Epicardial Fat Thickness Values Research Articles

A cut-off value of epicardial fat thickness for the prediction of large for gestational age foetuses

Estimation of foetal weight in the prenatal period is important in many respects. For this purpose, during different periods of pregnancy; mostly in the last trimester; many methods or formulas have been described, almost of them using ultrasound. Foetal epicardial adipose tissue has previously been described as a metabolic organ in studies. Foetal epicardial fat tissue thickness (EFT) measurement has been previously described in the literature and has been associated with metabolic conditions such as preeclampsia or gestational diabetes. The purpose of this study was to determine the strength and cut-off value of EFT measured by ultrasound in the second trimester in the prediction of large for gestational age (LGA) foetuses. Epicardial fat tissue thicknesses which were recorded during second trimester anomaly screening were evaluated retrospectively. Birth weights of the same cases were also obtained from the database and analysed with IBM SPSS Statistics for Windows Version 22.0 (IBM Corp., Armonk, NY, USA). LGA babies had thicker EFT measurements and we established a cut-off EFT value of 1.38 mm. Our results suggest that EFT thickness measured by ultrasound in the second trimester may be useful in predicting LGA foetuses. Impact statement What is already known on this subject? It is known that foetal epicardial fat tissue is an adipose tissue with metabolic functions. Previously the relationship between this tissue and prenatal complications; such as, preeclampsia, gestational diabetes and infant growth and development were investigated. We planned this study considering that a tissue with metabolic functions affecting foetal growth may also affect birth weight. What do the results of this study add? Foetal epicardial fat thickness measurement only once in the second trimester may predict the 90th percentile limit at birth which is considered as the LGA limit. What are the implications of these findings for clinical practice and/or further research? In our study, we determined that the thickness of epicardial fat tissue measured in the second tirmester could predict the 90 th percentile limit at birth and that the cut-off value for this group was 1.38 mm. We believe that this measurement may help to determine LGA babies at birth as early as the second trimester. In future studies, the 97 percentile limit can be determined from the early weeks with reaching larger groups. Thus, babies who are likely to experience birth trauma in clinical practice can be reached from early weeks.

Evaluation of Epicardial Adipose Tissue by Echocardiography and Its Correlation with Aortic Velocity Propagation and Carotid Intima-Media Thickness in Patients of Type 2 Diabetes Mellitus.

Epicardial fat thickness (EFT) is associated with aortic stiffness in diabetic patients. In this study, we aimed to determine if there is an association among the parameters of EFT, aortic velocity propagation (AVP), and carotid intima-media thickness (CIMT) in patients with non-insulin dependent diabetes mellitus. This study included 55 non-insulin dependent diabetes mellitus patients and 40 non-diabetic control patients. For all participants, EFT and AVP were determined by echocardiographic method and CIMT was calculated using an ultrasonographic exam. The EFT and CIMT values were found to be significantly increased in the non-insulin dependent diabetes mellitus group. On the other hand, aortic velocity propagation was decreased in the non-insulin dependent diabetes mellitus group compared to non-diabetic patients (EFT; 8.43 ± 1.68 versus 6.36 ± 2.21 mm, p < 0.001; CIMT; 0.92 ± 0.24 versus 0.58 ± 0.18 mm, p < 0.001; and AVP; 28.20 ± 16.02 versus 58.10 ± 17.50, p < 0.01, respectively). Significantly higher EFT and CIMT values were found in addition to lower AVP values in non-insulin dependent diabetes mellitus patients. Moreover, we demonstrated that there was a strong correlation between EFT, CIMT, and AVP.

P2595The role of epicardial fat thickness and other parameters of visceral adiposity in right ventricular diastolic function in patients with metabolic syndrome

Abstract Background Abdominal obesity is associated with an increased risk of cardiovascular disease and all-cause mortality especially in patients with metabolic syndrome (MetS). Despite the undeniable importance of right ventricle (RV) function, little is known about RV diastolic function implication in obesity and MetS. Purpose The objective of our study was to evaluate the role of epicardial fat thickness (EFT) and other parameters of visceral obesity in diastolic function of RV in patients with MetS. Methods The study included 70 subjects with MetS (mean age 52.6±9.4 years) and 70 controls without MetS (mean age 53.8±7.5 years). MetS was defined by ≥3 criteria of International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute. We assessed RV diastolic function by pulsed wave and tissue Doppler echocardiography and determined the ratio of early (TV E) and late (TV A) trans-tricuspid valve inflow velocities (TV E/A), early tricuspid valve (TV) annular tissue Doppler velocity (TV e'), the TV E/e' ratio and TV deceleration time (DT). Anthropometric and sonographic parameters of visceral adiposity included: waist circumference (WC), waist-to-hip ratio (WHR), visceral adiposity index (VAI), intraabdominal fat thickness (IFT), abdominal wall fat index (AWFI) and epicardial fat thickness (EFT). Results Mean values of WC (p=0.030), WHR (p=0.008), VAI (p=0.001), IFT (p=0.035), AWFI (p=0.013) and EFT (p=0.012) were significantly higher in the group with MetS vs. controls. RV diastolic function parameters were also significantly changed in the group with MetS vs controls (tab.1). TV E/e' was positively correlated with WC (r=0.297, p&lt;0.01), WHR (r=0.238, p&lt;0.05), VAI (r=0.271, p&lt;0.05), IFT (r=0.556, p&lt;0.01), AWFI (r=0.604, p&lt;0.01) and EFT (r=0.795, p&lt;0.01). Using multivariate regression analysis EFT, WC and plasma glucose level were the most important predictors for RV diastolic dysfunction in subjects with MetS (p&lt;0.05 for all parameters). Table 1. RV diastolic function Variables MetS (n=70) Controls (n=70) p TV E, cm/s 48±11.1 52.1±14 0.025 TV A, cm/s 56.54±11 52.3±11.7 0.034 TV E/A 0.92±0.4 1.07±0.44 0.029 TV e', cm/s 10.6±2.7 10.7±3.5 0.001 TV E/e' 5.84±1.04 4.59±0.82 0.001 DT, ms 227.9±12.4 217±17.8 0.009 Conclusion Our findings support that EFT and WC play an important role in RV diastolic dysfunction in patients with MetS.

Increased epicardial fat thickness and carotid intima-media thickness in migraine patients.

Migraine is a common and debilitating neurological disorder characterized with episodic attacks. Epicardial fat is metabolically active and is an important predictor of metabolic and vascular diseases. We aimed to examine whether the echocardiographic measurement of epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) is increased in patients with episodic migraine (EM). We studied 96 volunteers, including 48 patients with EM (mean age 40.10 ± 10years, 41 female patients) and 48 healthy subjects (mean age 42.69 ± 10years, gender is the same). All necessary biochemical parameters were analyzed; subsequently, EFT and CIMT were measured in all subjects. The migraine characteristics of the patients were questioned in detail. The patients with EM had a significantly higher EFT than the control group (5.34 ± 1.02 vs. 4.41 ± 0.68; P < 0.001) and CIMT was also found to be high (median 6.70 vs. 5.60; P < 0.001). Furthermore, there was a positive correlation between EFT and duration of disease and monthly frequency (r = 0.730; P < 0.001). EFT was significantly correlated with CIMT in the migraineurs (P < 0.001). As an optimal cut-off point, a high-risk EFT value of 5.54mm was determined to predict EM, with 58.3% sensitivity and 96.8% specificity. We found that EFT and CIMT were significantly higher in EM patients than in healthy individuals. Increased EFT may be a new risk factor in migraine patients especially in patients with increased pain frequency.

The Evaluation of Epicardial Fat Thickness and Carotid Intima-Media Thickness in the Patients with Subclinical and Overt Hypothyroidism

Bacgrounds: The studies conducted have shown that epicardial fat thickness (EFT) and Carotid intima-media thickness (CIMT) are closely associated with cardiovascular diseases and that this may be an indicator for the prediction of early atherosclerosis. In this study, we have attempted to identify EFT and CIMT in patients with hypothyroidism and to reveal the relationship between them and thyroid hormones.Material and method: 82 patients diagnosed with primary hypothyroidism and 37 patients from healthy control group were included in the study. The subclinic hypothyroidism group (SH) was made up of 50 patients; the overt hypothyroidism group (OH) was composed of 32 patients. Cases’ thyroid-stimulating hormone (TSH), FT3, FT4, thyroperoxidase antibodies (anti-tpo) and anti-tiroglobulin antibodies (anti-tg) were studied. Their EFT and CIMT values were measured. The statistical analysis was applied to EFT and CIMT. Results: Compared with the CG, the thickness of epicardial fat tissue increased in OH and SH groups (p&amp;lt;0,001, p&amp;lt;0,001 respectively). In terms of EFT, there was no significant difference between OH and SH groups. Compared with the CG, the mean CIMT increased in OH and SH (p&amp;lt;0,001, p&amp;lt;0.001 respectively), but there was no significant difference between OH and SH in terms of CIMT. In addition, there was a positive correlation between EFT and CIMT (p&amp;lt;0.001). Conclusions: The measurement of EFT and CIMT can be used as a marker for the diagnosis of early atherosclerosis both in OH and in SH patients. Because the thickness of EFT and CIMT increased in patients with SH who are debated as to whether they should be treated, it leads us to think that these patients should be treated in order to reduce the risk of cardiovascular diseases in these patients.

Internal obesity as a risk factor for arterial hypertension

Aim. To assess the role of ultrasound parameters of the extent of abdominal and epicardial visceral adipose tissue (VAT) as prognostic tools for determining the probability of arterial hypertension (AH) development in normotensive patients with obesity.Material and methods. We studied 526 normotensive (according to the results of daily monitoring of blood pressure (BP)) men (age 45,1±5,0 years) without cardiovascular diseases and type 2 diabetes mellitus, with a SCORE risk &lt;5% and abdominal obesity (waist circumference &gt;94 cm). We analyzed glycemia, lipid spectrum, blood creatinine and urine albumin level. Echocardiography with an assessment of epicardial fat thickness (EFT), triplex scanning of the brachiocephalic arteries, ultrasound assessment of the thickness of abdominal VAT and subcutaneous fat (SCF) were carried out. At the end of the observational phase of the study (duration 46,3±5,1 months), repeated daily monitoring of blood pressure was performed.Results. Of the 406 available patients, hypertension was detected in 157 (38,7%), including 72 (31,7%) of the initial age group of 35-45 years and 85 (47,5%) of the initial age group 46-55 years. These patients were characterized by initially higher values of EFT (5,2±0,7 mm vs 4,4±1,0 mm, p&lt;0,001) and the ratio of the thickness of abdominal VAT to the thickness of the SCF (2,9±0,6 vs 2,5±0,6, p&lt;0,001). In the group of individuals with developed AH, the initial incidence of epicardial and abdominal visceral obesity was higher (58,0% vs 23,4%, p&lt;0,001 and 44,6% vs 25,1%, p&lt;0,001, respectively). Ultrasound parameters of abdominal and ectopic (epicardial) VAT were included in mathematical models of the probability of development of AH with a high level of statistical significance and maximum standardized coefficients of regression equations.Conclusion. Ultrasonic parameters of the severity of abdominal and epicardial VAT can be an additional tools for AH predicting in normotensive people with overweight and obesity.

Epicardial fat thickness is significantly increased and related to LDL cholesterol level in patients with familial hypercholesterolemia.

Increased epicardial fat thickness (EFT) is accepted as a risk factfcardiovascular diseases in some studies. There are conflicting results about the relation between plasma low-density lipoprotein cholesterol (LDL-C) level and EFT. As well, the relation between EFT and familial hypercholesterolemia is not clearly documented in the literature. Our aim was to investigate EFT in familial hypercholesterolemia patients and to determine which parameters were related to EFT increase. A total of 150 subjects enrolled in our study. Subjects were separated into two groups: 75 hypercholesterolemia patients (16 men, mean age 52.8 ± 7.4years) and 75 familial hypercholesterolemia patients (26 men, mean age 50.7 ± 9.2years). Medical history assessments and complete physical examinations were done. Routine laboratory tests and echocardiographic measurements were performed. Coronary artery disease frequency was significantly higher in the familial hypercholesterolemia group (p < 0.001). This group had significantly higher TC and LDL-C levels than the hypercholesterolemia group (p < 0.05 for all). EFT values were higher in the familial hypercholesterolemia group, and were significantly different than in the other group (p < 0.001). LDL-C was found to be independently related to EFT in the linear regression analysis. Epicardial fat thickness increased in the familial hypercholesterolemia patients. In addition, LDL-C levels were significantly crelated with increased EFT.

Noninvasive assessment of subclinical atherosclerosis in patients with rosacea.

Rosacea is a chronic, inflammatory cutaneous disorder that is characterized by remissions and relapses that commonly occur in patients over the age of 30 years. There have been many studies in literature evaluating the relationship between cardiovascular disease and psoriasis, which is a chronic inflammatory disease; however, there have been very few studies to date evaluating the relationship between rosacea and cardiovascular disease risk. The study included 52 consecutive rosacea patients and 52 healthy controls matched for age, gender and Body Mass Index. Demographic data, anthropometric measurements, lipid parameters, C-reactive protein (CRP), epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) were recorded. The main finding of the present study is the significantly higher EFT (P˂0.001) and CIMT (P˂0.001) values identified in patients with rosacea than in the control group and CRP (P=0.004), total cholesterol (P=0.003) and low-density lipoprotein (P=0.004) levels were also significantly higher in the rosacea group. EFT was significantly correlated with CIMT in the rosacea group (P=0.041). Total cholesterol (OR=1.032, P=0.017), CIMT (OR=7.391, P˂0.001) and EFT (OR=3.959, P=0.036) were independently associated with rosacea. Clinicians should be aware of the risk of cardiovascular disease when presenting with conditions involving persistent subclinical inflammation, as in the case of rosacea. EFT and CIMT measurements, which are noninvasive, easily accessible and cheap, can be useful to determine cardiovascular risk in rosacea patients.

The value of epicardial adipose tissue thickness for outcome prediction of patients undergoing coronary artery bypass grafting surgery.

Background:The significant association between epicardial adipose tissue and cardiovascular risk factors as well as outcome of ischemic heart diseases has been recently proposed. We determined the association between epicardial adipose tissue thickness and in-hospital as well as 3-month outcome after coronary artery bypass grafting surgery (CABG).Materials and Methods:This cross-sectional study was performed on 78 consecutive patients who underwent CABG in our heart center. Associations between epicardial adipose tissue thickness and in-hospital as well as 3-month outcome after CABG were measured by logistic regression and value of epicardial fat thickness evaluated by receiver operating characteristic (ROC) curve analysis.Results:Patients in-intensive care unit (ICU) suffered a variety of events, which many of them were insignificant, but 23 events (29.4%) of 78 were considered as important. The most frequent complication occurred in ICU was atrial fibrillation (9%). The frequency of 3-month complications was 6.4%, including 3.8% rehospitalization, 1.3% reoperation, and 1.3% cardiac death. Ninety-day mortality rate was 1.3%. Mean epicardial adipose tissue thickness was significantly higher in those with in-ICU complications than those without complication (7.64 ± 2.80 mm vs. 6.16 ± 2.29 mm, P = 0.015); however, the difference for 90-day complications was statistically nonsignificant. According to ROC curve analysis, measuring epicardial adipose tissue thickness could moderately predict in-ICU complication (area under the curve = 0.65 8, 95% confidence interval: 0.536–0.779, P = 0.017). The best cut-off point of this adipose tissue thickness for predicting in-ICU complication was 6.5 mm with sensitivity of 65.9% and specificity of 58.8%.Conclusion:Epicardial adipose tissue thickness is a useful predicting parameter for in-ICU complications after CABG.

Evaluation of Epicardial Fat Thickness in Young Patients With Embolic Stroke of Undetermined Source.

Epicardial adipose tissue is metabolically active and is an important predictor of metabolic and cardiovascular diseases. This study investigated the echocardiographic epicardial adipose tissue measurement in young patients with embolic stroke of undetermined source (ESUS). We studied 77 volunteers, including 40 patients with ESUS (mean age 43±8 y, 16 female patients) and 37 healthy subjects (mean age 38±7 y, 20 female subjects). All necessary biochemical parameters were analyzed, and epicardial fat thickness (EFT) was measured by echocardiography in all subjects. Additional related diagnostic work-up was conducted in each patient, according to the patients' clinical presentation. The patients with ESUS had a significantly higher EFT than the control group (5.51±0.82 vs. 3.96±0.51; P<0.01). Furthermore, there was a positive correlation between EFT and serum C-reactive protein levels (r=0.284; P<0.05). As an optimal cut-off point, a high-risk EFT value of 4.6 mm was determined to predict ESUS, with an 87.5% sensitivity and an 81.1% specificity. We found that echocardiographic EFT was significantly higher in young patients with ESUS than in healthy individuals. Increased EFT might be a novel risk factor in these patients.

Epicardial Fat Thickness is Associated with Abnormal Left Ventricle Geometry in Newly Diagnosed Hypertension.

Epicardial adipose tissue is an emerging cardio metabolic risk factor. Although an association between epicardial fat thickness (EFT) and left ventricle (LV) hypertrophy in hypertensive patients is known, the relationship between abnormal LV geometric patterns and EFT has yet to be investigated. The aim of the present study was to investigate the relationship between EFT and abnormal LV geometric patterns in hypertensive patients. Measurements were obtained from 343 patients with untreated essential hypertension (mean age 51.6 ± 5.5 years) and 52 healthy control subjects (mean age 51.8 ± 4.5 years). Four different geometric patterns (NG; normal geometry, CR; concentric remodeling, EH; eccentric hypertrophy, and CH; concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness (RWt). EFT was measured using transthoracic echocardiography. High sensitive C-reactive protein (hs-CRP) and other biochemical markers were measured in all participants. The highest EFT and hs-CRP values were determined in the CH group (EFT = 8.9 ± 2.1 mm) compared with the controls (EFT = 5.7 ± 1.5 mm), followed by the NG (EFT = 5.9 ± 1.6 mm), CR (EFT = 5.9 ± 1.3 mm) and EH groups (EFT = 6.5 ± 1.6 mm) (all p < 0.05). In addition, the EFT values of the EH group were higher than the control, NG and CR groups (all p < 0.05). Multivariate linear regression analysis showed that EFT was independently associated with LV geometry (β = 0.161, p = 0.032), total cholesterol level (β = -0.129, p = 0.003), triglyceride level (β = 0.266, p < 0.001), hs-CRP level (β = 0.349, p < 0.001), and creatinine level (β = 0.108, p = 0.010). EFT is independently associated with abnormal LV geometry, LV hypertrophy, creatinine level, and low grade chronic inflammation.

Epicardial Fat Thickness is Associated with Abnormal Left Ventricle Geometry in Newly Diagnosed Hypertension.

Epicardial adipose tissue is an emerging cardio metabolic risk factor. Although an association between epicardial fat thickness (EFT) and left ventricle (LV) hypertrophy in hypertensive patients is known, the relationship between abnormal LV geometric patterns and EFT has yet to be investigated. The aim of the present study was to investigate the relationship between EFT and abnormal LV geometric patterns in hypertensive patients.Measurements were obtained from 343 patients with untreated essential hypertension (mean age 51.6 ± 5.5 years) and 52 healthy control subjects (mean age 51.8 ± 4.5 years). Four different geometric patterns (NG; normal geometry, CR; concentric remodeling, EH; eccentric hypertrophy, and CH; concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness (RWt). EFT was measured using transthoracic echocardiography. High sensitive C-reactive protein (hs-CRP) and other biochemical markers were measured in all participants.The highest EFT and hs-CRP values were determined in the CH group (EFT = 8.9 ± 2.1 mm) compared with the controls (EFT = 5.7 ± 1.5 mm), followed by the NG (EFT = 5.9 ± 1.6 mm), CR (EFT = 5.9 ± 1.3 mm) and EH groups (EFT = 6.5 ± 1.6 mm) (all p < 0.05). In addition, the EFT values of the EH group were higher than the control, NG and CR groups (all p < 0.05). Multivariate linear regression analysis showed that EFT was independently associated with LV geometry (β = 0.161, p = 0.032), total cholesterol level (β = -0.129, p = 0.003), triglyceride level (β = 0.266, p < 0.001), hs-CRP level (β = 0.349, p < 0.001), and creatinine level (β = 0.108, p = 0.010).EFT is independently associated with abnormal LV geometry, LV hypertrophy, creatinine level, and low grade chronic inflammation.

Epicardial fat thickness predicts atrial fibrillation recurrences after a first pulmonary vein isolation procedure using second generation cryoballoon

Atrial fibrillation (AF) is the most common arythmia in adult population. A relationship between epicardial adipose tissue and AF has recently been reported. The objective of this study was to evaluate the impact of epicardial fat thickness (EFT) on the outcome of patients who underwent a first pulmonary vein isolation (PVI) procedure using second generation cryoballoon. From February 2012 to February 2017, all patients who underwent a first PVI procedure using second generation cryoballoon in Rouen University Hospital were included. Data were retrospectively collected. EFT was assessed by cardiac magnetic resonance imagery (cMRI). Measures were preformed the long side of the right ventricle free wall on axial view in end diastolic time. The primary endpoint was documented AF recurrences at four months. Secondary endpoints were: EFT measurements, and AF recurrences before hospital discharge. PVI procedure was performed in 288 patients. Among them, 231 patients (80.2%) had a cMRI. EFT could be appropriately measured in 206 patients. Recurrences of AF at four months occurred in 32/206 patients (15.5%). In multivariate analysis, predictive factors of AF recurrences at four months were: EFT, the presence of high left atrium enlargement and AF recurrences before hospital discharge (respectively, HR = 1.96, 95% CI: 1.20–3.18, P = 0.007; HR = 4.63, 95% CI: 1.17–18.38, P = 0.03, and HR = 7.55, 95% CI: 2.50–22.81, P < 0.001). The best cutoff value of EFT to predict AF recurrences at four months was equal to 4.35 mm (Se = 0.75, and Sp = 0.60). EFT is an independent predictive factor of AF recurrences at four months after a first PVI procedure using second generation cryoballoon. In accordance with other studies, epicardial adipose tissue seems to be intimately bound to AF physiopathology.

Epicardial Fat Thickness in Non-Obese Neurologically Impaired Children: Association with Unfavorable Cardiometabolic Risk Profile

Background: Cardiovascular risk is reported in disabled children and epicardial fat (EF) is considered an independent predictor of cardiovascular disease (CVD). No data on the EF thickness (EFT) evaluation in disabled children have been published. Objective: We investigated EFT in neurologically impaired (NI) children; its relationship with their metabolic profile was also considered. Methods: Clinical data, body composition estimation, biochemical profile, and ultrasound-measured EFT were performed in 32 disabled patients (12.4 ± 6.3 years). Pathological parameters were defined using the following criteria: waist circumference >95th percentile, waist to height ratio (WHtR) >0.5, total cholesterol and triglycerides (TG) values >95th percentile, high density lipoprotein cholesterol <5th percentile, fasting blood glucose >100 mg/dL, homeostasis model assessment for insulin resistance (HOMA) >97.5th percentile, and EFT >3.6 mm. Results: EFT values in NI children were higher compared with control group values (p = 0.02). EFT correlated with gender (p < 0.001), age (p = 0.02), pubertal stage (p = 0.04), as well as WHtR (p = 0.03). A correlation between EFT and leptin was also noted (p = 0.04). EFT levels significantly correlated with pathological TG (p = 0.01) and HOMA-IR (p = 0.04). Conclusions: Higher EFT was observed in NI children compared with controls. EFT values correlated with clinical, metabolic, and endocrinological parameters. Ultrasound-measured EFT could be used to promptly detect subclinical CVD and to prevent adverse outcomes in disabled children.

Epicardial fat thickness predicts redo procedures following paroxysmal atrial fibrillation ablation using second generation cryoballoon catheter

Some studies have shown an association between epicardial fat thickness (EFT) and atrial fibrillation development or its recurrence after ablation. The objective of this study was to evaluate whether EFT could predict the outcome of patients undergoing a first pulmonary vein isolation (PVI) procedure using second-generation cryoballoon catheter for paroxysmal atrial fibrillation (PAF). Clinical and imaging data were retrospectively collected in patients who underwent a first PVI procedure for PAF using second-generation cryoballoon catheter, from February 2012 to October 2016, at Rouen university hospital. EFT was measured using either cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI), performed to evaluate the left atrium anatomy before the ablation procedure. A mean value of EFT was calculated for each patient using several measurements performed along the right ventricle free-wall in four-chamber view. Redo atrial fibrillation ablation procedure was the primary endpoint of the study. Among the 245 patients eligible for the study, EFT could be analyzed in 191 patients [MRI: n = 165 (86.4%); CT: n = 26 (13.6%)]. Twenty-seven patients (14.1%) underwent a redo procedure, which was performed 9.9 ± 9.5 months after the first ablation. In these patients, EFT was significantly greater than in the other patients using univariate analysis. It remained a significant predictive factor of redo procedure in multivariate analysis ( Table 1 ). The ROC curve exploring the relation between EFT and the performance of redo procedure reported an area under the curve equal to 0.79, and a best cut off value of 4.7 mm with sensitivity of 76% and a specificity of 74%. EFT seems to be an independent and strong predictive factor of redo ablation procedure following PVI using cryoballoon catheter for PAF. Whether this parameter could help to better define the PAF ablation, strategy remains to be determined.

The impact of diabetes on the association between epicardial fat thickness and extent and complexity of coronary artery disease in patients with non-ST elevation myocardial infarction.

Epicardial fat thickness (EFT) is associated with increased cardio metabolic risk. Recent studies have suggested that there is a strong relationship between diabetes and EFT. Although the relationship between EFT and coronary artery disease (CAD) is well known, the possible impact of diabetes on the relationship between EFT and extent and complexity of CAD was not fully investigated. We aimed to investigate the relationship between EFT and extent and complexity of CAD in patients with non-ST elevation myocardial infarction (NSTEMI) with and without diabetes. We prospectively included 454 patients with NSTEMI (mean age: 61.8 ± 10.4 years) in the present study. Patients were classified into two groups according to their diabetes status (diabetic group and non-diabetic group). EFT was measured by transthoracic echocardiography on the right ventricle in individuals having the left lateral decubitus position. SYNTAX score was used to define the extent and complexity of CAD. High-sensitivity C-reactive protein (hs-CRP) and other biochemical markers were measured in all participants. Diabetic patients had higher EFT values compared with non-diabetics (p < 0.05). EFT is independently associated with diabetes, SYNTAX score, and hs-CRP in all patients (p < 0.05, for all). When patients were divided into two groups, as diabetic and non-diabetic, the association between EFT and SYNTAX score was stronger in diabetic patients compared with non-diabetics (r = 0.635; p < 0.001 vs. r = 0.179; p = 0.003). Epicardial fat thickness is associated with SYNTAX score in both diabetic and non-diabetic patients. Furthermore, there is a stricter relationship between EFT and SYNTAX score in diabetic patients.

Abstract WP233: Epicardial Fat Thickness, Free Fatty Acid and Pro-BNP Predict Atrial Fibrillation in Acute Ischemic Stroke

Background/Objectives: Detection of atrial fibrillation (AF) is important for diagnosis of cardioembolic stroke. Few studies that cardioembolic stroke relate to some biomarkers such as high sensitive C-reactive protein (hs-CRP), free fatty acid (FFA), pro-brain natriuretic peptide (pro-BNP) and D-dimer have been reported. FFAs are major components of epicardial fat. Increased epicardial fat thickness (EFT) is known to be associated with the presence of AF. The object of this study is to find the useful markers to distinguish stroke with AF in acute ischemic stroke. Design/Method: Total 214 consecutive patients (mean age, 66.8±12.3 years; 39.7% women; 16.4% AF group) with acute ischemic stroke within 72 hours of onset were retrospectively enrolled. We analyzed the EFT and the several biomarkers between stroke with and without AF. Results: Age, heart rate, FFA, pro-BNP, hs-CRP, HDL and the frequency of woman were significantly higher in AF group (p &lt;0.05). Estimated glomerular filtration rate (eGFR) was significantly lower in AF group (p&lt;0.05). D-dimer and myoglobin were no significant difference. EFT (6.45±1.18 vs 5.30±1.23 mm, p&lt;0.001), Left atrium (LA) diameter and LA volume were significantly higher in AF group. The respective cut-off value of EFT, FFA and pro-BNP for prediction of the AF were 5.58mm, 1226.5 μEq/ml and 295.0 pg/ml (sensitivity 85%, specificity 61%, AUC 0.76 for EFT; 67%, 93%, 0.79 for FFA; 82%, 84%, 0.88 for pro-BNP). Multivariate logistic regression analysis demonstrated that age, FFA and EFT were independently associated with the presence of AF (p&lt;0.05). Conclusions: The combination of EFT, FFA and pro-BNP can be a useful marker for the prediction of the AF in acute ischemic stroke.

Echocardiographic Epicardial Fat Thickness Measurement: A new Screening Test for Subclinic Atherosclerosis in Patients With Inflammatory Bowel Diseases

OBJECTIVE:Inflammatory bowel diseases (IBD) consist of a number of chronic inflammatory diseases. Inflammatory process is known to be involved in all stages of atherosclerosis. Early atherosclerosis is reflected by increased levels of carotid artery intima media thickness (c-IMT) and high-sensitivity C-reactive protein (hs-CRP). Epicardial fat thickness (EFT) strongly influences both the formation and progression of atherosclerosis. Recent studies have demonstrated a relationship between c-IMT and hs-CRP levels and the risk of atherosclerosis in patients with IBD. However, no study has yet compared EFT between patients with IBD and the general healthy population. Hence, this study was designed to further evaluate whether patients with IBD have higher EFT values with increased c-IMT and hs-CRP levels compared to those in the healthy population.METHODS:A total of 110 patients with IBD and 105 healthy volunteers were enrolled into this study. EFT was evaluated by transthoracic echocardiography. c-IMT levels were measured using an ultrasound scanner with a linear probe. The plasma levels of hs-CRP were measured using a highly sensitive sandwich ELISA technique.RESULTS:The hs-CRP and c-IMT levels of patients with IBD were significantly higher than those of the control group. The EFT values of patients with IBD were significantly higher than those of the control group (0.54±0.13 vs. 0.49±0.09, p=0.002).CONCLUSION:Echocardiographic EFT measurements of patients with IBD were significantly higher than those of the normal population, which may be associated with an increased subclinical atherosclerosis risk in these patients.

Evaluation of Atrial Conduction Times, Epicardial Fat Thickness and Carotid Intima-Media Thickness in Patients With Ankylosing Spondylitis.

This study aims to determine the relationship between atrial electromechanical delay (EMD), carotid intima-media thickness (CIMT), and epicardial fat thickness (EFT) in ankylosing spondylitis (AS), which has a complicated inflammatory nature. The study population included 42 consecutive patients with AS (28 males, 14 females; mean age 39.3±8.5 years; range 22 to 60 years) and 40 healthy subjects as controls (24 males, 16 females; mean age 37.2±8.7 years; range 22 to 60 years) (p>0.05). All patients underwent a standard tissue Doppler echocardiography to assess the left ventricular diastolic dysfunction, atrial EMD, CIMT, and EFT. All values were compared between the groups. Interatrial (29.5±5.8 ms vs. 17.9±5.3 ms) left and right intraatrial EMD (18.2±4.6 ms and 11.7±3.5 ms vs. 11.9±3.2 ms and 7.1±3.2 ms, respectively) intervals were longer in AS patients than in healthy controls (all p<0.001). Left and right CIMT (0.50±0.11 mm and 0.44±0.06 mm vs. 0.51±0.11 mm and 0.43±0.04 mm, respectively) and EFT (0.73±0.15 cm and 0.63±0.07 cm) values were higher in AS patients than in healthy controls (all p<0.01). To our best knowledge, this is the first report evaluating the atrial EMD, CIMT, and EFT values together in AS patients. As indicators of cardiovascular involvement, all parameters were higher in AS patients.

Evaluation of Echocardiographic Epicardial Fat Thickness as a Sign of Cardiovascular Risk in Positive Exercise Test Patients.

The association between epicardial fat thickness (EFT) and positive exercise test results for the diagnosis of coronary artery diseases (CAD) has yet to be evaluated. This study assessed the predictive value of EFT for CAD on the angiographs of patients with positive exercise tests. A total of 91 subjects were chosen consecutively from stable angina pectoris patients who were referred for coronary angiography due to a positive exercise test result. The EFT measures were obtained by echocardiographic parasternal long-axis views on the free wall of the right ventricle at end-systole of three cardiac cycles. Gensini scores were calculated by a conventional coronary angiography technique using a calculation method previously defined. Receiver operator characteristic (ROC) curve analysis revealed a 0.65 cm (95% confidence interval: 0.628, 0.832, p < 0.001) area under the curve with 74.3% sensitivity and 62.3% specificity at the cut-off value of EFT for the prediction of critical coronary artery stenosis. Following ROC curve analysis, two groups were defined according to EFT cut-off value (groups 1 and 2). The severe coronary stenosis ratio was significantly higher in group 2 compared to group 1 (31.9 % vs. 11%, p < 0.001) and Gensini scores were significantly higher in group 2 (6.3 ± 13.3 vs. 16.5 ± 17.9; p < 0.001). There was no significant correlation between Gensini scores and EFT in group 1 (r = 0.093, p = 0.549), but there was a strong significant correlation in group 2 (r = 0.730, p < 0.001). Linear multivariate regression analysis revealed that EFT (> 0.65 cm) was the only independent risk factor for critical coronary artery stenosis (β = 0.451, p < 0.001). EFT was significantly correlated with the severity and prevalence of coronary artery disease in positive exercise test patients.