ABC | Volume 114, Nº4, April 2020

Original Article The Relationship Between Epicardial Adipose Tissue and Insulin Resistance in Obese Children Hatice Güneş, 1 Hakan Güneş, 2 Fatih Temiz 3 Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Pediatrics, 1 Kahramanmaras – Turquia Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology, 2 Kahramanmaraş – Turquia Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Pediatric Endocrinology and Metabolism, 3 Kahramanmaras – Turkey Mailing Address: Hakan Gunes • Sutcu Imam University, Faculty of Medicine, Department of Cardiology. Avşar Mah, Batı Çevreyolu Blv 251/A. Postal Code: 46000, Kahramanmaras – Turkey E-mail: drhakangunes83@hotmail.com Manuscript received March 26, 2019, revised manuscript June 12, 2019, accepted June 23, 2019 DOI: https://doi.org/10.36660/abc.20190197 Abstract Background: Insulin resistance (IR) is an important disorder in obese children because it is closely related to cardiovascular diseases. Epicardial adipose tissue (EAT) plays a role in the development of IR due to secreted bioactive molecules, and the inflammatory process of these molecules may cause atrial electromechanical delay (EMD). Objective: The objective of our study was to determine the relationship between EAT and EMD with IR in obese children. Methods: Ninety-four obese patients were included in the study. IR was calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and defined as HOMA-IR greater than the 90 th percentile in an age- and sex-specific percentile curve. Patients were divided into two groups according to their IR. All patients underwent echocardiographic examinations. Statistical significance was set to a two‑sided p-value < 0.05. Results: EAT was significantly higher in the IR group (p < 0.001). The optimal cut-off value for EAT to predict IR was found to be > 3.85 mm, with 92.5% specificity and 68.5% sensitivity (p = 0.002). In the multivariate logistic regression model, EAT (OR = 1.256, 95% CI: 1.016–1.53, p = 0.035) was also associated with IR after adjustment for variables found to be statistically significant in univariate analysis. Inter- and intra‑atrial EMD was significantly prolonged in the IR group compared to the group without IR (p < 0.010; p = 0.032 respectively). Conclusion: In our study, we revealed that EAT was positively correlated with IR and was an independent predictor of IR. (Arq Bras Cardiol. 2020; 114(4):675-682) Keywords: Pericardium; Adipose Tissue; Obesity; Child; Insulin Resistance; Echocardiography/methods. Introduction Obesity is a major health problem worldwide due to its growing prevalence and early development in life. 1-3 The number of overweight people tends to progressively increase in both developed and developing countries, and the proportion of obese people is around one third of the normal adolescents population. 4-6 As a result, complications of obesity, such as metabolic syndrome, type 2 diabetes mellitus (DM), cardiovascular disorders, respiratory disorders, and psychosocial problems tend to increase. 7,8 Obesity is typically associated with insulin resistance (IR) and glucose metabolism disorders. Adipose tissue stored in subcutaneous and visceral tissues plays an important role in the development of IR via the active proteins it secretes. 9 The distribution of this adipose tissue is equally important, with intra-abdominal fat accumulation being closely linked to IR. 10 Additionally, it is already known that subcutaneous fat tissue is correlated to IR whether or not DM is present. 11,12 Recent studies have demonstrated that extra-abdominal visceral fat deposits like mediastinal and epicardial adipose tissue (EAT) are also related to IR. 9,13,14 The association between obesity-dependent insulin resistance and EAT has not been fully explained. Childhood obesity is an important risk factor for atrial fibrillation whereas structural remodeling is very important. 15 In many studies, this close relationship was investigated with electromechanical delay (EMD), which is one of these echocardiographic markers defined as the temporal delay between the detected onset of electrical activity and the realization of force in the myocardium. EMD is an indicator of atrial conduction heterogeneity and can also be obtained easily by tissue Doppler imaging (TDI). 16 In addition, it has been demonstrated that EMD is prolonged in diseases associated with insulin resistance. 17,18 However, the relationship between electromechanical delay and insulin resistance in obese patients has not been studied. The aim of our study was to determine the relationship between EAT and insulin resistance. In addition, the relationship between insulin resistance and electromechanical delay was investigated. 675