The role of adipokines and epicardial fat tissue thickness in prognostication of acute coronary syndrome outcomes

Epicardial fat, taking into account its anatomical and physiological features, has been considered for many years as an important factor incardiovascular diseases (CVD) pathogenesis.

The aim: to evaluate the possibility of predicting the negative clinical course of stenocardia during the year after hospitalization for acute coronary syndrome. It is based on the thickness of epicardial fat and adipokines concentration in patients with metabolic disorders.

Material and methods. We studied 38 female and 64 male patients with overweight or obesity, median age 62 [55; 67] years hospitalized for unstable stenocardia of medium or high risk according to the Grace 2.0 scale. During their admission, a survey, examination, laboratory testing to determine the level of leptin, adiponectin, tumor necrosis factor-alpha (TNF-α) and interleukin (IL-6) were performed. Stenting of coronary arteries was made on the 1st–3rd day after hospitalization. Echocardiography on days 2–4 according to the standard protocol with epicardial fat thickness (TEF) measurement along the long axis of the left ventricle at the end of systole was performed. Patients were divided into two groups depending on TEF: Group 1 – TEF up to 7,6 mm (n=46); Group 2 – TEF >7,6 mm (n=56). After 12 months, the control visit of patients, as part of the second stage of the study took place. All together 89 persons (87,2%) were examined – 44 from Group 1 and 45 from Group 2.

Results. The dynamics of laboratory parameters in Group 1 was fixed relatively to the level of adiponectin (p=0,001), leptin (p=0,001), IL-6 (p=0,001) and TNF-α (p=0,001), in Group 2 – levels of leptin (p=0,001), TNF-α (p=0,001) and IL-6 (p=0,001). Significant differences in echocardiographic signs over time in Group 1 were identified in indexes of end-diastolic volume (EDV) and end-systolic volume (ESV; p=0,001), in Group 2- in indexes of left ventricular ejection fraction (LVEF); p=0,001), EDV and ESV (p=0,001). The following factors had a statistically significant effect on the probability of worsening stenocardia: leptin level – 1,08 (95% CI: 1,0–1,16; p=0,046), LV EF – 0,66 (95% CI: 0,52–0,84; p=0,001) and TEF – 2,18 (95% CI: 1,21–3,93; p=0,010).

Conclusion. TEF more than 7,6 mm, elevated leptin concentration and reduced LV EF were independent predictors of unfavorable course of stenocardia within 12 months in patients with unstable stenocardia and metabolic disorders.