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The Relation Between Echocardiographic Epicardial Fat Thickness and CHA

Mesut EnginI

DOI: 10.21470/1678-9741-2020-0017

Dear Editor,

I have read the article by Aksoy et al.[1], entitled “The Relation Between Echocardiographic Epicardial Fat Thickness and CHA2DS2-VASc Score in Patients with Sinus Rhythm”. First of all, I congratulate the authors for their invaluable contribution to the literature. On the other hand, I would like to clarify a point about the waist circumference (WC).

Obesity is one of the most important factors in cardiovascular diseases. Although body mass index (BMI) has been extensively investigated in cardiovascular diseases, WC and WC parameters have become more prominent in recent years[2]. In a large series of patients, it was shown that WC and its associated parameters were more correlated with myocardial infarction than BMI[3]. However, when the WC value is used alone, it is necessary to make a separate assessment for men and women[4-6]. In addition, this value is used as a risk factor for different values in different regions. For example, having a WC of >102 cm in men and of >88 cm in women is a risk factor for cardiovascular diseases in our country. A study by Girerd et al. included 2214 male patients who underwent coronary bypass surgery; the WC of >102 cm in these patients was found to be a risk factor for postoperative atrial fibrillation[7].

In the study by Aksoy et al.[1], the correlation between WC and epicardial adipose tissue was found to be mildly positive (r=0.184, P=0.02). However, WC was not defined as a gender-specific value by the authors[1]. Although this correlation is guiding us for future studies, I think that it may be more effective to evaluate patients according to their gender groups. Thus, the results of statistical analysis may change. Or this assessment can be performed using lipid accumulation product and/or visceral adiposity index and/or waist to height ratio, predictors of visceral fat[8,9].


1. Aksoy F, Guler S, Kahraman F, Oskay T, Varol E. The relation between echocardiographic epicardial fat thickness and CHA2DS2-VASc score in patients with sinus rhythm. Braz J Cardiovasc Surg. 2019;34(1):41-7. doi:10.21470/1678-9741-2018-0230. [MedLine]

2. Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev. 2011;12(9):680-7. doi:10.1111/j.1467789X.2011.00879.x.

3. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366(9497):1640-9. doi:10.1016/S0140-6736(05)67663-5.

4. de Sousa ELH, Cavalcante JEA, de Sousa DF, Ferreira JM, Meneses RRC, Sousa DL, et al. Comparison of early cardiovascular risk among Brazilian and African university students. Clin Biochem. 2020;75:7-14. doi:10.1016/j.clinbiochem.2019.09.007. [MedLine]

5. Ghachem A, Paquin J, Brochu M, Dionne IJ1. Should waist circumference cutoffs in the context of cardiometabolic risk factor assessment be specific to sex, age, and BMI? Metab Syndr Relat Disord. 2018;16(7):366-74. doi:10.1089/met.2017.0177.

6. Budimir D, Jeroncic A, Gunjaca G, Rudan I, Polasek O, Boban M. Sexspecific association of anthropometric measures of body composition with arterial stiffness in a healthy population. Med Sci Monit. 2012;18(2):CR65-71. doi:10.12659/msm.882457.

7. Girerd N, Pibarot P, Fournier D, Daleau P, Voisine P, O'Hara G, et al. Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery. Eur Heart J. 2009;30(10):1270-8. doi:10.1093/eurheartj/ehp091.

8. Zou J, Wang Y, Xu H, Xia Y, Qian Y, Zou J, et al. The use of visceral adiposity variables in the prediction of obstructive sleep apnea: evidence froma large cross-sectional study. Sleep Breath. 2019;10.1007/s11325-019-01980-7. doi:10.1007/s11325-019-01980-7.

9. Xu Z, Qi X, Dahl AK, Xu W. Waist-to-height ratio is the best indicator for undiagnosed type 2 diabetes. Diabet Med. 2013;30(6):e201-7. doi:10.1111/dme.12168.

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