CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 108 AFRICA Cardiovascular Topics Epicardial fat thickness assessment by multi-slice computed tomography for predicting cardiac outcomes in patients undergoing transcatheter aortic valve implantation Gökhan Ertaş, Ahmet Ekmekçi, Sinan Şahin, Ahmet Murat, Nijad Bakhshaliyev, Hatice Betül Erer, Tolga Sinan Güvenç, Mehmet Eren Abstract Introduction: Chronic inflammation promotes aortic valve calcification. It is known that epicardial fat is a source of inflammation. The aim of this study was to investigate the relationship between epicardial fat thickness, cardiac conduction disorders and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: During a three-year period, 45 patients with severe aortic stenosis who underwent TAVI were recruited to the study. Data were collected retrospectively. Epicardial fat was defined as the adipose tissue between the epicardium and the visceral pericardium. Mean epicardial fat thickness was determined by multi-slice computed tomography, which was performed before the procedure. Results: The average thickness of epicardial fat was 13.06 ± 3.29 mm. This study failed to reveal a significant correlation between epicardial fat thickness and post-procedural left bundle branch block, right bundle branch block, paravalvular aortic regurgitation and pacemaker implantation rates (p > 0.05). Conclusion: The results of this study failed to show a significant relationship between epicardial fat thickness, cardiac conduction disorders and outcomes, however further studies with larger sample numbers are required to explore the relationship. Keywords: epicardial fat thickness, calcific aortic stenosis, transcatheter aortic valve implantation, multi-slice computed tomography Submitted 17/11/20; accepted 13/9/21 Published online 15/10/21 Cardiovasc J Afr 2022; 33: 108–111 www.cvja.co.za DOI: 10.5830/CVJA-2021-043 Epicardial fat is a metabolically active visceral fat that has paracrine and endocrine functions. It surrounds the heart between the pericardium and myocardium and can be found in highest concentration in the atrioventricular and interventricular grooves and in direct contact with the major coronary arteries and their branches.1 Epicardial fat may also act as an endocrine organ due to its adipocytokine production.2,3 Epicardial fat thicknesses and volumes can be accurately evaluated by non-invasive imaging modalities such as echocardiography, computed tomography (CT) or magnetic resonance imaging (MRI).4 Recent studies indicate that epicardial fat may contribute to the progression of coronary atherosclerosis due to its proximity to the coronary arteries.3,5 Epicardial fat is independently associated with coronary atherosclerosis, adverse cardiovascular events and myocardial ischaemia.5-7 However, the exact underlying mechanisms are still not fully understood. The association between epicardial fat and atrial fibrillation has been demonstrated.8 Interestingly, an association between epicardial fat thickness and valvular heart disease has been found.9 The authors revealed that epicardial adipose tissue has an increased thickness in patients with calcific aortic stenosis. The aim of this study was to evaluate the epicardial fat thickness for predicting cardiac conduction disorders and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). As far as we know, this is the first study to address the potential association between epicardial fat thickness and outcomes in patients undergoing TAVI. Department of Cardiology, Memorial Sisli Hospital, Istanbul, Turkey Gökhan Ertaş, MD, drgokhanertas@yahoo.com.tr Ahmet Murat, MD Department of Cardiology, Medical Park Pendik Hospital, Istanbul, Turkey Ahmet Ekmekçi, MD Hatice Betül Erer, MD Tolga Sinan Güvenç, MD Department of Radiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Sinan Şahin, MD Department of Cardiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey Nijad Bakhshaliyev, MD Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Mehmet Eren, MD
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