CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 110 AFRICA Discussion This study is the first clinical study that evaluated the potential association between epicardial fat thickness and outcomes in patients undergoing TAVI. Our results failed to show a significant correlation between epicardial fat thickness and postprocedural LBBB, RBBB, paravalvular aortic regurgitation and pacemaker implantation rates. Obesity is an important determinant of cardiovascular disease. Previous studies have revealed that epicardial fat is strongly correlated with other visceral fat deposits.12 Higher epicardial fat volumes independently predicted major adverse cardiac events in a healthy population.13 Epicardial fat thickness has also been Table 1. Baseline demographic characteristics Characteristics Min–Max Mean ± SD Age (years) 60–89 79.07 ± 6.18 Weight (kg) 50–91 69.65 ± 10.74 Height (m) 1.50–1.78 1.64 ± 10.74 Body mass index (kg/m2) 20.52–33.06 25.78 ± 3.48 Number Percent Gender Female 28 62.2 Male 17 37.8 Hypertension 33 73.3 Diabetes mellitus 18 40.0 Coronary artery disease 20 44.4 Smoking 7 15.6 Previous heart surgery history 11 24.4 Chronic obstructive pulmonary disease 10 22.2 Sinus rhythm before TAVI 32 71.1 TAVI: transcatheter aortic valve implantation. Table 2. Baseline laboratory characteristics Characteristics Min–Max Mean ± SD Mean platelet volume (fl) 5.9–13.3 8.61 ± 1.31 Neutrophil (k/µl) 2–11.8 4.54 ± 2.04 Lymphocytes (k/µl) 0.3–3.2 1.58 ± 0.58 Creatinine (mg/dl) 0.5–11.3 1.23 ± 1.57 Haemoglobin (gr/dl) 8.2–14.8 11.25 ± 1.39 Haematocrit (%) 24.7–42.7 33.81 ± 4.16 Table 3. Pre-procedural data Variables Min–Max Mean ± SD STS score 1.06–19 5.15 ± 3.54 Logistic EuroSCORE 2.37–56.92 11.91 ± 9.14 Echocardiography data Aortic valve area (cm2) 0.6–1.1 0.78 ± 0.15 Aortic mean gradient (mmHg) 27–75 46.26 ± .77 Aortic max gradient (mmHg) 54–120 77.47 ± 14.40 Aortic velocity (m/s) 3.6–5,5 4.33 ± 0.38 Ascending aorta diameter (mm) 25–43 35.21 ± 4.24 Sinotubular junction diameter 18–38 27.95 ± 5.39 Aortic annulus diameter (TEE, mm) 20–29 20.79 ± 5.52 CT data Epicardial fat thickness (mm) 7.5–24.1 13.06 ± 3.29 MAD of iliac artery (mm) 8–16 11.43 ± 2.29 MAD of femoral artery (mm) 6–13 8.65 ± 1.81 Aortic annulus diameter (CT, mm) 18–33 23.79 ± 3.77 Pre-procedural valve data Number Percent Mitral valve stenosis 6 13.3 Coronary stent implantation before procedure 5 11.1 Mitral regurgitation 0 (none) 8 17.8 1 (mild) 25 55.6 2 (moderate) 12 26.7 Aortic regurgitation 0 (none) 14 31.1 1 (mild) 21 46.7 2 (moderate) 10 22.2 TEE: transesophageal echocardiography, CT: computed tomography, MAD: minimal artery diameter, STS: Society of Thoracic Surgeons, TAVI: transcatheter aortic valve implantation. Table 4. Post-procedural data Variables Number Percent Pacemaker implantation 7 18.9 Blood transfusion 12 27.3 Death 5 11.4 Heart failure 3 7.0 Rehospitalisation 7 16.3 Stroke 4 9.3 Paravalvular AR (aortography) 0 (none) 18 41.9 1 (mild) 18 41.9 2 (moderate) 7 16.3 Paravalvular AR (echocardiography) 0 (none) 18 40.9 1 (mild) 20 45.5 2 (moderate) 6 13.6 Valve diameter (mm) 23 13 30.2 26 24 55.8 29 6 14.0 Type of valve Core-valve 4 9.3 Edwards Sapien 39 90.7 AR: aortic regurgitation. Table 5. Association of epicardial fat thickness with post-procedural data Variables Epicardial fat thickness p-value Min–Max (median) Mean ± SD LBBB No 7.5–16.4 (12.7) 12.63 ± 2.78 0.709a Yes (n = 5) 9.1–18.5 (14.6) 13.40 ± 3.95 RBBB No 7.5–18.5 (13.5) 12.83 ± 2.94 0.743a Yes (n = 2) 9.0–15.8 (12.4) 12.40 ± 4.80 Pacemaker implantation No 9.0–18.5 (13.3) 13.16 ± 2.79 0.525a Yes (n = 7) 7.5–15.8 (13.5) 12.38 ± 3.08 Paravalvular AR (aortography) 0 9.7–24.1 (13.3) 13.94 ± 3.69 0.619b 1 7.5–16.4 (12.0) 12.32 ± 2.96 2 9.1–18.5 (14.6) 13.86 ± 3.48 Paravalvular AR (echocardiography) 0 9.0–24.1 (13.0) 13.10 ± 4.08 0.781b 1 9.2–16.4 (12.4) 12.74 ± 2.77 2 9.1–18.5 (14.6) 13.86 ± 3.48 aMann–Whitney U-test, bKruskall–Wallis test. LBBB: left bundle branch block, RBBB: right bundle branch block, AR: aortic regurgitation.
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