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Epicardial adipose and pre-sternal subcutaneous tissues associated with extent of pneumonia and hospitalization in COVID-19

Objectives: The aims of this study were, to analyze epicardial adipose tissue and pre-sternal adipose tissue thicknesses and the relationship of the ratio of these two parameters with radiological progression, age, gender, concomitant diseases, hospitalization, length of hospital stay, need for intensive care and survival status of COVID-19 patients. Methods: In this retrospective study, a total number of 204 PCR-positive COVID-19 patients, who have initial lung computed tomography (CT) and a second CT within 15 days due to prolonged symptoms or suspected complications were included. According to patterns of lung involvement at the time of diagnosis, patients were divided into 4 groups. In initial CT scans, epicardial adipose tissue and pre-sternal subcutaneous adipose tissue thickness were measured. Progression or regression of the disease is evaluated by comparing the findings in initial and control CTs. Results: The mean age, epicardial adipose tissue thickness (EAT), pre-sternal adipose tissue thickness (PAT), and the EAT/PAT ratio of patients with involvement in both lungs were found to be higher than those in patients with one lung or without lung involvement and there was a statistically significant positive correlation between them. Conclusions: This study is thought to be the first in which epicardial adipose tissue and pre-sternal adipose tissue were evaluated together in COVID-19 patients. Epicardial adipose tissue is a metabolically active organ and measurement in initial CT scans may give an easy and quick idea of the evolution of the disease.

Keywords:

COVID-19, epicardial adipose tissue lung inflammation, disease evolution,

Tam Metin

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1. Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-13.
3. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology 2020;296:E115-7.
4. Fitzgibbons TP, Czech MP. Epicardial and perivascular adipose tissues and their influence on cardiovascular disease: basic mechanisms and clinical associations. J Am Heart Assoc 2014;3:e000582.
5. Kwack WG, Kang Y-S, Jeong YJ, Oh JY, Cha YK, Kim JS, et al. Association between thoracic fat measured using computed tomography and lung function in a population without respiratory diseases. J Thorac Dis 2019;11:5300-9.
6. Long BD, Stojanovska J, Brown RKJ, Attili AK, Jackson EA, Ognenovski V. Increased epicardial fat volume is independently associated with the presence and severity of systemic sclerosis. Acad Radiol 2017;24:1473-81
7. Franssens CT, Nathoe HM, Leiner T, van der Graaf Y, Visseren FL. Relation between cardiovascular disease risk factors and epicardial adipose tissue density on cardiac computed tomography in patients at high risk of cardiovascular events. Eur J Prev Cardiol 2017;24:660-70.
8. Goeller M, Achenbach S, Marwan M, Doris MK, Cadet S, Commandeur F, et al. Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. J Cardiovasc Comput Tomogr 2018;12:67-73.
9. Malavazos AE, Goldberger JJ, Iacobellis G. Does epicardial fat contribute to COVID-19 myocardial inflammation? Eur Heart J. 2020;41:2333.
10. Kim I-C, Han S. Epicardial adipose tissue: fuel for COVID-19-induced cardiac injury? Eur Heart J 2020;41:2334-5.
11. Watanabe M, Risi R, Tuccinardi D, Baquero CJ, Manfrini S, Gnessi L. Obesity and SARS-CoV-2: a population to safeguard. Diabetes Metab Res Rev 2020:e3325.
12. Malavazos AE, Corsi Romanelli MM, Bandera F, Iacobellis G. Targeting the adipose tissue in COVID-19. Obesity 2020;28:1178-9.
13. Huang R, Zhu L, Xue L, Liu L, Yan X, Wang J, et al. Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: a retrospective, multicenter study. PLoS Negl Trop Dis 2020;14:e0008280.
14. Andersen CJ, Murphy KE, Fernandez ML. Impact of obesity and metabolic syndrome on immunity. Adv Nutr 2016;7:66-75).
15. Yu S, Xing L, Du Z, Tian Y, Jing L, Yan H, et al. Prevalence of obesity and associated risk factors and cardiometabolic comorbidities in rural northeast China. Biomed Res Int 2019;2019:6509083.
16. Kabat GC, Kim MY, Lee JS, Ho GY, Going SB, Beebe-Dimmer J, et al. Metabolic obesity phenotypes and risk of breast cancer in postmenopausal women. Cancer Epidemiol Biomarkers Prev 2017;26:1730-5.
17. Watanabe M, Caruso D, Tuccinardi D, Risi R, Zerunian M, Polici M, et al. Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19. Metabolism 2020;111:154319.
18. Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham heart study. Circulation 2008;117:605-13.
19. Lin A, Dey D, Wong DTL, Nerlekar N. Perivascular adipose tissue and coronary atherosclerosis: from biology to imaging phenotyping. Curr Atheroscler Rep 2019;21:47.
20. Talman AH, Psaltis PJ, Cameron JD. Epicardial adipose tissue: far more than a fat depot. Cardiovasc Diagn Therapy 2014;4:416-29.
21. Grodecki K, Lin A, Razipour A, Cadet S, McElhinney PA, Chan C, et al. Epicardial adipose tissue is associated with the extent of pneumonia and adverse outcomes in patients with COVID-19. Metabolism 2021;115:154436.
22. Deng M, Qi Y, Deng L. Obesity as a potential predictor of disease severity in young COVID-19 patients: a retrospective study. Obesity (Silver Spring) 2020;28:1815-25.
23. Iacobellis G, Secchi F, Capitanio G. Epicardial fat inflammation in severe COVID-19. Obesity (Silver Spring) 2020;29:2260-2.
24. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev 2010;11:11-8.
25. Bouadma L, Lescure FX, Lucet JC, Yazdanpanah Y, Timsit JF. Severe SARS-CoV-2 infections: practical considerations and management strategy for intensivists. Intensive Care Med 2020;46:579-82.
26. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med 2020;8;506-17.

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AMA	Sönmez Topcu F. , Yurtlu Temel Ş. Epicardial adipose and pre-sternal subcutaneous tissues associated with extent of pneumonia and hospitalization in COVID-19. Eur Res J. 2023; 9(5): 840-847.