Diastolic dysfunction in patients with acute coronary pathology in the presence of an increase in epicardial adipose tissue

Objective. To evaluate diastolic disturbances in patients with unstable angina (UA) in the presence of an increase in epicardial adipose tissue (EAT). Subjects and methods. The investigation involved 64 men and 38 women (mean age, 612+7.6 years) with UA treated in the emergency cardiology unit. The patients were examined; standard laboratory parameters were determined, coronary angiography (CAG) and stenting of one or more coronary arteries were performed on days 1-3 of hospitalization. Echocardiography (EchoCG) with measurement of EAT thickness (EATT) was done at 2-4 days after CAG. EAT was measured from the parasternal position along the long and short axes of the left ventricle (LV) at the end of systole during 3 cardiac cycles; the average of three successive values was taken as the EATT value. According to EATT, the patients were divided Into 2 groups: 1)46 patients who had an EATT of <7.6 mm; 2) 56 patients who had an EATT of >7.6 mm. Results.Analysis of anamnestic and anthropometric data showed no significant differences between the groups, with the exception of waist-to-hip ratio (higher in Group 1; p=0.0026). EchoCG revealed heart failure with preserved LV e/ection fraction (EF); however, LV EF had lower values In Group 2 than In Group 1 (55 [51-59]% versus 58 [53-60]%; p=0.031). There was a significant decrease In the following indicators of diastolic function (DF) in Group 2 compared to Group 1: lateral Em was 6.5 (4.2-8.1) versus 9.3 (6.5-11.1) cm/s (p<0.001); median Em was 5.7 (4.6-6.6) versus 7 (5.6-8.5) cm/s (p=0.001), a significant increase In DT was 228 [207-273] versus 178 [150-211] ms (p<0.001),as well as the E/Em ratio was 11.4 (8.3-14.9) relative units versus 8.7 (5.1-14.2) relative units (p=0.017). There was a positive correlation between EATT and DT (r=0.498; p=0.001) and a moderate negative correlation between EAT and lateral Em (r= -0.374; p = 0.001) and between EATT and median Em (r=-0.331; p=0.001). In Group 2, grade 2 DF disturbances were detected significantly more often (60.8% versus 30.5%; p=0.013). Thus, the individuals with UA were observed to have more pronounced DF disturbances with an increase in EATT. To evaluate diastolic disturbances in patients with acute coronary syndrome without ST segment elevation in the presence of an increase in EAT, it is advisable to use myocardial tissue Doppler EchoCG. The increased EATT In patients with UA should be considered as a possible adverse factor for myocardial dysfunction.