Impact of Epicardial Adipose Tissue on Infarct Size and Left Ventricular Systolic Function in Patients with Anterior ST-Segment Elevation Myocardial Infarction

Figures

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  Figure 1. Flowchart of patients. Reasons for exclusion are depicted in boxes. Abbreviations: CMR = cardiovascular magnetic resonance; STEMI = ST-segment elevation myocardial infarction.

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  Figure 2. EAT measurement. EAT (light blue area) was quantified at the 1-week and 6-month cardiovascular magnetic resonance by manually tracing the outer myocardial wall (red dotted line) and the visceral layer of the pericardium (arrowheads and dark blue dotted line). The left panel illustrates a patient with high EAT (>third tertile, 35 mL/m2) and the right panel corresponds to a patient with low EAT (≤35 mL/m2). Abbreviation: EAT = Epicardial adipose tissue.

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  Figure 3. Association of EAT with IS at 1-week CMR. (A) Patients with high EAT (>35 mL/m2) displayed larger IS at 1-week CMR. (B) After adjustment, EAT showed a significant and direct association with IS. Abbreviations: CMR = Cardiovascular magnetic resonance. EAT = Epicardial adipose tissue. IS = Infarct size. LV = Left ventricular.

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  Figure 4. Association of 1-week EAT with 6-month LVEF. After adjustment, 1-week EAT did not show a significant association with 6-month LVEF. Abbreviations: EAT = Epicardial adipose tissue. LVEF = Left ventricular ejection fraction.

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  Figure 5. Association of 1-week EAT with 6-month LVEF. After adjustment, 1-week EAT was not correlated with 6-month LVEF in patients with non-extensive IS (A). Nevertheless, an independent and direct association of 1-week EAT with 6-month LVEF existed in those with extensive IS at the 1-week cardiovascular magnetic resonance (B). No significant differences between patients with high and low 1-week EAT were detected in terms of 6-month LVEF in the subgroup with non-extensive 1-week IS (C). Nevertheless, in patients with extensive 1-week IS, those with high 1-week EAT exhibited more preserved LVEF at 6 months (D). Abbreviations: EAT = Epicardial adipose tissue. IS = Infarct size. LVEF = Left ventricular ejection fraction.

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  Figure 6. Association of 1-week EAT with LVEF in the matched population. In the matched patients, compared with 1-week LVEF, 6-month LVEF improved in those with high EAT but did not vary in patients with low 1-week EAT. Abbreviations. EAT = Epicardial adipose tissue. IS = Infarct size. LVEF = Left ventricular ejection fraction.

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  Figure 7. Dynamics of EAT. EAT decreased from the 1-week to the 6-month cardiovascular magnetic resonance. Compared with patients with non-extensive IS, more substantial EAT reduction occurred in those with extensive 1-week IS. Abbreviations: CMR = Cardiovascular magnetic resonance. EAT = Epicardial adipose tissue. IS = Infarct size. ∆EAT = Variation in EAT (mL/m2) from 1-week to 6-month CMR.

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  Figure 8. Association of ∆EAT with 6-month LVEF. ∆EAT was not associated with 6-month LVEF in patients with non-extensive IS (A). Nevertheless, an independent association of ∆EAT with 6-month LVEF existed in those with extensive 1-week IS (B). The p-value for the interaction between non-extensive and extensive IS was <0.05. Abbreviations. CMR = Cardiovascular magnetic resonance. EAT = Epicardial adipose tissue. IS = Infarct size. LVEF = Left ventricular ejection fraction. ∆EAT = Variation of EAT (mL/m2) from 1-week to 6-month CMR.

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  Figure 9. Association of ∆EAT with 6-month LVEF. In patients with extensive 1-week IS, those with ∆EAT < 0 mL/m2 (first tertile) displayed more preserved 6-month LVEF than those with ∆EAT ≥ 0 mL/m2 (A). These differences did not occur in patient with non-extensive IS (B). Abbreviations: CMR = Cardiovascular magnetic resonance. EAT = Epicardial adipose. IS = Infarct size. LVEF = Left ventricular ejection fraction. ∆EAT = Variation of EAT (mL/m2) from 1-week to 6-month CMR.

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  Figure 10. Central Illustration. In patients with a first anterior STEMI, the presence of high EAT upon reperfusion is associated with the occurrence of large infarctions (upper panels). However, in patients with already established large infarctions, high EAT and greater subsequent EAT reduction are related to more preserved left ventricular systolic function in the chronic phase (lower panels). Abbreviations: EAT = Epicardial adipose tissue. IS = Infarct size. LVEF = Left ventricular ejection fraction. STEMI = ST-segment elevation myocardial infarction. ∆EAT = Variation of EAT from 1-week to 6-month cardiovascular magnetic resonance.