Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity

Background and Aim: Epicardial fat (EF) is increased in obesity and has important interactions with atrial and ventricular myocardium. Most of the evidence in this scenario can be confused by the presence of comorbidities such as hypertension, diabetes and dyslipidemia, which are very common in this population. The influence of EF on atrial remodeling and cardiac function demands further investigation on morbidly obese without these comorbidities. Methods and Results: We prospectively recruited 20 metabolically healthy morbidly obese and 20 normo-weights controls. The maximum P-wave duration (PWD) was analyzed by 12-lead electrocardiogram. Left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and EF thickness (EFT) were evaluated by two-dimensional echocardiography. The mean of maximum PWD and LAD were significantly larger in the obese group as compared to the control group: 109.55 +/- 11.52 ms x 89.38 +/- 11.19 ms and 36.12 +/- 3.46 mm x 31.45 +/- 2.64 mm, (p < 0.0001). The mean LVEF was lower in the obese group: 63.15 +/- 4.25% x 66.17 +/- 3.37% (p < 0.017). The mean EFT was higher in the obese group: 7.72 +/- 1.60 mm x 3.10 +/- 0.85 mm (p < 0.0001). A positive correlation was found between EFT and PWD (r = 0.70; p = 0.001) and LAD (r = 0.667; p = 0.001). An inverse correlation was found between EFT and LVEF (r = 0.523; p = 0.001). In a multiple multivariate regression analysis the EFT remains correlated with LAD and LVEF. Conclusions: In a select group of morbidly obese, the excess of EF had a significant impact on atrial remodeling and cardiac function. (C) 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.