Different Imaging Modalities in Quantification of Epicardial Adipose Tissue Thickness

We read with great interest the article entitled “Increased Epicardial Adipose Tissue Thickness as a Predictor for Hypertension: A Cross-Sectional Observational Study” by Dicker and colleagues.1 They showed that hypertensive patients have significantly higher-than-normal epicardial adipose tissue thickness (EAT). The authors concluded that epicardial adipose tissue thickness may serve as a risk indicator for hypertension and cardiovascular morbidity. EAT is an emerging cardiometabolic risk factor and can be measured using echocardiography. EAT measurement with echocardiography has several advantages such as its low cost, easy accessibility, and good reproducibility. A positive relationship has been established between EAT and cardiovascular risk factors. Echocardiographic EAT assessment is independently associated with hypertension and obesity.2 Newly identified inflammatory markers are considered to reflect major risk factors predisposing patients to cardiovascular morbidity and mortality. EAT and neutrophil to lymphocyte ratio are highly associated with types of nonvalvular atrial fibrillation independent of traditional risk factors.3 EAT was strongly correlated with waist circumference and carotid intima-media thickness in patients with type 2 diabetes mellitus.4 Recently, EAT has begun to be evaluated by using cardiac computed tomography in several studies.5, 6 However, computed tomography has some disadvantages, including radiation exposition and high cost, which make it less practical for routine use. We strongly believe that the findings obtained in the current study will lead to further studies examining EAT using cardiac computed tomography. It would have been even more beneficial if the authors evaluated epicardial fat thickness using echocardiography to examine whether there is a correlation between computed tomographic and echocardiographic measurements. Therefore, EAT should be assessed with two methods in patients with cardiovascular risk factors in future studies. There are no conflicts of interest associated with this study.