Association of Epicardial Adipose Tissue Adipocytes Hypertrophy with Biomarkers of Low-Grade Inflammation and Extracellular Matrix Remodeling in Patients with Coronary Artery Disease

Round 1

Reviewer 1 Report

The authors have conducted an interestingly and timely research about the connection between biomarkers of low-grade inflammation such as TNF, sPLA2 and 439 CTX-I, matrix remodeling and epicardial adipose tissue adipocytes hypertrophy.

 

Minor recommendation:

|2.1. . Patients,  and  2.2. . Echocardiography” needs corrections;

In tables, I suggest to give in legend an explanation for the bold values;

Row 274, “TNF- “  needs “α” to be added;

Row 306, “In in vitro study”,, repetition;

Row 351, “at al. (2019)”, needs corrections into et. al.

Row 369, the meaning for PPARγ and C/EBP should be included;

Author Response

Dear Reviewer!

Thank you for your efforts that you put working on our article! It had certainly led to its improvement. We corrected our manuscript according to your suggestions.

1. |2.1. . Patients, and  2. . Echocardiography” needs corrections

• We introduced the correction

2. In tables, I suggest to give in legend an explanation for the bold values;

• We added explanation under the Tables 4, 5, 6

3. Row 274, “TNF- “ needs “α” to be added;

• We have added the symbol “α”

4. Row 306, “In in vitro study”,, repetition;

• We have corrected the sentence

5. Row 351, “at al. (2019)”, needs corrections into et. al.

• We introduced the correction

6. Row 369, the meaning for PPARγ and C/EBP should be included

• We have deciphered the above mentioned abbreviations.

Best regards,

The team of authors

Reviewer 2 Report

This is  an interesting  study about association of epicardial adipose tissue hypertrophy and  markers  of  low-grade inflammation and  MMP\TIMP system. Authors collected  epicardial adipose tissue specimens  in 42 patients during  GABG surgery that made this study unique. However, several major issues have to be corrected or mentioned.

 

Abstract

 

Represented the body of the paper.

 

Background

 

In the Introduction section the authors  reflected the  current knowledge about  epicardial adipose tissue.

 

Materials and  methods

 

Baseline patients characteristic have to  include data about LV function, CAD severity  and  atrial fibrillation. There is an increasing amount of publications  on impact of  epicardial adipose tissue on atrial fibrillation incidence  etc. Those clinical data have  to be  mentioned.

 

Statistics is  essential

 

Results

 

The  major  question to the  paper is  about the  problem that was investigated by  authors.

Two associations were found.  Number one  is obesity and  epicardial cell hypertrophy. Patients with  EAT dimensions  above  median  differ significantly  in  BMI and   WC. Second is correlation between  EAT  hypertrophy and  pro-inflammatory  state. Does it mean that  the results of  the paper only  supported well-known thesis about  low-grate inflammation in patients  with  obesity?  Thus, novelty of  the study seems to be limited.  It can be recommended to include  BMI or WC to the  model etc.

Figures are good.

 

 

Discussion

In that  part authors compare own results with published. Have  to be  partly corrected after changings in the  Results  section.  

Author Response

Dear Reviewer!

Thank you for your efforts that you put working on our article! It had certainly led to its improvement. We corrected our manuscript according to your suggestions:

1. Materials and methods

Baseline patients characteristic have to include data about LV function, CAD severity and atrial fibrillation. There is an increasing amount of publications on impact of  epicardial adipose tissue on atrial fibrillation incidence  etc. Those clinical data have  to be  mentioned. Statistics is  essential.

We have retrieved additional data from patients’ history and inserted them both in Tables 1 and 2. Table 1 had already reflected the severity of atherosclerosis, represented by Gensini Score, but we also added data on the frequency of multivessel CAD in patients. Gensini Score was higher in the group of patients with EAT adipocytes’ hypertrophy. We added a brief discussion of this finding and provided a link to our previous work, where interconnection between EAT cell size and the severity of atherosclerosis was studied in more details (Link  55 in the revised version of the manuscript). The frequency of atrial fibrillation was negligible (was present only in 3 patients), which we described in 3.1.    

2. Results

The  major  question to the  paper is  about the  problem that was investigated by  authors. Two associations were found.  Number one  is obesity and  epicardial cell hypertrophy. Patients with  EAT dimensions  above  median  differ significantly  in  BMI and WC. Second is correlation between  EAT  hypertrophy and  pro-inflammatory  state. Does it mean that  the results of  the paper only  supported well-known thesis about  low-grate inflammation in patients  with  obesity?  Thus, novelty of  the study seems to be limited.  It can be recommended to include  BMI or WC to the  model etc.

We have consulted with our specialist on medical statistics, and she insisted not to include BMI and WC into the present model, as they possess a high degree of collinearity with each other and CTX-I. We have described this fact in the end of the Results section.  

We tried to stress an importance of the interconnection between the studied parameters and the degree of EAT adipocytes’ hypertrophy, as this adipose tissue depot remains not so well studied as subcutaneous and omental fat tissues. The fragment of discussion is added, as well as additional links – 51-53. The creation of the model of logistic regression adds a potential practical significance to our study, which can be elaborated in the future. We hope that it added emphasize to the novelty of the study.

3. Discussion

In that part authors compare own results with published. Have  to be  partly corrected after changings in the  Results  section. 

We did introduce some corrections, as it is described above.

4. We had also asked a native English speaker to read through our manuscript, who had suggested some minor grammar and style corrections, which were introduced accordingly.

Best regards,

The team of authors

Round 2

Reviewer 2 Report

The paper can be recommended  for the  Journal