The relation between epicardial fat thickness and metabolic syndrome.

Abstract

We greatly appreciate the thoughtful comments by Balta, et al. on our study, which makes two points: first, the limitation use of transthoracic echocardiography (TTE) in defining epicardial fat tissue thickness (EFTT); and second, EFTT is highly dependent on inter-observer and intra-observer variability. We would like to respond to each of the points delineated by Dr. Balta. We partially agree with Dr. Balta's comment on the measurement of the EFTT using TTE. More detailed information would be gained by assessing EFTT using computed tomography or magnetic resonance imaging along with TTE, our investigation would perhaps provide deeper insight into the levels of the EFTT for geriatric patients with metabolic syndrome and might add to the value of our manuscript. However, among those techniques, TTE is the simplest method which is easily applicable, reproducible, inexpensive, and does not expose patients to radiation. Besides, several studies have confirmed the validity and reliability of a direct assessment of EFTT by means of TTE.[1]–[4] We also agree with the second point of Dr. Balta. All TTE assessments were performed by the same experienced cardiologist to prevent inter-observer variabilities. Intra-observer variability for EFTT measurements was < 5%. We should have stated this knowledge in the methods section of our manuscript. We hope we have addressed the comments raised by Balta, et al. and we thank them for their constructive input.