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Impact of long-term steroid therapy on epicardial and pericardial fat deposition: a cardiac MRI study.

Kitterer D, Latus J, Henes J, Birkmeier S, Backes M, Braun N, Sechtem U, Dominik Alscher M, Mahrholdt H, Greulich S - Cardiovasc Diabetol (2015)

Bottom Line: Metabolic syndrome is associated with increased cardiac fat deposition.In addition, we sought to investigate if this effect might be dose-dependent.Furthermore, this accumulation of cardiac fat seems to be dose-dependent, pointing towards a cumulative effect of steroids.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Daniel.Kitterer@rbk.de.

ABSTRACT

Background: Increased cardiac fat has been identified as a risk factor for coronary artery disease. Metabolic syndrome is associated with increased cardiac fat deposition. Steroids are known to imitate some effects of metabolic syndrome and are frequently used in patients with rheumatic disorders. Primary aim was to evaluate the impact of long-term steroid use on cardiac fat deposition in patients with rheumatic disorders. In addition, we sought to investigate if this effect might be dose-dependent.

Methods: Patients were enrolled as follows: (1) rheumatic disorder; and (2) long-term steroid therapy, and (3) underwent cardiovascular magnetic resonance (CMR) imaging. Patients were stratified in a high-dose (>7.5 mg prednisone equivalent/day for at least 6 months) and a low-dose steroid group (<7.5 mg prednisone equivalent/day) and compared to steroid-naïve controls without rheumatic disorders.

Results: 122 patients were included (n = 61 steroid patients, n = 61 controls). N = 36 were classified as high-dose, n = 25 as low-dose steroid group. Steroid patients showed larger epicardial 5.7 [3.5-9.1] cm(2) and pericardial 13.0 [6.1-26.8] cm(2) areas of fat than controls 4.2 [1.3-5.8] cm(2)/6.4 [1.6-15.4] cm(2), p < 0.001, p < 0.01, respectively. High-dose steroid patients had more epi- and pericardial fat both than controls: 7.2 [4.2-11.1] cm(2) vs. 4.4 [1.0-6.0] cm(2), p < 0.001; 18.6 [8.9-38.2] cm(2) vs. 10.7 [4.7-26.8] cm(2), p < 0.05, and patients in the low-dose steroid group (p < 0.01, p < 0.001, respectively).

Conclusion: The present data suggest increased cardiac fat deposition in steroid-treated patients with rheumatic disorders. Furthermore, this accumulation of cardiac fat seems to be dose-dependent, pointing towards a cumulative effect of steroids.

No MeSH data available.


Related in: MedlinePlus

Patient examples of 4-chamber oriented end-diastolic images for determination of epicardial and pericardial fat. a, b 55-year old male with high-dose steroid treated rheumatoid arthritis for more than 8 years. Patients BMI was 27.8 kg/m2, beside arterial hypertension he suffered from diabetes. CMR 4-chamber view revealed extensive epicardial fat deposition (shown in red) and pericardial fat deposition (shown in blue). c, d Age, sex and BMI matched steroid-naïve control to the high-dose steroid-treated patient in panels A/B with less amounts of epicardial and pericardial fat. e, f 49-year old steroid-naïve female (control group) with moderate epi- and pericardial fat deposition despite a high elevated BMI of 41.2 kg/m2 (obese class III). g, h 69-year old steroid-naïve female (control group) with a BMI of 26.8 kg/m2. Despite only moderate elevated BMI and no history of steroid intake, this patient showed considerable amounts of epi- and pericardial fat, underlining the lack of association between BMI and amounts of epi- and pericardial fat in the steroid-naïve control group
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Fig5: Patient examples of 4-chamber oriented end-diastolic images for determination of epicardial and pericardial fat. a, b 55-year old male with high-dose steroid treated rheumatoid arthritis for more than 8 years. Patients BMI was 27.8 kg/m2, beside arterial hypertension he suffered from diabetes. CMR 4-chamber view revealed extensive epicardial fat deposition (shown in red) and pericardial fat deposition (shown in blue). c, d Age, sex and BMI matched steroid-naïve control to the high-dose steroid-treated patient in panels A/B with less amounts of epicardial and pericardial fat. e, f 49-year old steroid-naïve female (control group) with moderate epi- and pericardial fat deposition despite a high elevated BMI of 41.2 kg/m2 (obese class III). g, h 69-year old steroid-naïve female (control group) with a BMI of 26.8 kg/m2. Despite only moderate elevated BMI and no history of steroid intake, this patient showed considerable amounts of epi- and pericardial fat, underlining the lack of association between BMI and amounts of epi- and pericardial fat in the steroid-naïve control group

Mentions: Dividing patients on steroids and matched controls in an obese (BMI > 25 kg/m2) and a non-obese group (BMI < 25 kg/m2) revealed, that steroid patients with a BMI > 25 kg/m2 showed significantly more epicardial fat than steroid patients with a BMI < 25 kg/m2 (p < 0.0001). Similar results could be found for pericardial fat in the steroid-treated group (p = 0.001), see Fig. 4. However, no statistical significant difference in cardiac fat distribution between obese and non-obese control patients could be reported. Typical CMR results are displayed in Fig. 5.Fig. 4


Impact of long-term steroid therapy on epicardial and pericardial fat deposition: a cardiac MRI study.

Kitterer D, Latus J, Henes J, Birkmeier S, Backes M, Braun N, Sechtem U, Dominik Alscher M, Mahrholdt H, Greulich S - Cardiovasc Diabetol (2015)

Patient examples of 4-chamber oriented end-diastolic images for determination of epicardial and pericardial fat. a, b 55-year old male with high-dose steroid treated rheumatoid arthritis for more than 8 years. Patients BMI was 27.8 kg/m2, beside arterial hypertension he suffered from diabetes. CMR 4-chamber view revealed extensive epicardial fat deposition (shown in red) and pericardial fat deposition (shown in blue). c, d Age, sex and BMI matched steroid-naïve control to the high-dose steroid-treated patient in panels A/B with less amounts of epicardial and pericardial fat. e, f 49-year old steroid-naïve female (control group) with moderate epi- and pericardial fat deposition despite a high elevated BMI of 41.2 kg/m2 (obese class III). g, h 69-year old steroid-naïve female (control group) with a BMI of 26.8 kg/m2. Despite only moderate elevated BMI and no history of steroid intake, this patient showed considerable amounts of epi- and pericardial fat, underlining the lack of association between BMI and amounts of epi- and pericardial fat in the steroid-naïve control group
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4588496&req=5

Fig5: Patient examples of 4-chamber oriented end-diastolic images for determination of epicardial and pericardial fat. a, b 55-year old male with high-dose steroid treated rheumatoid arthritis for more than 8 years. Patients BMI was 27.8 kg/m2, beside arterial hypertension he suffered from diabetes. CMR 4-chamber view revealed extensive epicardial fat deposition (shown in red) and pericardial fat deposition (shown in blue). c, d Age, sex and BMI matched steroid-naïve control to the high-dose steroid-treated patient in panels A/B with less amounts of epicardial and pericardial fat. e, f 49-year old steroid-naïve female (control group) with moderate epi- and pericardial fat deposition despite a high elevated BMI of 41.2 kg/m2 (obese class III). g, h 69-year old steroid-naïve female (control group) with a BMI of 26.8 kg/m2. Despite only moderate elevated BMI and no history of steroid intake, this patient showed considerable amounts of epi- and pericardial fat, underlining the lack of association between BMI and amounts of epi- and pericardial fat in the steroid-naïve control group
Mentions: Dividing patients on steroids and matched controls in an obese (BMI > 25 kg/m2) and a non-obese group (BMI < 25 kg/m2) revealed, that steroid patients with a BMI > 25 kg/m2 showed significantly more epicardial fat than steroid patients with a BMI < 25 kg/m2 (p < 0.0001). Similar results could be found for pericardial fat in the steroid-treated group (p = 0.001), see Fig. 4. However, no statistical significant difference in cardiac fat distribution between obese and non-obese control patients could be reported. Typical CMR results are displayed in Fig. 5.Fig. 4

Bottom Line: Metabolic syndrome is associated with increased cardiac fat deposition.In addition, we sought to investigate if this effect might be dose-dependent.Furthermore, this accumulation of cardiac fat seems to be dose-dependent, pointing towards a cumulative effect of steroids.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Daniel.Kitterer@rbk.de.

ABSTRACT

Background: Increased cardiac fat has been identified as a risk factor for coronary artery disease. Metabolic syndrome is associated with increased cardiac fat deposition. Steroids are known to imitate some effects of metabolic syndrome and are frequently used in patients with rheumatic disorders. Primary aim was to evaluate the impact of long-term steroid use on cardiac fat deposition in patients with rheumatic disorders. In addition, we sought to investigate if this effect might be dose-dependent.

Methods: Patients were enrolled as follows: (1) rheumatic disorder; and (2) long-term steroid therapy, and (3) underwent cardiovascular magnetic resonance (CMR) imaging. Patients were stratified in a high-dose (>7.5 mg prednisone equivalent/day for at least 6 months) and a low-dose steroid group (<7.5 mg prednisone equivalent/day) and compared to steroid-naïve controls without rheumatic disorders.

Results: 122 patients were included (n = 61 steroid patients, n = 61 controls). N = 36 were classified as high-dose, n = 25 as low-dose steroid group. Steroid patients showed larger epicardial 5.7 [3.5-9.1] cm(2) and pericardial 13.0 [6.1-26.8] cm(2) areas of fat than controls 4.2 [1.3-5.8] cm(2)/6.4 [1.6-15.4] cm(2), p < 0.001, p < 0.01, respectively. High-dose steroid patients had more epi- and pericardial fat both than controls: 7.2 [4.2-11.1] cm(2) vs. 4.4 [1.0-6.0] cm(2), p < 0.001; 18.6 [8.9-38.2] cm(2) vs. 10.7 [4.7-26.8] cm(2), p < 0.05, and patients in the low-dose steroid group (p < 0.01, p < 0.001, respectively).

Conclusion: The present data suggest increased cardiac fat deposition in steroid-treated patients with rheumatic disorders. Furthermore, this accumulation of cardiac fat seems to be dose-dependent, pointing towards a cumulative effect of steroids.

No MeSH data available.


Related in: MedlinePlus