LETTER
TO
THE
EDITOR
Different Imaging Modalities in Quantification of Epicardial Adipose Tissue Thickness To the Editor, We read with great interest the article entitled “Increased Epicardial Adipose Tissue Thickness as a Predictor for Hypertension: A Cross-Sectional Observational Study” by Dicker and colleagues.1 They showed that hypertensive patients have significantly higher-than-normal epicardial adipose tissue thickness (EAT). The authors concluded that epicardial adipose tissue thickness may serve as a risk indicator for hypertension and cardiovascular morbidity. EAT is an emerging cardiometabolic risk factor and can be measured using echocardiography. EAT measurement with echocardiography has several advantages such as its low cost, easy accessibility, and good reproducibility. A positive relationship has been established between EAT and cardiovascular risk factors. Echocardiographic EAT assessment is independently associated with hypertension and obesity.2 Newly identified inflammatory markers are considered to reflect major risk factors predisposing patients to cardiovascular morbidity and mortality. EAT and neutrophil to lymphocyte ratio are highly associated with types of nonvalvular atrial fibrillation independent of traditional risk factors.3 EAT was strongly correlated with waist circumference and carotid intima-media thickness in patients with type 2 diabetes mellitus.4 Recently, EAT has begun to be evaluated by using cardiac computed tomography in several studies.5,6 However, computed tomography has some disadvantages, including radiation exposition and high cost, which make it less practical for routine use. We strongly believe that the findings obtained in the current study will lead to further studies examining EAT using cardiac computed tomography. It would have
doi: 10.1111/jch.12346
616
The Journal of Clinical Hypertension
Vol 16 | No 8 | August 2014
been even more beneficial if the authors evaluated epicardial fat thickness using echocardiography to examine whether there is a correlation between computed tomographic and echocardiographic measurements. Therefore, EAT should be assessed with two methods in patients with cardiovascular risk factors in future studies. Conflict of Interest: There are no conflicts of interest associated with this study.
Sait Demirkol, MD; Sevket Balta, MD; Cengiz Ozturk, MD; Turgay Celik, MD; Atila Iyisoy, MD Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey References 1. Dicker D, Atar E, Kornowski R, et al. Increased epicardial adipose tissue thickness as a predictor for hypertension: a cross-sectional observational study. J Clin Hypertens (Greenwich). 2013;15:893–898. € 2. Turak O, Ozcan F, Canpolat U, et al. Increased echocardiographic epicardial fat thickness and high-sensitivity CRP level indicate diastolic dysfunction in patients with newly diagnosed essential hypertension. Blood Press Monit. 2013;18:259–264. 3. Acet H, Ertasß F, Akıl MA, et al. New inflammatory predictors for nonvalvular atrial fibrillation: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio. Int J Cardiovasc Imaging. 2014; 30:81–89. 4. Cetin M, Cakici M, Polat M, et al. Relation ofepicardial fat thickness with carotid intima-media thickness in patients with type 2 diabetes mellitus. Int J Endocrinol. 2013;2013:769175. 5. Bachar GN, Dicker D, Kornowski R, et al. Epicardial adipose tissue as a predictor of coronary artery disease in asymptomatic subjects. Am J Cardiol. 2012;110:534–538. 6. Gorter PM, van Lindert AS, de Vos AM, et al. Quantification of epicardial and pericoronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis. 2008; 197:896–903.
TO
THE
EDITOR
Different Imaging Modalities in Quantification of Epicardial Adipose Tissue Thickness To the Editor, We read with great interest the article entitled “Increased Epicardial Adipose Tissue Thickness as a Predictor for Hypertension: A Cross-Sectional Observational Study” by Dicker and colleagues.1 They showed that hypertensive patients have significantly higher-than-normal epicardial adipose tissue thickness (EAT). The authors concluded that epicardial adipose tissue thickness may serve as a risk indicator for hypertension and cardiovascular morbidity. EAT is an emerging cardiometabolic risk factor and can be measured using echocardiography. EAT measurement with echocardiography has several advantages such as its low cost, easy accessibility, and good reproducibility. A positive relationship has been established between EAT and cardiovascular risk factors. Echocardiographic EAT assessment is independently associated with hypertension and obesity.2 Newly identified inflammatory markers are considered to reflect major risk factors predisposing patients to cardiovascular morbidity and mortality. EAT and neutrophil to lymphocyte ratio are highly associated with types of nonvalvular atrial fibrillation independent of traditional risk factors.3 EAT was strongly correlated with waist circumference and carotid intima-media thickness in patients with type 2 diabetes mellitus.4 Recently, EAT has begun to be evaluated by using cardiac computed tomography in several studies.5,6 However, computed tomography has some disadvantages, including radiation exposition and high cost, which make it less practical for routine use. We strongly believe that the findings obtained in the current study will lead to further studies examining EAT using cardiac computed tomography. It would have
doi: 10.1111/jch.12346
616
The Journal of Clinical Hypertension
Vol 16 | No 8 | August 2014
been even more beneficial if the authors evaluated epicardial fat thickness using echocardiography to examine whether there is a correlation between computed tomographic and echocardiographic measurements. Therefore, EAT should be assessed with two methods in patients with cardiovascular risk factors in future studies. Conflict of Interest: There are no conflicts of interest associated with this study.
Sait Demirkol, MD; Sevket Balta, MD; Cengiz Ozturk, MD; Turgay Celik, MD; Atila Iyisoy, MD Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey References 1. Dicker D, Atar E, Kornowski R, et al. Increased epicardial adipose tissue thickness as a predictor for hypertension: a cross-sectional observational study. J Clin Hypertens (Greenwich). 2013;15:893–898. € 2. Turak O, Ozcan F, Canpolat U, et al. Increased echocardiographic epicardial fat thickness and high-sensitivity CRP level indicate diastolic dysfunction in patients with newly diagnosed essential hypertension. Blood Press Monit. 2013;18:259–264. 3. Acet H, Ertasß F, Akıl MA, et al. New inflammatory predictors for nonvalvular atrial fibrillation: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio. Int J Cardiovasc Imaging. 2014; 30:81–89. 4. Cetin M, Cakici M, Polat M, et al. Relation ofepicardial fat thickness with carotid intima-media thickness in patients with type 2 diabetes mellitus. Int J Endocrinol. 2013;2013:769175. 5. Bachar GN, Dicker D, Kornowski R, et al. Epicardial adipose tissue as a predictor of coronary artery disease in asymptomatic subjects. Am J Cardiol. 2012;110:534–538. 6. Gorter PM, van Lindert AS, de Vos AM, et al. Quantification of epicardial and pericoronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis. 2008; 197:896–903.
