title: Relation of epicardial fat thickness to subclinical right ventricular dysfunction assessed by strain and strain rate imaging in subjects with metabolic syndrome: a two-dimensional speckle tracking echocardiography study.
abstract: BACKGROUND
  Right ventricular (RV) function is known to be impaired in the presence of metabolic syndrome (MetS). Epicardial adipose tissue is a metabolically active organ that generates various bioactive molecules, which might affect cardiac function and morphology. Thus, we hypothesized that RV dysfunction in patients with MetS may be related to increased epicardial fat thickness (EFT) in these patients. In patients with MetS, we aimed to assess the relation of EFT with RV function using two-dimensional speckle tracking echocardiography (2DSTE)-derived strain and strain rate imaging.
  
  
  METHODS
  The study involved 76 subjects with MetS and 61 subjects without MetS. Biventricular structure and function together with EFT were evaluated by conventional echocardiography. RV free and septal walls strain (RVFW-S & RVSW-S), systolic and early diastolic strain rates (RVSRs & RVSRe) were evaluated by 2DSTE.
  
  
  RESULTS
  Epicardial fat thickness was significantly higher in subjects with MetS (6.45 ± 1.48 mm vs. 5.49 ± 1.05 mm, P < 0.001). RVFW-S (-22.95 ± 4.97% vs. -24.96 ± 3.63%; P = 0.007), RVSRs (1.53 ± 0.33/sec vs. -1.70 ± 0.33/sec; P = 0.002), and RVSRe (1.40 ± 0.44/sec vs. 1.75 ± 0.49/sec; P < 0.001) were all lower in subjects with MetS, while RVSW-S did not differ. Multiple regression analysis showed that EFT was independently associated with RVFW-S (β = -0.547, P < 0.001), RVSRs (β = -0.332, P = 0.001), and RVSRe (β = -0.187, P = 0.019) in subjects with MetS.
  
  
  CONCLUSIONS
  Metabolic syndrome is associated with subclinical RV systolic and diastolic dysfunction. In subjects with MetS, increased EFT is independently related to RV systolic and diastolic dysfunction.
authors.affiliation: Department of Cardiology, Kafkas University Medical School, Kars, Turkey.
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Ezgi
authors.initials: E
authors.lastname: Kalaycıoğlu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Çağrı Aykan
authors.forename: İlker
authors.initials: İ
authors.lastname: Gül
authors.forename: Faruk
authors.initials: F
authors.lastname: Boyacı
authors.forename: Burak
authors.initials: B
authors.lastname: Turan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkan
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging*
keywords: epicardial fat thickness; metabolic syndrome; right ventricle; strain imaging; two-dimensional speckle tracking