Coronary Artery Disease Clinical Trial
Official title:
Association of the Volume and Proteome of Epicardial Adipose Tissue With Coronary Artery Disease, Left Atrial Remodelling and Atrial Fibrillation in Severe Aortic Stenosis Patients
This translational study was designed to explore the association of the quantity and quality of epicardial adipose tissue (EAT) with coronary artery disease (CAD), left atrial remodeling and postoperative atrial fibrillation in a high cardiovascular disease-risk population. The investigators expect to identify new biochemical factors and biomarkers in the crosstalk between the epicardial adipocytes, coronary plaques and atrial cardiomyocytes that are involved in the pathogenesis of atherosclerosis and atrial fibrillation, respectively.
Background: EAT has emerged as a new independent, and, potentially, modifiable cardiovascular
risk factor for CAD. EAT volume assessed by computed tomography (CT) was independently
associated with the presence of coronary stenosis, coronary calcification and myocardial
ischemia in cross-sectional studies, and, prospectively, with major adverse cardiovascular
events. Most of these clinical studies were, however, derived from community-based patients
with low-to intermediate-risk profile and the role of EAT in high-risk patients is currently
unclear. Accumulation of EAT has been also associated with left atrial (LA) dilation,
presence, chronicity, and recurrence of atrial fibrillation (AF). Although there is evidence
suggesting that EAT may be a major determinant of the LA vulnerable substrate of AF, the
mechanisms in the causal pathway between the EAT and LA remodeling are not completely
elucidated.
Aims: The main aims are to investigate if the volume of the EAT on CT and EAT proteome
assessed by SWATH-mass spectrometry are associated with extent, distribution and complexity
of coronary stenosis and coronary artery calcification, left atrial strain and incidence of
postoperative atrial fibrillation in patients with symptomatic severe aortic stenosis.
Methods: This a prospective study enrolling symptomatic severe aortic stenosis patients
referred to aortic valve replacement. The protocol includes preoperative detailed clinical
and nutritional evaluations, echocardiography, CT, cardiac magnetic resonance imaging and
invasive coronary angiography. During cardiac surgery, biopsies from the EAT, mediastinal and
subcutaneous thoracic adipose tissues will be performed to undergo analysis of proteome using
SWAT-mass spectrometry. Samples from the pericardial fluid, circulating and coronary sinus
blood samples will be collected as well in order to find local and peripheral adipose
tissue-derived biomarkers of the disease.
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