Pediatric Cardiology

, Volume 31, Issue 6, pp 853–860

Echocardiographic Measurement of Epicardial Adipose Tissue in Obese Children

  • Osman Ozdemir
  • Samil Hizli
  • Ayhan Abaci
  • Kadir Agladioglu
  • Sinef Aksoy
Original Article

Abstract

The echocardiographic measurement of epicardial adipose tissue (EAT) has been suggested as an easy method for evaluation of the visceral adipose tissue and its related cardiovascular risks in adults. However, a direct effect of obesity on cardiac function is not well established, and echocardiographic EAT thickness has not been studied in children. The aims of this study were to evaluate cardiac function and echocardiographic EAT thickness and to correlate EAT with the other echocardiographic findings in obese children. The study population included 106 obese and 62 lean children. Echocardiographic indexes of systolic and diastolic function were obtained. We measured EAT thickness on the free wall of the right ventricle from parasternal long-axis views. The septal and posterior wall thicknesses, relative wall thickness, left atrial diameter, and left ventricular mass were increased (p = 0.001) in obese children. However, systolic and diastolic functions of the left ventricle were normal in the patients. The obese children had a significantly thicker EAT (p = 0.001) compared to the lean subjects. EAT thickness correlated significantly with body mass index (r = 0.50, p = 0.001), left atrial diameter (r = 0.37, p = 0.001), and left ventricular mass (r = 0.33, p = 0.001). In conclusion, the present study demonstrates a close relationship between EAT thickness and obesity in children. Assessment of EAT thickness in routine echocardiographic examinations might be used as a feasible and reliable method for the evaluation of obesity and its related cardiovascular risks during childhood.

Keywords

Childhood obesity Echocardiography Epicardial adipose tissue Epicardial fat 

References

  1. 1.
    Abaci A, Tascilar ME, Saritas T, Yozgat Y, Yesilkaya E, Kilic A, Okutan V, Lenk MK (2009) Threshold value of subepicardial adipose tissue to detect insulin resistance in obese children. Int J Obes (Lond) 33:440–446CrossRefGoogle Scholar
  2. 2.
    Chinali M, de Simone G, Roman MJ, Lee ET, Best LG, Howard BV, Devereux RB (2006) Impact of obesity on cardiac geometry and function in a population of adolescents: the Strong Heart Study. J Am Coll Cardiol 47:2267–2273CrossRefPubMedGoogle Scholar
  3. 3.
    Daniels SR, Loggie JM, Khoury P, Kimball TR (1998) Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 97:1907–1911PubMedGoogle Scholar
  4. 4.
    de Divitiis O, Fazio S, Petitto M, Maddalena G, Contaldo F, Mancini M (1981) Obesity and cardiac function. Circulation 64:477–482PubMedGoogle Scholar
  5. 5.
    de Onis M, Blossner M (2000) Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr 72:1032–1039PubMedGoogle Scholar
  6. 6.
    de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Org 85:660–667CrossRefPubMedGoogle Scholar
  7. 7.
    Djaberi R, Schuijf JD, van Werkhoven JM, Nucifora G, Jukema JW, Bax JJ (2008) Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol 102:1602–1607CrossRefPubMedGoogle Scholar
  8. 8.
    Freedman DS, Dietz WH, Srinivasan SR, Berenson GS (1999) The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 103:1175–1182CrossRefPubMedGoogle Scholar
  9. 9.
    Friberg P, Allansdotter-Johnsson Å, Ambring A, Ahl R, Arheden H, Framme J, Johansson Å, Holmgren D, Wåhlander H, Mårild S (2004) Increased left ventricular mass in obese adolescents. Eur Heart J 25:987–992CrossRefPubMedGoogle Scholar
  10. 10.
    Goran MI, Nagy TR, Treuth MS, Trowbridge C, Dezenberg C, McGloin A, Gower BA (1997) Visceral fat in white and African American prepubertal children. Am J Clin Nutr 65:1703–1708PubMedGoogle Scholar
  11. 11.
    Harada K, Orino T, Takada G (2001) Body mass index can predict left ventricular diastolic filling in asymptomatic obese children. Pediatr Cardiol 22:273–278CrossRefPubMedGoogle Scholar
  12. 12.
    Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291:2847–2850CrossRefPubMedGoogle Scholar
  13. 13.
    Hirschler V, Acebo HL, Fernandez GB, de Luján Calcagno M, Gonzalez C, Jadzinsky M (2006) Influence of obesity and insulin resistance on left atrial size in children. Pediatr Diabetes 7:39–44CrossRefPubMedGoogle Scholar
  14. 14.
    Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A, Di Mario U, Leonetti F (2003) Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 88:5163–5168CrossRefPubMedGoogle Scholar
  15. 15.
    Iacobellis G, Ribaudo MC, Zappaterreno A, Iannucci CV, Leonetti F (2004) Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol 94:1084–1087CrossRefPubMedGoogle Scholar
  16. 16.
    Iacobellis G, Corradi D, Sharma AM (2005) Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2:536–543CrossRefPubMedGoogle Scholar
  17. 17.
    Ippisch HM, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, Glascock BJ, Garcia VF, Kimball TR (2008) Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol 51:1342–1348CrossRefPubMedGoogle Scholar
  18. 18.
    Kapusta L, Thijssen JM, Cuypers MH, Peer PG, Daniëls O (2000) Assessment of myocardial velocities in healthy children using tissue Doppler imaging. Ultrasound Med Biol 26:229–237CrossRefPubMedGoogle Scholar
  19. 19.
    Khositseth A, Suthutvoravut U, Chongviriyaphan N, Ruangkanchanasetr S (2007) Cardiac dimensions and function in children with obesity. Indian Heart J 59:142–146PubMedGoogle Scholar
  20. 20.
    Kimball TR, Michelfelder EC (2008) Echocardiography. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (eds) Moss and Adams’ heart disease in infants, children, and adolescents: including the fetus and young adult, vol 1, 7th edn. Lippincott Williams & Wilkins, Philadelphia, pp 95–163Google Scholar
  21. 21.
    Kinik ST, Varan B, Yildirim SV, Tokel K (2006) The effect of obesity on echocardiographic and metabolic parameters in childhood. J Pediatr Endocrinol Metab 19:1007–1014PubMedGoogle Scholar
  22. 22.
    Kono Y, Yoshinaga M, Oku S, Nomura Y, Nakamura M, Aihoshi S (1994) Effect of obesity on echocardiographic parameters in children. Int J Cardiol 46:7–13CrossRefPubMedGoogle Scholar
  23. 23.
    Ku CS, Lin SL, Wang DJ, Chang SK, Lee WJ (1994) Left ventricular filling in young normotensive obese adults. Am J Cardiol 73:613–615CrossRefPubMedGoogle Scholar
  24. 24.
    Lean ME, Han TS, Deurenberg P (1996) Predicting body composition by densitometry from simple anthropometric measurements. Am J Clin Nutr 63:4–14PubMedGoogle Scholar
  25. 25.
    Levent E, Gökşen D, Ozyürek AR, Darcan S, Coker M (2005) Usefulness of the myocardial performance index (MPI) for assessing ventricular function in obese pediatric patients. Turk J Pediatr 47:34–38PubMedGoogle Scholar
  26. 26.
    Marchington JM, Mattacks CA, Pond CM (1989) Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B 94:225–232CrossRefPubMedGoogle Scholar
  27. 27.
    McGill HC Jr, McMahan CA, Gidding SS (2008) Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Circulation 117:1216–1227CrossRefPubMedGoogle Scholar
  28. 28.
    Mehta SK, Holliday C, Hayduk L, Wiersma L, Richards N, Younoszai A (2004) Comparison of myocardial function in children with body mass indexes ≥25 versus those <25 kg/m2. Am J Cardiol 93:1567–1569CrossRefPubMedGoogle Scholar
  29. 29.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRefGoogle Scholar
  30. 30.
    Quinn SF, Gosink BB (1985) Characteristic sonographic signs of hepatic fatty infiltration. AJR Am J Roentgenol 145:753–755PubMedGoogle Scholar
  31. 31.
    Rabkin SW (2007) Epicardial fat: properties, function and relationship to obesity. Obes Rev 8:253–261CrossRefPubMedGoogle Scholar
  32. 32.
    Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083PubMedGoogle Scholar
  33. 33.
    Sharpe JA, Naylor LH, Jones TW, Davis EA, O’Driscoll G, Ramsay JM, Green DJ (2006) Impact of obesity on diastolic function in subjects ≤16 years of age. Am J Cardiol 98:691–693CrossRefPubMedGoogle Scholar
  34. 34.
    Tei C (1995) New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 26:135–136PubMedGoogle Scholar
  35. 35.
    van Putte-Katier N, Rooman RP, Haas L, Verhulst SL, Desager KN, Ramet J, Suys BE (2008) Early cardiac abnormalities in obese children: importance of obesity per se versus associated cardiovascular risk factors. Pediatr Res 64:205–209CrossRefPubMedGoogle Scholar
  36. 36.
    Yu JJ, Yeom HH, Chung S, Park Y, Lee DH (2006) Left atrial diameters in overweight children with normal blood pressure. J Pediatr 148:321–325CrossRefPubMedGoogle Scholar
  37. 37.
    Zhang H, Zhang C (2009) Regulation of microvascular function by adipose tissue in obesity and type 2 diabetes: evidence of an adipose-vascular loop. Am J Biomed Sci 1:133–142CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Osman Ozdemir
    • 1
  • Samil Hizli
    • 2
  • Ayhan Abaci
    • 3
  • Kadir Agladioglu
    • 4
  • Sinef Aksoy
    • 4
  1. 1.Department of Paediatric CardiologyKecioren Training and Research HospitalAnkaraTurkey
  2. 2.Department of Paediatric Gastroenterology, Hepatology and NutritionKecioren Training and Research HospitalAnkaraTurkey
  3. 3.Department of Paediatric EndocrinologyKecioren Training and Research HospitalAnkaraTurkey
  4. 4.Department of RadiologyKecioren Training and Research HospitalAnkaraTurkey

Personalised recommendations