Relación del volumen de grasa epicárdica con los factores de riesgo cardiovascular clásicos, la presencia de enfermedad arterial coronaria y los eventos clínicos

Introducción y objetivos: El tejido adiposo epicárdico es un depósito metabólicamente activo que ha demostrado estar implicado en el desarrollo de enfermedad arterial coronaria y en la predicción de eventos cardiovasculares. Sin embargo, la forma en la cual se encuentran relacionados es controvertida, y, además, estos hallazgos podrían estar influidos por el tamaño corporal, ya que existe correlación entre la cantidad de grasa epicárdica y las medidas antropométricas. Nuestro objetivo fue analizar la asociación entre el tejido adiposo epicárdico indexado y la enfermedad coronaria, los eventos cardiovasculares adversos y el perfil de riesgo cardiovascular en una cohorte de pacientes sintomáticos. Métodos: Se incluyeron pacientes derivados para la realización de tomografía computarizada coronaria entre marzo de 2010 y abril de 2017. Se definió enfermedad coronaria por la presencia de estenosis coronarias obstructivas o una cantidad elevada de calcio coronario. Se cuantificó el volumen de grasa epicárdica mediante un programa informático semiautomático y se indexó el volumen al área de superficie corporal. Se realizó un análisis de regresión para determinar la relación entre la presencia de enfermedad coronaria y volumen de grasa epicárdica indexado, edad, género, factores de riesgo cardiovascular y comorbilidades. La asociación entre volumen de grasa epicárdica indexado y eventos cardiovasculares se analizó con modelos de regresión de Cox. Resultados: Se incluyeron 179 pacientes (56 ± 12 años, 57,5% varones). El volumen de grasa epicárdica indexado (p = 0,003), la edad (p < 0,001) y el sexo masculino (p < 0,001) se asociaron de forma independiente con la presencia de enfermedad coronaria. Los pacientes con mayor volumen de grasa epicárdica indexado mostraron un mayor riesgo de eventos cardiovasculares durante el seguimiento (5,5 años, 2,4 - 6,4) (HR = 2,44; IC 95 %, 1,07 - 5,56; p = 0,033). Además, este volumen es superior en pacientes hipertensos (p < 0,001), diabéticos (p < 0,001) y dislipémicos (p = 0,008). Conclusiones: En pacientes sintomáticos, un mayor volumen de tejido adiposo epicárdico indexado se asocia con la enfermedad coronaria obstructiva, así como con eventos cardiovasculares. Además, los pacientes con factores de riesgo cardiovascular muestran una mayor cantidad de grasa epicárdica.Introduction and objectives: The epicardial adipose tissue is a metabolically active fat depot that has shown to be implicated in the development of coronary artery disease and the prediction of cardiovascular events. However, the way both factors interact is controversial, and these findings might be influenced by body size since previous studies have demonstrated a strong correlation between the amount of epicardial fat and anthropometric measurements. Our objective was to assess the association between indexed epicardial adipose tissue volume and the presence of coronary artery disease, cardiovascular events and the cardiovascular risk profile in a cohort of symptomatic patients. Methods: Patients referred for cardiac computed tomography from March 2010 to April 2017 were included. Coronary artery disease was defined as the presence of obstructive coronary stenosis or a high amount of coronary calcium. Epicardial adipose tissue volume was assessed using a semiautomatic software and indexed to body surface area. A regression analysis was performed to determine the relationship between relevant coronary artery disease and indexed epicardial adipose tissue, age, sex, cardiovascular risk factors, and comorbidities. The association between indexed epicardial adipose tissue and cardiovascular events was analyzed with Cox regression models. Results: A total of 179 patients were recruited (56 ± 12 years, 57.5% male). Indexed epicardial adipose tissue (p = 0.003), age (p <0.001) and male sex (p < 0.001) were significantly and independently associated with coronary artery disease. During follow-up (5.5 years, 2.4 – 6.4) patients with elevated indexed epicardial adipose tissue showed an increased risk of events (HR 2.44; 95% CI, 1.07 - 5.56; p = 0.033). Furthermore, this volume is higher in subjects with hypertension (p < 0.001), diabetes (p < 0.001) and dyslipidemia (p = 0.008). Conclusions: In symptomatic patients, an increased volume of indexed epicardial fat was associated with obstructive coronary artery disease as well as with cardiovascular events. Patients with cardiovascular risk factors show a high amount of epicardial adipose tissue

Low Performance of a Clinical-Genetic Model in the Estimation of Time in Therapeutic Range in Acenocoumarol-Adherent Patients with Nonvalvular Atrial Fibrillation: The Quality of Anticoagulation Challenge

Background. Anticoagulation with vitamin K antagonists continues to be a challenging task given the difficulty of achieving a correct time in therapeutic range (TTR). The SAMeTT2R2 score has been proposed to identify patients that will be good responders. In this study we aimed to analyse clinical and genetic factors involved in a correct level of anticoagulation in patients with atrial fibrillation and thereby potentially improve the diagnostic performance of SAMeTT2R2 score. Methods. We prospectively included 212 consecutive patients with nonvalvular atrial fibrillation under treatment with acenocoumarol for at least 6 months that were attended in a cardiology outpatient clinic and were categorized as adherent to medication. We carried out a multivariate regression analysis to detect the independent predictive factors of good control. In all patients VKORC1, CYP2C9⁎2, CYP2C9⁎3, and MIR133A2 genotyping was performed. Results. A total of 128 (60.4%) patients presented TTR <70% (average TTR = 63.2). We identified body mass index (OR 0.94, 95%CI 0.89-0.99, p=0.032) and regular vitamin K intake (OR 0.53, 95%CI 0.28-0.99, p= 0.046) as independent predictors of poor anticoagulation control. The discriminatory power of a clinical-genetic model derived from our cohort was significantly better compared to the SAMeTT2R2 score (C-statistic 0.658 versus 0.524, p<0.001). Conclusions. In our study the SAMeTT2R2 score revealed a poor ability in the prediction of TTR. Besides SAMeTT2R2, body mass index and possibly vitamin K intake should be taken into account when deciding the optimal anticoagulation strategy. The information provided by the identified genotypes was marginal

Low Performance of a Clinical-Genetic Model in the Estimation of Time in Therapeutic Range in Acenocoumarol-Adherent Patients with Nonvalvular Atrial Fibrillation: The Quality of Anticoagulation Challenge

Background. Anticoagulation with vitamin K antagonists continues to be a challenging task given the difficulty of achieving a correct time in therapeutic range (TTR). The SAMeTT2R2 score has been proposed to identify patients that will be good responders. In this study we aimed to analyse clinical and genetic factors involved in a correct level of anticoagulation in patients with atrial fibrillation and thereby potentially improve the diagnostic performance of SAMeTT2R2 score. Methods. We prospectively included 212 consecutive patients with nonvalvular atrial fibrillation under treatment with acenocoumarol for at least 6 months that were attended in a cardiology outpatient clinic and were categorized as adherent to medication. We carried out a multivariate regression analysis to detect the independent predictive factors of good control. In all patients VKORC1, CYP2C9⁎2, CYP2C9⁎3, and MIR133A2 genotyping was performed. Results. A total of 128 (60.4%) patients presented TTR <70% (average TTR = 63.2). We identified body mass index (OR 0.94, 95%CI 0.89-0.99, p=0.032) and regular vitamin K intake (OR 0.53, 95%CI 0.28-0.99, p= 0.046) as independent predictors of poor anticoagulation control. The discriminatory power of a clinical-genetic model derived from our cohort was significantly better compared to the SAMeTT2R2 score (C-statistic 0.658 versus 0.524, p<0.001). Conclusions. In our study the SAMeTT2R2 score revealed a poor ability in the prediction of TTR. Besides SAMeTT2R2, body mass index and possibly vitamin K intake should be taken into account when deciding the optimal anticoagulation strategy. The information provided by the identified genotypes was marginal