Objective:Carotid intima-media thickness (CIMT) is reliable marker of subclinical atherosclerosis and cardiovascular events. Until today, there was no study that investigated whether epicardial adipose tissue (EAT), which is a surrogate for lipid depot in a special visceral tissue or circulating lipids, is more important for CIMT and atherosclerotic plaque.Methods:Our study, having cross-sectional and prospective observational design, included 252 patients who were admitted to our outpatient clinic. EAT identified as an echo-free space under the pericardial layer on 2-dimensional echocardiography, was measured perpendicularly in front of the right ventricular free wall at end-systole.Results:EAT significantly correlated with CIMT (r=0.623, p<0.001). CIMT was significantly increased with rising EAT thickness (0.72±0.15 mm, 0.85±0.16 mm, and 0.95±0.12 mm in patients with EAT <5 mm, 5–7, and >7 mm, p<0.001, respectively). Multiple linear regression analysis revealed that age (Beta: 0.406, p<0.001), male gender (Beta: 0.244, p<0.001), and EAT (Beta: 0.450, p<0.001) as independent correlates of CIMT. Otherwise, in logistic regression analysis, only EAT (OR, 1.386; 95% CI, 1.203–1.597, p<0.001) and LDL cholesterol (OR, 1.013; 95% CI, 1.002–1.013, p=0.02) were independent predictors for presence of carotid plaque.Conclusion:Our study showed that EAT has a relationship with both CIMT and the presence of carotid plaque, but LDL is independently related to the plaque. This finding suggests that EAT thickness may be a risk factor and biomarker, playing an important role beginning from early stages of atherosclerosis, unlike LDL cholesterol, which appear to have a role in later stages of atherosclerosis.

Echocardiography has the long development history beginning with amplitude imaging. Nowadays, two- and three- dimensional imaging are standard tools available in almost every echocardiography machine. Myocardial deformation imaging is gaining popularity out of research projects. The future will bring new and sophisticated tools for echocardiographic analysis such intracardiac flow imaging and an automated 3D volume calculation.

Left and right atria have gained interest from scientific community. Two or three-dimensional echocardiographic methods have been implemented for better understanding of atrial functions in both healthy persons and patients with various diseases. Atrial volume could be calculated from 2D or 3D images. Volumetric data and derived parameters could be used for determining atrial phasic functions. Nowadays, atrial deformation imaging with 2D-TDI, 2D-speckle tracking imaging or with recently introduced 3D speckle tracking is possible. All those methods have some advantages and disadvantages, which define their clinical value in the future.

Prosthetic valve obstruction due to pannus formation can be a life-threatening complication. We showed that real time three dimensional echocardiography has incremental value in diagnosing pannus localization and extent.

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