Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBCzqtHq9jXpxHT3kYXmDGNFxMS0066-782X201600450060710.5935/abc.20160185Letter to the EditorThe Relation between Epicardial Fat Thickness and Prognostic Risk ScoresBaltaSevketOzturkCengizCelikTurgayGulhane Medical AcademyDepartment of CardiologyAnkaraTurkeyDepartment of Cardiology, Gulhane Medical Academy, Ankara, TurkeyMaling Address: Sevket Balta, Gulhane Medical Faculty, Ankara, Turkey. E-mail: drsevketb@gmail.com1220161076607607220420161508201615082016This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.KeywordsAcute Coronary Syndrome / complicationsAdipose TissuePericardiumEchocardiographyScore GRACE
Dear Editor,
We read the article "The Relationship between GRACE Score and Epicardial Fat Thickness(EFT) in non-STEMI Patients" by Gul et al.1 The authors concluded that end-systolic and end-diastolic EFTs were found to be increased in the higher GRACE group.
Several risk scores including have been evaluated so as to identify high/low risk of mortality or complications in patients with STEMI. These methods have been extensively evaluated for the follow-up of short or long term events.2 However, some studies showed that the GRACE risk score had low predictive accuracy for mortality. On the other hand, other studies showed that the GRACE risk score had the highest prognostic accuracy for long-term mortality.2 For this challenge, these risk scores may not give accurate information about high/low risk of mortality or complications in patients with STEMI. So, several risk scores should be evaluated when assessing the relation between any of the risk scores and high/low risk of mortality or complications in patients with STEMI.
Furthermore, epicardial tissue as a endocrine organ releases a lot of markers that may be related to oxidative stress, inflammation, endothelial dysfunction and atherosclerosis. Epicardial adiposity can also be associated with cardiovascular mobidity and mortality.3 Furthermore, EFT is also associated with hyperlipidemia, obesity, diabetes, hypertension, smoking, and carotid atherosclerosis, as well as with cardiovascular risk factors like metabolic syndrome, nonalcoholic fatty liver disease, and chronic kidney disease.(4 )Moreover, some endocrin tissue dysfunction like thyroid issue is associated with EFT. Furthermore, some inflammatory diseases like psoriasis have higher EFT values and EFT may be a possible marker of endothelial dysfunction and increased cardiovascular risk in patients with psoriasis5
GRACE risk score may give about mortality or complications in patients with STEMI, but both use the risk scores or inflammatory markers. We believe that these findings will evaluate further studies about EFT and GRACE risk score in STEMI patients.
References1 Gul I, Zungur M, Aykan AC, Gokdeniz T, Kalaycioglu E, Turan T, et al. The relationship between GRACE score and epicardial fat thickness in non-STEMI patients. Arq Bras Cardiol. 2016;106(3):194-200.GulIZungurMAykanACGokdenizTKalayciogluETuranTThe relationship between GRACE score and epicardial fat thickness in non-STEMI patientsArq Bras Cardiol201610631942002 Littnerova S, Kala P, Jarkovsky J, Kubkova L, Prymusova K, Kubena P, et al. GRACE Score among Six Risk Scoring Systems (CADILLAC, PAMI, TIMI, Dynamic TIMI, Zwolle) demonstrated the best predictive value for prediction of long-term mortality in patients with ST-elevation myocardial infarction. PLoS One. 2015;10(4):e0123215.LittnerovaSKalaPJarkovskyJKubkovaLPrymusovaKKubenaPGRACE Score among Six Risk Scoring Systems (CADILLAC, PAMI, TIMI, Dynamic TIMI, Zwolle) demonstrated the best predictive value for prediction of long-term mortality in patients with ST-elevation myocardial infarctionPLoS One2015104e01232153 Balta S, Demirkol S, Kucuk U, Unlu M, Dinc M, Arslan Z. Epicardial fat thickness and cardio-ankle vascular index without other inflammatory markers may not provide information to clinicians about the systemic inflammation. Cardiology. 2013;125(1):13-4.BaltaSDemirkolSKucukUUnluMDincMArslanZEpicardial fat thickness and cardio-ankle vascular index without other inflammatory markers may not provide information to clinicians about the systemic inflammationCardiology2013125113144 Balta S, Demirkol S, Arslan Z, Unlu M, Kucuk U, Iyisoy A. Epicardial fat thickness should be evaluated with other inflammatory markers and cardiovascular risk factors. Echocardiography. 2013;30(6):739.BaltaSDemirkolSArslanZUnluMKucukUIyisoyAEpicardial fat thickness should be evaluated with other inflammatory markers and cardiovascular risk factorsEchocardiography20133067397395 Balta I, Balta S, Ozturk C, Demirkol S, Demir M. Epicardial fat thickness in psoriasis patients. Dermatology. 2014;228(2):132-3.BaltaIBaltaSOzturkCDemirkolSDemirMEpicardial fat thickness in psoriasis patientsDermatology20142282132133Carta ao EditorA Relação entre a Espessura da Gordura Epicárdica e os Escores de Risco PrognósticosBaltaSevketOzturkCengizCelikTurgayDepartment of Cardiology, Gulhane Medical Academy, Ankara, TurkeyCorrespondência: Sevket Balta, Gulhane Medical Faculty, Ankara, Turkey. E-mail: drsevketb@gmail.comPalavras-chaveSíndrome Coronariana Aguda / complicaçõesTecido AdiposoPericárdioEcocardiografiaEscore de GRACE
Caro Editor,
Lemos o artigo "A Relação entre o Escore GRACE e a Espessura da Gordura Epicárdica (EGE) em Pacientes sem IAMCST", por Gul et al.1 Os autores concluíram que EGEs sistólicas finais e diastólicas finais foram determinadas aumentadas no grupo GRACE superior.
Diversos escores de riscos foram avaliados, de modo a identificar altos/baixos riscos de mortalidade ou complicações em pacientes com IAMCST. Estes métodos foram extensamente avaliados para o acompanhamento de eventos de curto ou longo prazo.2 Entretanto, alguns estudos mostraram que o escore de risco GRACE teve baixa exatidão preditiva para mortalidade. Por outro lado, outros estudos mostraram que o escore de risco GRACE teve a exatidão prognóstica mais alta para mortalidade em longo prazo.2 Para este desafio, estes escores de risco podem não fornecer informações precisas sobre altos/baixos riscos de mortalidade ou complicações em pacientes com IAMCST. Assim, diversos escores de risco devem ser avaliados ao calcular a relação entre quaisquer escores de risco e altos/baixos riscos de mortalidade ou complicações em pacientes com IAMCST.
Adicionalmente, o tecido epicárdico como órgão endócrino libera muitos marcadores que podem estar relacionados ao estresse oxidativo, a inflamação, a disfunção endotelial e a aterosclerose. A adiposidade epicárdica também pode estar associada à morbidez e mortalidade cardiovascular.3 Além disto, a EGE também está associada à hiperlipidemia, a obesidade, diabetes, hipertensão, tabagismo e aterosclerose carotídea, bem como com fatores de risco cardiovasculares, como síndrome metabólica, doença hepática gordurosa não alcoólica, e doença renal crônica.4 Ademais, algumas disfunções do tecido endócrino, como problema de tireoide, estão associadas à EGE. Além disto, algumas doenças inflamatórias, como a psoríase, possuem valores de EGE mais altos, e a EGE pode ser um possível marcador de disfunção endotelial e risco cardiovascular aumentado em pacientes com psoríase.5
O escore de risco GRACE pode fornecer informações sobre mortalidade ou complicações em pacientes com IAMCST, porém, ambas usam os escores de risco ou marcadores inflamatórios. Acreditamos que estes achados avaliarão estudos adicionais sobre a EGE e o escore de risco GRACE em pacientes com IAMCST.