# The Relationship between the Amount of Epicardial Adipose Tissue Measured on Echocardiography and Decreased Heart Rate Recovery in Exercise Stress Test in Patients with Metabolic Syndrome

## Authors

- Ferit Boyuk ([ORCID](https://orcid.org/0000-0003-2313-1495)) — Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
- Bulent Ozdemir ([ORCID](https://orcid.org/0000-0002-8886-7703)) — Department of Cardiology, Uludag University, Medical School, Görükle Campus, Bursa, Turkey
- Sumeyye Gullulu ([ORCID](https://orcid.org/0000-0003-2831-002X)) — Department of Cardiology, Uludag University, Medical School, Görükle Campus, Bursa, Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 6, Issue 3 (2020), pages 139–144
- **Article type:** Original Article
- **Published online:** 2020-09-19
- **DOI:** [10.5455/umj.20200709025530](https://doi.org/10.5455/umj.20200709025530)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=18142
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/18142.pdf

## Abstract

Introduction: In this study, the impact of the epicardial adipose tissue (EAT) thickness on the heart rate recovery (HRV) was investigated by comparing the HRV values in the second minute of the recovery phase of the exercise test applied to metabolic syndrome (MS) patients and the healthy control group. Materials and Methods: A total of 78 people, 30 of them healthy control group and 48 of them diagnosed with MS for the first time were included in the study which was carried out in a Uludağ University's Medical Faculty Hospital in Turkey. The study was designed prospectively. The EAT thickness measurement was performed and recorded for all individuals. All patients underwent a symptom-limited exercise test following the Bruce protocol. The relationship between known risk factors of coronary artery disease of the EAT thickness measured by echocardiography and decreased HRV index in the recovery phase in the exercise stress test was investigated. Results: Metabolic syndrome group was found out to have a significantly thicker EAT thickness (p

## Keywords

Epicardial fat; heart rate recovery; metabolic syndrome; echocardiography; exercise stress test

## How to cite

Boyuk F, Ozdemir B, Gullulu S. The Relationship between the Amount of Epicardial Adipose Tissue Measured on Echocardiography and Decreased Heart Rate Recovery in Exercise Stress Test in Patients with Metabolic Syndrome. Ulutas Med J. 2020;6(3):139-144. doi:10.5455/umj.20200709025530

## References

1. YW, Zhu S, Palaniappan L Heshka S, Carnethon MR, Heymsfield, SB. The Metabolic Syndrome: Prevalence And Associated Risk Factor Findings Đn The US Population From The Third National Health And Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003;163(4):427-436
2. Onat A, Yüksel M, Köroğlu B, Gümrükçüoğlu HA, Aydın M, Çakmak HA, et al. Turkish Adult Risk Factor Study survey 2012: overall and coronary mortality and trends in the prevalence of metabolic syndrome. Arch Turk Soc Cardiol 2013;41(5):373- https://doi.org/10.5543/tkda.2013.15853
3. Gorter PM, De Vos AM, Van der Graaf Y, Stella PR, Doevendans PA, Meijs MF, et al. Relation of epicardial and pericoronary fat to coronary atherosclerosis and coronary artery calci-um in patients undergoing coronary angiography. Am J Cardiol 2008;102(4):380-385 https://doi.org/10.1016/j.amjcard.2008.04.002
4. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart rate recovery immediately after exercise as a predictor of mortality, N Engl J Med 1999;341(18):1351-57 https://doi.org/10.1056/nejm199910283411804
5. Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart Rate Recovery after Submaximal Exercise Testing as a Predictor of Mortality in a Cardiovascularly Healthy. Ann Intern Med 2000; 132(7):552-555 https://doi.org/10.7326/0003-4819-132-7-200004040-00007
6. Park JS, Ahn SG, Hwang JW, Lim HS, Choi BJ, Choi SY, et al. Impact of body mass index on the relationship of epicardial adipose tissue to metabolic syndrome and coronary artery disease in Asian population. Cardiovasc Diabetol 2010;9(1):29 https://doi.org/10.1186/1475-2840-9-29
7. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Committee for Practice Guidelines. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2011;32:2999-3054 https://doi.org/10.1016/j.rec.2011.11.006
8. Singh N, Singh H, Khanijoun HK, Iacobellis G. Echocardio graphic assessment of epicardial adipose tissue - a marker of visceral adiposity. McGill J Med 2007;10(1):26-30
9. Iacobellis G, Willens HJ. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009;22(12):1311-1319 https://doi.org/10.1016/j.echo.2009.10.013
10. Malavazos AE, Ermetici F, Cereda E, Coman C, Locati M, Morricone L, et al. Epicardial fat thickness: relationship with plasma visfatin and plasminogen activator inhibitor-1 levels in visceral obesity. Nutr Metab Cardiovasc Dis 2008;18(8):523-530 https://doi.org/10.1016/j.numecd.2007.09.001
11. Lima-Martínez MM, Paoli M, Donis JH, Odreman R, Torres C, Iacobellis G. Cut-off point of epicardial adipose tissue thickness for predicting metabolic syndrome in Venezuelan population. Endocrinol Nutr 2013;60(10):570-576 https://doi.org/10.1016/j.endoen.2013.12.007
12. Wang CP, Hsu HL, Hung WC, Yu TH, Chen YH, Chiu CA, et al. Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis. Clin Endocrinol 2009;70(6):876-882 https://doi.org/10.1111/j.1365-2265.2008.03411.x
13. Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: A new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003;88(11):5163-5168 https://doi.org/10.1210/jc.2003-030698
14. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 1994;24(6):1529-35 https://doi.org/10.1016/0735-1097(94)90150-3
15. Christensen RH, Wedell-Neergaard AS, Lehrskov LL, Legaard GE, Dorph E, Larsen MK, et al. Effect of Aerobic and resistance exercise on cardiac adipose tissues: Secondary analyses from a randomized clinical trial. JAMA Cardiol 2019;4(8):778-787 https://doi.org/10.1001/jamacardio.2019.2074
16. Ferrara D, Montecucco F, Dallegri F, Carbone F. Impact of different ectopic fat depots on cardiovascular and metabolic diseases. J Cell Physiol 2019;234(12):21630-21641 https://doi.org/10.1002/jcp.28821
17. Şengül C, Duman D. The association of epicardial fat thickness with blunted heart rate recovery in patients with metabolic syndrome. Tohoku J Exp Med 2011;224(4):257-62 https://doi.org/10.1620/tjem.224.257