cross-link among EFT, NAFLD, and cardiac autonomic dysfunction in patients with MetS.
authors.affiliation: 1 Department of Internal Medicine, Kosin University College of Medicine , Busan, South Korea .|2 Convergence Medicine and Exercise Science Research Institute, Kosin University College of Medicine , Busan, South Korea .
authors.forename: Kyoung Im
authors.initials: KI
authors.lastname: Cho
authors.affiliation: 1 Department of Internal Medicine, Kosin University College of Medicine , Busan, South Korea .|2 Convergence Medicine and Exercise Science Research Institute, Kosin University College of Medicine , Busan, South Korea .
authors.forename: Eun Ah
authors.initials: EA
authors.lastname: Jo
authors.affiliation: 3 Department of Statistics and Actuarial Science, Soongsil University , Seoul, South Korea .
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Cho
authors.affiliation: 4 Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital and Biomedical Research Institute , Busan, South Korea .
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Kim
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050154:Adiposity; D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010496:Pericardium; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors
keywords: autonomic function; epicardial fat; heart rate recovery; metabolic syndrome