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Journals / Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi / 2026 / Cilt: 55 Sayı: 2

Epicardial adipose tissue thickness in adult patients with Familial Mediterranean Fever as a predictor of coronary artery disease

Ailevi Akdeniz Ateşi olan erişkin hastalarda koroner arter hastalığının belirteci olarak epikardiyal yağ doku kalınlığının değerlendirilmesi

Ayşe Bahar Keleşoğu Dinçer(UNIVERSITY OF HEALTH SCIENCES, ANKARA DIŞKAPI YILDIRIM BEYAZIT HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE)0000-0001-8810-2869
Haluk Furkan Şahan(UNIVERSITY OF HEALTH SCIENCES, ANKARA DIŞKAPI YILDIRIM BEYAZIT HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF CARDIOLOGY)0000-0003-1815-6567
Pages
81–85
Publication Date
2022-08-31
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Determining the atherosclerotic risk in the early stages of the disease may reduce long-term mortality and morbidity in FMF patients.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: Familial Mediterranean Fever (FMF), is a chronic auto-inflammatory disease characterized with recurrent attacks.
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Key Findings & Data:In between attacks, subclinical inflammation persists which results in increased risk of atherosclerosis.
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Conclusion & Impact:Determining the atherosclerotic risk in the early stages of the disease may reduce long-term mortality and morbidity in FMF patients.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Ailesel Akdeniz Ateşi · Koroner Arter Hastalığı · Ekokardiyografi

Abstract

Aim: Familial Mediterranean Fever (FMF), is a chronic auto-inflammatory disease characterized with recurrent attacks. In between attacks, subclinical inflammation persists which results in increased risk of atherosclerosis. Epicardial adipose tissue is a novel cardiometabolic risk factor which predicts the risk of atherosclerosis. The aim of this study was to measure the epicardial adipose tissue thickness (EATT) and to evaluate the risk of subclinical atherosclerosis in patients with FMF. Materials and Methods: 18 years old and older FMF patients diagnosed according to Tel-Hashomer criteria and age and sex matched healthy individuals were recruited for this cross-sectional study. Disease characteristics, gene mutations, erythrocyte sedimentation rate, C-reactive protein, serum amyloid-A, fibrinogen, lipid levels and complete blood counts were recorded at the time of inclusion. EATT was measured by a two-dimensional transthoracic echocardiography. A p value <0.05 was accepted as significant. Results: A total of 50 FMF patients (58% female) and 50 healthy controls (54%female) were involved in the study (p=0.69). The median age of healthy controls were 45 years and FMF patients were 33 years which were statistically insignificant (p=0.13) Epicardial adipose tissue was statistically significantly higher in FMF patients (5,4 mm [4,7-5,8]) in comparison to healthy controls (3,0 mm [2,8-3,2]) (p<0.001). There were no correlations between EATT and inflammatory markers. The ROC analysis to predict the best cut-off value for EATT showed 4 mm with a sensitivity of 86%, specificity 94%, positive likelihood ratio 14.3 and Youden Index 0.80 (AUC:0.962, 95%CI 0.924-0.999, p≤0.001) Conclusion: EATT is significantly higher in FMF patients compared to healthy individuals which results in increased cardiovascular risk in FMF. The measurement of epicardial adipose tissue with echocardiography is a practical, cheap and an accurate method. Determining the atherosclerotic risk in the early stages of the disease may reduce long-term mortality and morbidity in FMF patients.

Özet

Amaç: Ailevi Akdeniz Ateşi (FMF), ataklar halinde giden kronik otoinflamatuvar bir hastalıktır. Ataklar arası dönemde subklinik düzeyde inflamasyonun devam etmesi nedeniyle bu hastalarda artmış ateroskleroz riski mevcuttur. Epikardiyal yağ doku yeni bir kardiyometabolik risk faktörü olup aterosklerotik riskin belirlenmesinde kullanılmaktadır. Bu çalışmanın amacı FMF tanısı ile takip edilen erişkin hastalarda epikardiyal yağ doku kalınlığının ölçülmesi ve subklinik aterosklerotik hastalık riskinin değerlendirilmesidir. Gereç ve yöntemler: Tel-Hashomer kriterlerine göre tanı almış 18 yaş ve üzeri FMF hastası ile yaş ve cinsiyet uyumlu sağlıklı kontrol bu kesitsel çalışmaya dahil edilmiştir. Hastalık özellikleri, FMF gen mutasyonları ve eritrosit sedimentasyon hızı, C-reaktif protein, serum amiloid-A, fibrinojen, lipid düzeyleri ve tam kan sayımları çalışmaya dahil edilme esnasında kaydedilmiştir. Epikardiyal yağ doku kalınlığı, iki boyutlu transtorasik ekokardiyografi ile ölçülmüştür. P değeri<0,05 istatistiksel olarak anlamlılık sınırı olarak kabul edilmiştir. Bulgular: Çalışmaya toplam 50 FMF (%58 kadın) hastası ile 50 sağlıklı kontrol (%54 kadın) alınmıştır (p=0,69). Sağlıklı kontrol grubunda ortanca yaş 45 yıl iken FMF hastalarında 33 yıl olup yaş ve cinsiyet açısından iki grup arasında fark yoktur (p=0,13). FMF hastalarında epikardiyal yağ doku kalınlığı (5,4 mm [4,7-5,8]) sağlıklı bireylere (3,0 mm [2,8-3,2]) göre istatistiksel olarak anlamlı bir şekilde daha yüksek bulunmuştur (p<0,001). Epikardiyal yağ doku kalınlığı ile akut faz değerleri arasında istatistiksel olarak anlamlı ilişki gösterilmemiştir. Epikardiyal yağ doku kalınlığı kestirim değeri belirlemek için yapılan ROC analizinde ideal sınır 4 mm olup; bu değer için duyarlılık %86, özgüllük %94, pozitif olabilirlik oranı 14,3 Youden indeksi ise 0,80’dir (EAA: 0,962 %95 GA 0,924-0,999 p≤ 0,001). Sonuç: Epikardiyal yağ doku kalınlığı FMF hastalarında sağlıklı bireylere göre anlamlı bir şekilde daha yüksek olup bu durum, FMF hastalarında artmış kardiyovasküler risk ile ilişkilidir. Ekokardiyografik olarak epikardiyal yağ dokunun ölçümü pratik, ucuz ve güvenilir bir yöntemdir. Erken dönemde aterosklerotik riskin belirlenmesi bu hastalarda uzun vadede mortalite ve morbiditenin azalmasına imkan sağlayabilir.

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Cite This Article

Dinçer, A. B. K., Şahan, H. F. (2022). Epicardial adipose tissue thickness in adult patients with Familial Mediterranean Fever as a predictor of coronary artery disease. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, Cilt: 55 Sayı: 2, 81–85. https://doi.org/10.20492/aeahtd.1038470

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References (30)

  1. Sönmez HE, Batu ED, Özen S. Familial Mediterranean fever: current perspectives. Journal of inflammation research. 2016;9:13.
  2. Onen F. Familial mediterranean fever. Rheumatology international. 2006;26(6):489-96.
  3. Migita K, Asano T, Sato S, et al. Familial Mediterranean fever: overview of pathogenesis, clinical features and management. Immunological medicine. 2018;41(2):55-61.
  4. Chung CP, Avalos I, Raggi P, et al. Atherosclerosis and inflammation: insights from rheumatoid arthritis. Clinical rheumatology. 2007;26(8):1228-33.
  5. Yüksel Ş, Ayvazyan L, Gasparyan AY. Familial Mediterranean fever as an emerging clinical model of atherogenesis associated with low-grade inflammation. The open cardiovascular medicine journal. 2010;4:51.
  6. Livnehneh A, Langevitz P, Zemer D, et al. The changing face of familial Mediterranean fever. Seminars in arthritis and rheumatism; 1996: Elsevier.
  7. Boyraz I, Onur CS, Erdem F. Assessment of relation between neutrophil lympocyte, platelet lympocyte ratios and epicardial fat thickness in patients with ankylosing spondylitis. Med Glas (Zenica). 2016;13(1):14-7.
  8. Packer M. Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardium. Journal of the American College of Cardiology. 2018;71(20):2360-72.
  9. Iacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends in Endocrinology & Metabolism. 2011;22(11):450-7.
  10. Pierdomenico SD, Pierdomenico AM, Cuccurullo F,et al. Meta-analysis of the relation of echocardiographic epicardial adipose tissue thickness and the metabolic syndrome. The American journal of cardiology. 2013;111(1):73-8.
  11. Temiz A, Gökmen F, Gazi E, et al. Epicardial adipose tissue thickness, flow-mediated dilatation of the brachial artery, and carotid intima–media thickness. Herz. 2015;40(3):217-24.
  12. Lipson A, Alexopoulos N, Hartlage GR, et al. Epicardial adipose tissue is increased in patients with systemic lupus erythematosus. Atherosclerosis. 2012;223(2):389-93.
  13. Livneh A, Langevitz P, Zemer D, et al. Criteria for the diagnosis of familial Mediterranean fever. Arthritis & Rheumatism. 1997;40(10):1879-85.
  14. Nishimura RA, Miller Jr FA, Callahan MJ, et al. Doppler echocardiography: theory, instrumentation, technique, and application. Mayo Clinic Proceedings; 1985: Elsevier.
  15. Tajik AJ, Seward J, Hagler D, et al. Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation. Mayo Clinic Proceedings; 1978.
  16. Sahn DJ, DeMaria A, Kisslo J, et al. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. circulation. 1978;58(6):1072-83.
  17. Iacobellis G, Ribaudo MC, Assael F, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. The Journal of Clinical Endocrinology & Metabolism. 2003;88(11):5163-8.
  18. Moriya J. Critical roles of inflammation in atherosclerosis. Journal of cardiology. 2019;73(1):22-7.
  19. Arida A, Protogerou AD, Kitas GD,et al. Systemic inflammatory response and atherosclerosis: the paradigm of chronic inflammatory rheumatic diseases. International journal of molecular sciences. 2018;19(7):1890.
  20. Kozan M, Ozan ZT, Demir V, et al. The relation of novel cardiovascular risk parameters in patients with familial Mediterranean fever. JRSM cardiovascular disease. 2019;8:2048004018823856.
  21. Alsarah A, Alsara O, Laird-Fick HS. Cardiac manifestations of Familial Mediterranean fever. Avicenna journal of medicine. 2017;7(4):158.
  22. Uluca Ü, Demir F, Ece A, et al. Assessment of epicardial adipose tissue thickness and the mean platelet volume in children with familial Mediterranean fever. Italian journal of pediatrics. 2015;41(1):1-4.
  23. Ghobrial EE, Farag YM, Abdul-Aziz DM, et al. Assessment of Epicardial Adipose Tissue Thickness in Children with Familial Mediterranean Fever. Journal of tropical pediatrics. 2020;66(2):121-8.
  24. Ormseth MJ, Lipson A, Alexopoulos N, et al. Association of epicardial adipose tissue with cardiometabolic risk and metabolic syndrome in patients with rheumatoid arthritis. Arthritis care & research. 2013;65(9):1410-5.
  25. Ganjali S, Gotto Jr AM, Ruscica M, et al. Monocyte‐to‐HDL‐cholesterol ratio as a prognostic marker in cardiovascular diseases. Journal of cellular physiology. 2018;233(12):9237-46.
  26. Sari I, Karaoglu O, Can G, et al. Early ultrasonographic markers of atherosclerosis in patients with familial Mediterranean fever. Clinical rheumatology. 2007;26(9):1467-73.
  27. Langevitz P, Livneh A, Neumann L, et al. Prevalence of ischemic heart disease in patients with familial Mediterranean fever. The Israel Medical Association journal: IMAJ. 2001;3(1):9-12.
  28. Akdogan A, Calguneri M, Yavuz B, et al. Are familial Mediterranean fever (FMF) patients at increased risk for atherosclerosis? Impaired endothelial function and increased intima media thickness are found in FMF. Journal of the American College of Cardiology. 2006;48(11):2351-3.
  29. Korkmaz C, Özdogan H, Kasapçopur Ö, et al. Acute phase response in familial Mediterranean fever. Annals of the rheumatic diseases. 2002;61(1):79-81.
  30. Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obesity research. 2003;11(2):304-10.