Epicardial Adipose Tissue Thickness And Plasma Interleukin-35 Predict Acute Myocardial Infarction In Patients With Coronary Artery Disease

This study aimed to investigate the associations of echocardiographic epicardial adipose tissue (EAT) thickness and levels of plasma cytokines with acute coronary syndromes and extent of coronary atherosclerosis. The study enrolled 117 patients diagnosed with coronary artery disease (CAD) who underwent coronary angiography (May 2013 to April 2014) and 30 patients with chest pain and normal angiography (control group). Patients with CAD were divided into acute myocardial infarction (AMI, n = 40), unstable angina pectoris (UAP, n = 40) and stable angina pectoris (SAP, n = 37) groups. In a separate analysis, patients with CAD were divided into groups according to Gensini score (A: < 26; B: 26-54; C: > 54). EAT thickness and plasma concentrations of interleukin-35 (IL-35), YKL-40, adiponectin and high-sensitivity C-reactive protein (hs-CRP) were measured. Adiponectin, hs-CRP and YKL-40 levels correlated with coronary lesion severity. Mean EAT thicknesses in the control, SAP, UAP and AMI groups were 4.3 +/- 0.8 mm, 5.1 +/- 1.6 mm, 6.2 +/- 1.8 mm and 7.9 +/- 1.5 mm, respectively (P < 0.01). Multivariate logistic regression identified EAT thickness (OR: 2.196; 95% CI, 1.465-3.292), IL-35 (OR: 0.926; 95% CI, 0.891-0.963) and YKL-40 (OR: 1.114; 95% CI, 1.049-1.184) as independently associated with AMI. Using an optimal EAT thickness cut-off value of 6.75 mm, the sensitivity, specificity, positive and negative predictive values for predicting AMI were 82.5%, 81.3%, 62.3% and 92.6%, respectively. Measurements of EAT thickness and serum levels of interleukins, cytokines and adipokines may help identify patients needing a more aggressive approach for risk reduction. IL-35 gene regulation and EAT thickness reduction may be effective treatments for atherosclerosis and CAD.