CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 AFRICA 111 found to be significantly correlated with the severity of coronary artery disease in patients with known coronary artery disease.14 Epicardial adipose tissue has been shown to be a source of inflammatory mediators such as interleukin (IL)-1β, IL-6 and tumour necrosis factor.15 Inflammatory mediators have been shown to play a role in the pathogenesis of calcific aortic stenosis as well.16,17 A significant correlation between epicardial fat thickness and levels of pro-inflammatory cytokines and calcific aortic stenosis has been described.9 The authors indicated a strong association between epicardial fat thickness and aortic stenosis.9 Epicardial adipose tissue is an important source of several pro-inflammatory mediators and it may play a role in promoting aortic valve degeneration and calcification. Mancio et al. reported that low body mass index (BMI) was paradoxically associated with aortic valve calcification and mortality in elderly aortic stenosis patients submitted for TAVI.18 Koifman et al. also concluded that patients with BMI < 20 kg/ m2 were associated with a higher risk of mortality.19 Interestingly, in another study, the authors revealed that patients with larger epicardial adipose tissue volume had an increased all-cause one-, two- and three-year mortality rate after TAVI.20 In our study, we aimed to evaluate the association of epicardial fat thickness with post-procedural outcomes of TAVI. To the best of our knowledge, our study is the first report to focus on the relationship between epicardial fat thickness and outcomes of patients who underwent TAVI. Our results failed to reveal any significant relationship. The limitations of this study are the small sample size and retrospective design. There is no consensus on the gold standard for an in vivo quantification of epicardial adipose tissue. Volume measurement could be more accurate in the assessment of epicardial adipose tissue, however, epicardial fat thickness measurement is less time consuming and easier. Conclusion Larger trials are needed to evaluate whether epicardial fat thickness might have predictive properties and become a routine way of assessing cardiovascular risk in a clinical setting of TAVI. References 1. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005; 2: 536–543. 2. Jazet IM, Pijl H, Meinders AE. Adipose tissue as an endocrine organ: impact on insulin resistance. Neth J Med 2003; 61: 194–212. 3. Demircelik MB, Yilmaz OC, Gurel OM, Selcoki Y, Atar IA, Bozkurt A, et al. 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