EPICARDIALADIPOSE TISSUE THICKNESS IN PATIENTS WITH METABOLIC SYNDROME AND ITS ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS.

Abstract

INTRODUCTION Metabolic syndrome is a constellation of several cardiovascular risk factors, and is defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III criteria (2001) or the International Diabetes Federation (IDF) criteria (2005). 1, 2The prevalence of metabolic syndrome varies between 24.6 - 41% in different parts of Indian subcontinent and based on different criteria for metabolic syndrome. OBJECTIVES To assess epicardial adipose tissue (EAT) thickness by echocardiography in patients with metabolic syndrome, and find out if there is any association between EAT thickness and different cardiovascular risk factors. MATERIALS AND METHODS This cross-sectional observational study was conducted in a tertiary care hospital in India among patients attending the Medicine and Cardiology out-patient department (OPD) during the study period of six months from May 2018 to October 2018. Patients satisfying the diagnostic criteria of metabolic syndrome as per the IDF criteria (2005) were included in the study, as there are separate cut off points for waist circumference for South Asian population. Design: Cross-sectional observational study. Setting: Single centre study in a tertiary care teaching hospital. Participants: Initially 450 patients with metabolic syndrome as per International Diabetes Federation (IDF) criteria (2005) were screened. Patients having age above 65 years, deranged liver/renal function, ischemic heart disease, heart failure, malignancy, pregnancy, ascitis, poor echo window, history of endocrine disorders like Cushing Syndrome, glucocorticoid use, having any acute illness and those not giving consent were excluded. Final sample size was 397. For defining the normal EAT thickness in this geographic region, 50 age and gender matched healthy volunteers without any conventional cardiovascular risk factors (except age in some cases) acted as controls. Study period was six months. RESULT The mean value of EAT thickness in the control group was 2.97 (± 0.86) mm, hence the upper reference limit of EAT thickness in this study was taken as more than mean + 2SD, i.e. 4.69mm. Mean EAT thickness in patients suffering from metabolic syndrome was 5.48 ± 0.83 mm, which was significantly increased compared to controls. Taking 4.69mm as cut off, it was seen that 311 (78.34%) patients had increased EAT thickness >4.69mm. CONCLUSION Further studies with larger sample size and longitudinal design are required to establish the ability of EAT thickness to predict cardiovascular risk.