Cut-off point of epicardial adipose tissue thickness for predicting metabolic syndrome in Venezuelan population | Endocrinología y Nutrición (English Edition)

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Lima-Martínez, Mariela Paoli, José H. Donis, Rodolfo Odreman, Christopher Torres, Gianluca Iacobellis" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Marcos M." "apellidos" => "Lima-Martínez" "email" => array:1 [ 0 => "marcoslimamedical@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mariela" "apellidos" => "Paoli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José H." "apellidos" => "Donis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Rodolfo" "apellidos" => "Odreman" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Christopher" "apellidos" => "Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Gianluca" "apellidos" => "Iacobellis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Departamento de Ciencias Fisiológicas, Escuela de Ciencias de la Salud, Universidad de Oriente, Núcleo Bolívar, Ciudad Bolívar, Venezuela" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Investigaciones Cardiovasculares, Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Instituto Venezolano de los Seguros Sociales, Hospital Dr. Hector Nouel Joubert, Ciudad Bolívar, Venezuela" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Division of Endocrinology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Punto de corte de espesor de tejido adiposo epicárdico para predecir síndrome metabólico en población venezolana" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1571 "Ancho" => 1039 "Tamanyo" => 103245 ] ] "descripcion" => array:1 [ "en" => "Receiver operating characteristic curve of epicardial adipose tissue thickness measured by echocardiography for predicting metabolic syndrome." ] ] ] "textoCompleto" => "IntroductionEpicardial adipose tissue (EAT) evolves from brown adipose tissue during embryogenesis, and in adult age tends to be located in the atrioventricular and interventricular grooves, extending toward the apex.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> There is no fascia of similar tissues separating epicardial fat from the myocardium and even from the coronary vessels, which suggests that a significant interaction exists between these structures.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>EAT has a number of biochemical properties that differentiate it from other visceral fat deposits. Such properties include a high rate of free fatty acid uptake and release, which is particularly important because the myocardium uses and metabolizes fatty acids through the β-oxidation process, which accounts for 50–70% of cardiac muscle energy.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> In addition, the expression of uncoupling protein 1 (UCP1) is greater in EAT as compared to other fat deposits, which suggests that this tissue may act to protect the myocardium and the coronary arteries from hypothermia.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> However, the property that confers the greatest clinical and scientific interest in EAT is its capacity to serve as a source of adipocytokines, which may diffuse into coronary arteries through a paracrine and vasocrine secretion mechanism with beneficial or harmful effects depending on the metabolic context of the patient.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The factors modulating the metabolic profile of EAT are currently unclear, but it has been postulated that a mechanism dependent on the mass of this tissue is the main regulator of its endocrine actions. This hypothesis has been supported by a meta-analysis including 2872 patients which showed that EAT thickness and volume were greater in subjects with coronary artery disease, and that patients in the highest EAT tertile were more prone to coronary artery disease as compared to those in the lowest tertile.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Similarly, a recent meta-analysis including 2027 subjects, of whom 1030 had metabolic syndrome (MS), showed that EAT thickness was significantly greater in patients with MS as compared to control subjects (standardized means difference of 1.15mm, 95% CI: 0.78–1.53; p=0.0001).<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Subgroup analysis showed that this difference was independent of the criteria used to define MS, but varied according to ethnic group.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> In this regard, Iacobellis et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> reported in a sample of 246 Caucasian subjects in Europe that EAT thickness ≥9.5mm in males and 7.5mm in females increased both the sensitivity and specificity for predicting MS. This finding emphasizes the importance of echocardiographic measurement of EAT as a marker of visceral adiposity and a diagnostic tool of increasing value for the stratification of cardiometabolic risk. However, because of racial differences in the distribution of visceral adipose tissue, EAT and its relationship to MS should be studied in each population. Thus, our purpose was to define a cut-off point of EAT thickness, as measured by echocardiography, associated with the anthropometric, clinical, and biochemical components of MS in Venezuelan subjects.Subjects and methodsStudy design and subjectsBased on the proposed objective, an observational, analytical, cross-sectional study was designed for which 52 consecutive subjects, 31 females and 21 males aged 20–65 years, were selected. The subjects had to meet at least three of the diagnostic criteria of MS according to the International Diabetes Federation (IDF)<a class="elsevierStyleCrossRef" href="#bib0040">8</a>: abdominal circumference (AC) ≥80cm in females and ≥90cm in males, blood pressure ≥130/80mmHg, fasting blood glucose ≥100mg/dL, plasma triglyceride levels ≥150mg/dL, and high density lipoprotein cholesterol (HDL-C) levels <50mg/dL in females and <40mg/dL in males. These subjects were compared to 45 controls, 29 females and 16 males, of similar ages with no MS. All study subjects were Venezuelan, 39 from Ciudad Bolívar, a town located in the south of the country, and 58 from Mérida, a town in the Venezuelan Andes. Subjects with primary hyperlipidemia and endocrine diseases such as diabetes mellitus, hypothyroidism, Cushing's syndrome, and acromegaly, as well as any comorbidity or who were using drugs (glucocorticoids, lipid lowering drugs, metformin, anticonvulsants, etc.) which could affect metabolic parameters were excluded from the study. The study was approved by the ethics committee of each institution and was conducted in compliance with the principles of the Declaration of Helsinki. All subjects gave their written consent to participation in the study.Anthropometric and clinical variablesWeight and height were measured under fasting conditions and with subjects in underwear. Body mass index (BMI) was calculated as weight divided into squared height. AC was measured in centimeters, with subjects standing, at the level of a midline between the lower margin of the last rib and the iliac crests. Blood pressure was measured in the right arm after the subject had been seated for 10min by the auscultatory method, using a standard mercury sphygmomanometer.Biochemical variablesA blood sample was drawn from the antecubital vein after subject fasting for at least 8h to measure blood glucose and lipids (total cholesterol, triglycerides, and HDL-C). Tests were performed by enzymatic methods using a Hitachi 911® autoanalyzer and Cienvar reagents. Low density lipoprotein cholesterol (LDL-C) was estimated using the Friedewald equation, where LDL-C=total cholesterol−[HDL-C+(triglycerides/5)].Echocardiographic variablesA two-dimensional (2D) transthoracic echocardiogram using Vivid 7® equipment (GE Healthcare, Wauwatosa, USA) by the standard procedure, with patients in left lateral decubitus was performed on each subject. An electrocardiogram was simultaneously recorded in all subjects. The procedure validated by Iacobellis et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> was used for EAT measurement. Echocardiograms were interpreted by a cardiologist experienced in echocardiography to guarantee the validity of the measurements.Echocardiographically, EAT was identified as the echolucent space between the external wall of the myocardium and the visceral layer of the pericardium. This thickness was measured perpendicularly on the free wall of the right ventricle at the end of systole in three cardiac cycles using a parasternal long or parasternal short axis view. The measurement was performed on the free wall of the right ventricle for two reasons: (a) this point is anatomically recognized as the one with the greatest epicardial fat thickness and (b) the parasternal long and parasternal short axes allow for more accurate measures of EAT on the right ventricle, with an optimum slide orientation in each view.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Left ventricular mass was similarly measured in the parasternal long axis using the anatomically validated formula of Devereux et al.,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> and was subsequently indexed with the patient's body surface area.Statistical analysisContinuous variables are given as mean±standard deviation, and categorical variables as absolute numbers and percentages. A Chi-square test was used to assess potential sex-related differences between the groups. In order to determine the difference in the means of continuous variables between subjects with and without MS, a Student's t test for independent data was applied to normally distributed variables, while a Mann–Whitney U test was used for non-normally distributed variables.To obtain the cut-off point of EAT thickness for predicting MS in this population, the receptor operating curve (ROC) curve was constructed, for which subjects were categorized into groups with and without MS. An area under the curve (AUC) of 1 was considered optimal, while an AUC less than 0.5 was considered to have very little validity, and the power of the test for this sample size was calculated. The Youden index was used to determine the optimum cut-off point from the ROC curve, calculated with the formula YI=(sensitivity+specificity)−1. The risk (odds ratio) of having MS was determined using the epicardial fat value obtained. SPSS version 15.0 for Windows and MedCalc software version 9.3.7.0 were used for statistical analyses. A value of p≤0.05 was considered statistically significant.Results<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the anthropometric and clinical data of the participants. The control group consisted of 45 subjects, 64.4% females and 35.6% males, with a mean age of 39.22±9.01 years and mean BMI of 24.98±3.98kg/m2. The study group consisted of 52 subjects, 59.6% females and 40.4% males, with a mean age of 40.31±10.52 years and mean BMI of 34.52±6.04kg/m2. There were no statistically significant differences in age, sex, and height between the groups, while weight, BMI, AC, and systolic (SBP) and diastolic blood pressure (DBP) were significantly higher (p=0.0001) in the MS group.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>When biochemical and echocardiographic variables were compared between the participants (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), the study group had, as expected, significantly higher values of fasting plasma blood glucose (p=0.0001), total cholesterol (p=0.002), LDL-C (p=0.007), non-HDL-C (p=0.0001), triglycerides (p=0.0001), and triglycerides/HDL-C ratio (p=0.0001), and lower HDL-C levels (p=0.0001) as compared to the control group. Similarly, EAT thickness (p=0.0001) and left ventricular mass (p=0.017) were significantly greater in the group of subjects with MS.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Analysis of the ROC curve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed an AUC of 0.852 (p=0.0001), which is an indication of the very high precision of the test. The power of the test for an error alpha of 0.05, a 95% confidence interval, and this sample consisting of 45 control subjects and 52 subjects with MS was 0.99. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the sensitivity and specificity of different EAT thickness values measured to predict MS. The cut-off value of 5mm obtained the highest Youden index, with 84.62% sensitivity (CI 95%: 71.9–93.1) and 71.11% specificity (95% CI: 55.7–83.6) for predicting MS in this population of Venezuelan males and females.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the distribution of subjects in the control and study groups by EAT thickness. Most patients with MS, 84.6% (44 patients), had thickness values ≥5mm, and most control subjects, 60% (27 subjects), had values <5mm. The risk (odds ratio) of MS occurrence in this population due to EAT thickness ≥5mm was 8.25, with a 95% CI of 3.15–21.56 and a value of p=0.0001.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThere are no prior studies in Venezuela defining the cut-off points of EAT thickness associated with the anthropometric, clinical, and biochemical changes of MS. The results of this study suggest that EAT thickness ≥5mm is associated with a risk of MS. This same cut-off value has previously been associated in another population with both morphological and functional cardiovascular changes including left atrial enlargement, increased left ventricular mass, diastolic dysfunction, and lower ejection fraction.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>Our results differ from those reported by Iacobellis et al.,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> who found in Caucasian subjects that EAT cut-off values of 9.5mm and 7.5mm increased the sensitivity and specificity for predicting MS in males and females respectively. These differences are consistent with the findings of Pierdomenico et al.,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> who showed that the difference in EAT thickness between subjects with and without MS varies depending on ethnic group, being significantly greater in Caucasian subjects, followed by Hispanic, Turkish, and Asian subjects. Alexopoulos et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> also found significant differences in epicardial fat volume quantified by computed tomography between Caucasian (96±44mL) and Hispanic subjects (54±17mL). The reasons for these differences are not known, but they may possibly be due to racial variability in the amount and distribution of visceral adipose tissue, as previously reported in some ethnic groups.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>Cabrera-Rego et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> recently found in a Cuban population that a cut-off value of epicardial fat ≥4.9mm had 85% sensitivity and 75% specificity for predicting insulin resistance (HOMA-IR index≥2.6). These results are similar to those found in our study, which may possibly be due to the fact that the Cuban and Venezuelan populations belong to the same ethnic group (Hispanic). It should be noted, however, that both studies are not fully comparable, because not all subjects with MS show insulin resistance. Moreover, Reaven<a class="elsevierStyleCrossRef" href="#bib0080">16</a> makes a marked contrast between the terms, in that insulin resistance is considered not as identifying a particular clinical diagnosis, but as representing the biochemical expression of a pathophysiological process that increases the risk of experiencing such diverse diseases as essential hypertension, polycystic ovary syndrome, obstructive sleep apnea, and even certain forms of cancer, while MS is considered as a diagnostic tool rather than as a pathophysiological concept, and serves to identify a group of individuals (some of them insulin-resistant) at high cardiovascular risk.The cut-off values of epicardial fat associated with other conditions have been defined. Thus, Ahn et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> showed that EAT thickness ≥3.0mm was independently associated with the presence of coronary artery disease in both Korean men and women, and Natale et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> similarly reported that EAT thickness ≥7.0mm was associated with the presence of subclinical atherosclerosis in both European men and women. Moreover, a lower EAT thickness (4.5mm) showed a good sensitivity and specificity for detecting a low coronary flow reserve in Turkish women,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> while EAT values ≥6.5mm predicted the occurrence of a hypertensive response in normotensive subjects undergoing a stress test in the same population.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>On the other hand, Iacobellis et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> have shown that obese subjects have greater left ventricular mass than normal subjects. This finding, also made in our study, is possibly due to an adaptive response of the left ventricle to diffuse fat deposition in subjects with MS. In addition, a significant correlation between EAT and left ventricular mass has been shown in subjects from Ciudad Bolívar.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Several mechanisms may explain this association, including the following: (a) excess EAT represents a load for the heart, which may lead to compensatory cardiac remodeling;<a class="elsevierStyleCrossRef" href="#bib0060">12</a> (b) an increase in EAT is associated with a greater myocardial lipid content, and thus with myocardial steatosis and lipotoxicity, which may cause adverse structural and functional adaptations, including cardiomyopathy;<a class="elsevierStyleCrossRefs" href="#bib0115">23,24</a> and (c) EAT may affect heart morphology through the local and systemic effects of the adipocytokines it synthesizes, because some of them are able to induce cardiac remodeling.<a class="elsevierStyleCrossRefs" href="#bib0010">2,25</a> Moreover, at the systemic level, EAT may induce insulin resistance, which could act as an intermediary between visceral fat and left ventricular hypertrophy through the direct mitogenic action of insulin on myocardial cells, the activation of the sympathetic nervous system, and the renin–angiotensin system.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>AC measurement is undoubtedly the most practical and inexpensive marker of visceral fat. However, this measurement may overestimate the individual risk in each subject because it includes subcutaneous adipose tissue, which is not associated with increased cardiometabolic risk,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> while echocardiographic EAT measurement is an objective, noninvasive measurement of a visceral fat deposit which has also been shown to reflect intra-abdominal visceral fat contents irrespective of the degree of obesity and age.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> EAT measurement has also been shown to be of value not only as a diagnostic tool, but also as a therapeutic target of different interventions,<a class="elsevierStyleCrossRefs" href="#bib0145">29–31</a> and since echocardiographic studies are routinely performed on subjects with cardiovascular risk, EAT may be measured at no additional cost because it requires no special preparation and can be done in the echocardiographic views (long parasternal or short parasternal) used to assess other traditional cardiac parameters.All echocardiographic EAT measurements in this study were performed by a single observer, but most studies have shown an excellent inter-observer agreement (range, 0.90–0.98), which suggests the good reproducibility and reliability of the procedure.<a class="elsevierStyleCrossRefs" href="#bib0035">7,18,32</a> Despite this, echocardiographic EAT measurement is only a linear measurement at a single location, and may therefore not reflect the total epicardial fat volume, which should be measured using other imaging techniques such as computed tomography or magnetic resonance imaging.In conclusion, the main contribution of this study is that it provides helpful tools for predicting MS in the Venezuelan population through the echocardiographic measurement of EAT. However, prospective studies that allow for assessing the occurrence of cardiovascular events in subjects with EAT ≥5mm are needed.Conflicts of interestThe authors state that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres311187" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec294339" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres311186" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Metodología" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec294340" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Subjects and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design and subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Anthropometric and clinical variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Biochemical variables" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Echocardiographic variables" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-12-30" "fechaAceptado" => "2013-03-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec294339" "palabras" => array:4 [ 0 => "Epicardial adipose tissue" 1 => "Epicardial fat" 2 => "Metabolic syndrome" 3 => "Hispanics" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec294340" "palabras" => array:4 [ 0 => "Tejido adiposo epicárdico" 1 => "Grasa epicárdica" 2 => "Síndrome metabólico" 3 => "Hispanos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo define an echocardiographically assessed cut-off point for epicardial adipose tissue (EAT) thickness associated to metabolic syndrome (MS) components in Venezuelan subjects. MethodsFifty-two subjects aged 20–65 years diagnosed with MS according to International Diabetes Federation criteria and 45 sex- and age-matched controls were selected. Blood glucose and plasma lipids were tested; EAT thickness and left ventricular mass were measured by echocardiography. ResultsNo significant age and sex differences were found between the two groups. Body weight, body mass index, waist circumference, and systolic and diastolic blood pressure were significantly higher (p=0.0001) in the MS group. This group showed significantly higher levels of fasting blood glucose (p=0.0001), total cholesterol (p=0.002), LDL-C (p=0.007), non-HDL-C (p=0.0001), triglycerides (p=0.0001), Tg-HDL-C ratio (p=0.0001), and lower HDL-C levels (p=0.0001) as compared to the control group. EAT thickness (p=0.0001) and left ventricular mass (p=0.017) were significantly higher in the MS group. The ROC curve showed an AUC of 0.852 (p=0.0001) with a power of the test of 0.99. A 5-mm EAT thickness showed a sensitivity of 84.62% (95% CI: 71.9–93.1) and a specificity of 71.11% (95% CI: 55.7–83.6) for predicting MS. The odds ratio of this population for experiencing MS due to an EAT ≥5mm was 8.25 (95% CI: 3.15–21.56; p=0.0001). ConclusionAn EAT value ≥5mm has good sensitivity and specificity for predicting MS in the Venezuelan population." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoDefinir un punto de corte de espesor de tejido adiposo epicárdico (TAE) medido por ecocardiografía asociado con los componentes del síndrome metabólico (SM) en sujetos venezolanos. MetodologíaSe seleccionaron 52sujetos de entre 20 y 65años con diagnóstico de SM según la Federación Internacional de Diabetes y 45controles, comparables en edad y sexo. Se midieron glucemia y lípidos plasmáticos. Se determinaron el espesor del TAE y la masa del ventrículo izquierdo mediante ecocardiografía. ResultadosNo hubo diferencias significativas en edad y sexo entre ambos grupos, y el peso, el índice de masa corporal, la circunferencia abdominal, la presión arterial sistólica y la diastólica fueron significativamente más altos (p=0,0001) en el grupo con SM. Este grupo presentó niveles significativamente más altos de glucemia en ayunas (p=0,0001), colesterol total (p=0,002), c-LDL (p=0,007), c-noHDL (p=0,0001), triglicéridos (p=0,0001), cociente triglicéridos/c-HDL (p=0,0001) y más bajos de c-HDL (p=0,0001) que el grupo control. El espesor del TAE (p=0,0001) y la masa del ventrículo izquierdo (p=0,017) fueron significativamente mayores en el grupo con SM. La curva operador receptor (COR) demostró un AUC de 0,852 (p=0,0001), con un poder del test de 0,99. El valor de 5mm de TAE mostró una sensibilidad del 84,62% (IC 95%: 71,9–93,1) y una especificidad del 71,11% (IC 95%: 55,7–83,6) para predecir SM. La odds ratio de presentar SM en esta población por tener un espesor de TAE ≥5mm fue de 8,25 (IC 95%: 3,15–21,56; p=0,0001). ConclusiónUn valor de TAE ≥5mm presenta una buena sensibilidad y especificidad para predecir SM en población venezolana." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Lima-Martínez MM, Paoli M, Donis JH, Odreman R, Torres C, Iacobellis G. Punto de corte de espesor de tejido adiposo epicárdico para predecir síndrome metabólico en población venezolana. Endocrinol Nutr. 2013;60:570–576." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1571 "Ancho" => 1039 "Tamanyo" => 103245 ] ] "descripcion" => array:1 [ "en" => "Receiver operating characteristic curve of epicardial adipose tissue thickness measured by echocardiography for predicting metabolic syndrome." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AC, abdominal circumference; BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic blood pressure.Continuous variables are given as X±SD, and categorical variables as n (%)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Control group n=45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Study group n=52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.22±9.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.31±10.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.585 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex: male/female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (64.4)/16 (35.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (59.6)/21 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.679 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.27±12.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.24±19.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Height (m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.64±0.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.64±0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.887 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.98±3.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.52±6.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AC (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.79±12.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">103.77±13.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">112.22±8.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">134.81±17.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.44±7.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.65±10.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab457216.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Anthropometric and clinical variables of the control and study (patients with metabolic syndrome) groups." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; Tg, triglycerides; LV, left ventricle.Continuous variables are given as X±SD." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Control group n=45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Study group n=52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood glucose (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.84±8.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.98±13.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total cholesterol (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">170.44±24.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">193.50±44.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL-C (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.27±12.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.79±8.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL-C (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.24±21.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113.96±40.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-HDL-C (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">118.17±24.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">149.71±41.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triglycerides (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">108.27±46.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">184.60±85.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tg/HDL-C ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.20±1.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.29±2.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epicardial fat (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.31±1.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.81±2.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LV mass (g/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.16±16.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.45±30.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab457218.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Biochemical and echocardiographic variables of the control and study (patients with metabolic syndrome) groups." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Data are percentages (95% CI)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EAT thickness (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Specificity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Youden index \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (93.2–100.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.78 (8.0–32.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.178 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.15 (86.8– 99.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.11 (35.8–66.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.473 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.62 (71.9–93.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.11 (55.7–83.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.557 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.85 (39.5–67.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.11 (78.8–97.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.450 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.92 (15.6–41.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.78 (88.2–99.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.247 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.46 (5.6–25.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (92.1–100.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.135 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab457217.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity and specificity of different values of epicardial adipose tissue (EAT) thickness measured by echocardiography for predicting metabolic syndrome based on analysis of the receiver operating curve." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Data are n (%)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Control group n=45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Study group n=52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Odds ratio: 8.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EAT thickness <5mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (60.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95% CI: 3.15–21.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EAT thickness ≥5mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (40.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (84.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p=0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab457215.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of subjects in the control and study groups by epicardial adipose tissue (EAT) thickness." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epicardial adipose tissue: anatomical, biomolecular and clinical relation to the heart" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. 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Cut-off point of epicardial adipose tissue thickness for predicting metabolic syndrome in Venezuelan population

Punto de corte de espesor de tejido adiposo epicárdico para predecir síndrome metabólico en población venezolana

Marcos M. Lima-Martíneza,

Corresponding author

marcoslimamedical@hotmail.com

Corresponding author.

, Mariela Paolib, José H. Donisc, Rodolfo Odremanc, Christopher Torresd, Gianluca Iacobellise

a Departamento de Ciencias Fisiológicas, Escuela de Ciencias de la Salud, Universidad de Oriente, Núcleo Bolívar, Ciudad Bolívar, Venezuela

b Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela

c Instituto de Investigaciones Cardiovasculares, Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela

d Instituto Venezolano de los Seguros Sociales, Hospital Dr. Hector Nouel Joubert, Ciudad Bolívar, Venezuela

e Division of Endocrinology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Epicardial adipose tissue &#40;EAT&#41; evolves from brown adipose tissue during embryogenesis&#44; and in adult age tends to be located in the atrioventricular and interventricular grooves&#44; extending toward the apex&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There is no fascia of similar tissues separating epicardial fat from the myocardium and even from the coronary vessels&#44; which suggests that a significant interaction exists between these structures&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">EAT has a number of biochemical properties that differentiate it from other visceral fat deposits&#46; Such properties include a high rate of free fatty acid uptake and release&#44; which is particularly important because the myocardium uses and metabolizes fatty acids through the &#946;-oxidation process&#44; which accounts for 50&#8211;70&#37; of cardiac muscle energy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In addition&#44; the expression of uncoupling protein 1 &#40;UCP1&#41; is greater in EAT as compared to other fat deposits&#44; which suggests that this tissue may act to protect the myocardium and the coronary arteries from hypothermia&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; the property that confers the greatest clinical and scientific interest in EAT is its capacity to serve as a source of adipocytokines&#44; which may diffuse into coronary arteries through a paracrine and vasocrine secretion mechanism with beneficial or harmful effects depending on the metabolic context of the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The factors modulating the metabolic profile of EAT are currently unclear&#44; but it has been postulated that a mechanism dependent on the mass of this tissue is the main regulator of its endocrine actions&#46; This hypothesis has been supported by a meta-analysis including 2872 patients which showed that EAT thickness and volume were greater in subjects with coronary artery disease&#44; and that patients in the highest EAT tertile were more prone to coronary artery disease as compared to those in the lowest tertile&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Similarly&#44; a recent meta-analysis including 2027 subjects&#44; of whom 1030 had metabolic syndrome &#40;MS&#41;&#44; showed that EAT thickness was significantly greater in patients with MS as compared to control subjects &#40;standardized means difference of 1&#46;15<span class="elsevierStyleHsp" style=""></span>mm&#44; 95&#37; CI&#58; 0&#46;78&#8211;1&#46;53&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Subgroup analysis showed that this difference was independent of the criteria used to define MS&#44; but varied according to ethnic group&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In this regard&#44; Iacobellis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reported in a sample of 246 Caucasian subjects in Europe that EAT thickness &#8805;9&#46;5<span class="elsevierStyleHsp" style=""></span>mm in males and 7&#46;5<span class="elsevierStyleHsp" style=""></span>mm in females increased both the sensitivity and specificity for predicting MS&#46; This finding emphasizes the importance of echocardiographic measurement of EAT as a marker of visceral adiposity and a diagnostic tool of increasing value for the stratification of cardiometabolic risk&#46; However&#44; because of racial differences in the distribution of visceral adipose tissue&#44; EAT and its relationship to MS should be studied in each population&#46; Thus&#44; our purpose was to define a cut-off point of EAT thickness&#44; as measured by echocardiography&#44; associated with the anthropometric&#44; clinical&#44; and biochemical components of MS in Venezuelan subjects&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design and subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the proposed objective&#44; an observational&#44; analytical&#44; cross-sectional study was designed for which 52 consecutive subjects&#44; 31 females and 21 males aged 20&#8211;65 years&#44; were selected&#46; The subjects had to meet at least three of the diagnostic criteria of MS according to the International Diabetes Federation &#40;IDF&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#58; abdominal circumference &#40;AC&#41; &#8805;80<span class="elsevierStyleHsp" style=""></span>cm in females and &#8805;90<span class="elsevierStyleHsp" style=""></span>cm in males&#44; blood pressure &#8805;130&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg&#44; fasting blood glucose &#8805;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; plasma triglyceride levels &#8805;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and high density lipoprotein cholesterol &#40;HDL-C&#41; levels &#60;50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in females and &#60;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in males&#46; These subjects were compared to 45 controls&#44; 29 females and 16 males&#44; of similar ages with no MS&#46; All study subjects were Venezuelan&#44; 39 from Ciudad Bol&#237;var&#44; a town located in the south of the country&#44; and 58 from M&#233;rida&#44; a town in the Venezuelan Andes&#46; Subjects with primary hyperlipidemia and endocrine diseases such as diabetes mellitus&#44; hypothyroidism&#44; Cushing&#39;s syndrome&#44; and acromegaly&#44; as well as any comorbidity or who were using drugs &#40;glucocorticoids&#44; lipid lowering drugs&#44; metformin&#44; anticonvulsants&#44; etc&#46;&#41; which could affect metabolic parameters were excluded from the study&#46; The study was approved by the ethics committee of each institution and was conducted in compliance with the principles of the Declaration of Helsinki&#46; All subjects gave their written consent to participation in the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Anthropometric and clinical variables</span><p id="par0030" class="elsevierStylePara elsevierViewall">Weight and height were measured under fasting conditions and with subjects in underwear&#46; Body mass index &#40;BMI&#41; was calculated as weight divided into squared height&#46; AC was measured in centimeters&#44; with subjects standing&#44; at the level of a midline between the lower margin of the last rib and the iliac crests&#46; Blood pressure was measured in the right arm after the subject had been seated for 10<span class="elsevierStyleHsp" style=""></span>min by the auscultatory method&#44; using a standard mercury sphygmomanometer&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Biochemical variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">A blood sample was drawn from the antecubital vein after subject fasting for at least 8<span class="elsevierStyleHsp" style=""></span>h to measure blood glucose and lipids &#40;total cholesterol&#44; triglycerides&#44; and HDL-C&#41;&#46; Tests were performed by enzymatic methods using a Hitachi 911<span class="elsevierStyleSup">&#174;</span> autoanalyzer and Cienvar reagents&#46; Low density lipoprotein cholesterol &#40;LDL-C&#41; was estimated using the Friedewald equation&#44; where LDL-C<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>total cholesterol<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#91;HDL-C<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;triglycerides&#47;5&#41;&#93;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Echocardiographic variables</span><p id="par0040" class="elsevierStylePara elsevierViewall">A two-dimensional &#40;2D&#41; transthoracic echocardiogram using Vivid 7<span class="elsevierStyleSup">&#174;</span> equipment &#40;GE Healthcare&#44; Wauwatosa&#44; USA&#41; by the standard procedure&#44; with patients in left lateral decubitus was performed on each subject&#46; An electrocardiogram was simultaneously recorded in all subjects&#46; The procedure validated by Iacobellis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> was used for EAT measurement&#46; Echocardiograms were interpreted by a cardiologist experienced in echocardiography to guarantee the validity of the measurements&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Echocardiographically&#44; EAT was identified as the echolucent space between the external wall of the myocardium and the visceral layer of the pericardium&#46; This thickness was measured perpendicularly on the free wall of the right ventricle at the end of systole in three cardiac cycles using a parasternal long or parasternal short axis view&#46; The measurement was performed on the free wall of the right ventricle for two reasons&#58; &#40;a&#41; this point is anatomically recognized as the one with the greatest epicardial fat thickness and &#40;b&#41; the parasternal long and parasternal short axes allow for more accurate measures of EAT on the right ventricle&#44; with an optimum slide orientation in each view&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Left ventricular mass was similarly measured in the parasternal long axis using the anatomically validated formula of Devereux et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and was subsequently indexed with the patient&#39;s body surface area&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Continuous variables are given as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; and categorical variables as absolute numbers and percentages&#46; A Chi-square test was used to assess potential sex-related differences between the groups&#46; In order to determine the difference in the means of continuous variables between subjects with and without MS&#44; a Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent data was applied to normally distributed variables&#44; while a Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for non-normally distributed variables&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">To obtain the cut-off point of EAT thickness for predicting MS in this population&#44; the receptor operating curve &#40;ROC&#41; curve was constructed&#44; for which subjects were categorized into groups with and without MS&#46; An area under the curve &#40;AUC&#41; of 1 was considered optimal&#44; while an AUC less than 0&#46;5 was considered to have very little validity&#44; and the power of the test for this sample size was calculated&#46; The Youden index was used to determine the optimum cut-off point from the ROC curve&#44; calculated with the formula YI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;sensitivity<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>specificity&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>1&#46; The risk &#40;odds ratio&#41; of having MS was determined using the epicardial fat value obtained&#46; SPSS version 15&#46;0 for Windows and MedCalc software version 9&#46;3&#46;7&#46;0 were used for statistical analyses&#46; A value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the anthropometric and clinical data of the participants&#46; 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sex&#44; and height between the groups&#44; while weight&#44; BMI&#44; AC&#44; and systolic &#40;SBP&#41; and diastolic blood pressure &#40;DBP&#41; were significantly higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; in the MS group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">When biochemical and echocardiographic variables were compared between the participants &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; the study group had&#44; as expected&#44; significantly higher values of fasting plasma blood glucose &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; total cholesterol &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; LDL-C &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#44; non-HDL-C &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; triglycerides &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; and triglycerides&#47;HDL-C ratio &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; and lower HDL-C levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; as compared to the control group&#46; Similarly&#44; EAT thickness &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and left ventricular mass &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41; were significantly greater in the group of subjects with MS&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Analysis of the ROC curve &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; showed an AUC of 0&#46;852 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; which is an indication of the very high precision of the test&#46; The power of the test for an error alpha of 0&#46;05&#44; a 95&#37; confidence interval&#44; and this sample consisting of 45 control subjects and 52 subjects with MS was 0&#46;99&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the sensitivity and specificity of different EAT thickness values measured to predict MS&#46; The cut-off value of 5<span class="elsevierStyleHsp" style=""></span>mm obtained the highest Youden index&#44; with 84&#46;62&#37; sensitivity &#40;CI 95&#37;&#58; 71&#46;9&#8211;93&#46;1&#41; and 71&#46;11&#37; specificity &#40;95&#37; CI&#58; 55&#46;7&#8211;83&#46;6&#41; for predicting MS in this population of Venezuelan males and females&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the distribution of subjects in the control and study groups by EAT thickness&#46; Most patients with MS&#44; 84&#46;6&#37; &#40;44 patients&#41;&#44; had thickness values &#8805;5<span class="elsevierStyleHsp" style=""></span>mm&#44; and most control subjects&#44; 60&#37; &#40;27 subjects&#41;&#44; had values &#60;5<span class="elsevierStyleHsp" style=""></span>mm&#46; The risk &#40;odds ratio&#41; of MS occurrence in this population due to EAT thickness &#8805;5<span class="elsevierStyleHsp" style=""></span>mm was 8&#46;25&#44; with a 95&#37; CI of 3&#46;15&#8211;21&#46;56 and a value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">There are no prior studies in Venezuela defining the cut-off points of EAT thickness associated with the anthropometric&#44; clinical&#44; and biochemical changes of MS&#46; The results of this study suggest that EAT thickness &#8805;5<span class="elsevierStyleHsp" style=""></span>mm is associated with a risk of MS&#46; This same cut-off value has previously been associated in another population with both morphological and functional cardiovascular changes including left atrial enlargement&#44; increased left ventricular mass&#44; diastolic dysfunction&#44; and lower ejection fraction&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Our results differ from those reported by Iacobellis et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> who found in Caucasian subjects that EAT cut-off values of 9&#46;5<span class="elsevierStyleHsp" style=""></span>mm and 7&#46;5<span class="elsevierStyleHsp" style=""></span>mm increased the sensitivity and specificity for predicting MS in males and females respectively&#46; These differences are consistent with the findings of Pierdomenico et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> who showed that the difference in EAT thickness between subjects with and without MS varies depending on ethnic group&#44; being significantly greater in Caucasian subjects&#44; followed by Hispanic&#44; Turkish&#44; and Asian subjects&#46; Alexopoulos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> also found significant differences in epicardial fat volume quantified by computed tomography between Caucasian &#40;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>44<span class="elsevierStyleHsp" style=""></span>mL&#41; and Hispanic subjects &#40;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>mL&#41;&#46; The reasons for these differences are not known&#44; but they may possibly be due to racial variability in the amount and distribution of visceral adipose tissue&#44; as previously reported in some ethnic groups&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Cabrera-Rego et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> recently found in a Cuban population that a cut-off value of epicardial fat &#8805;4&#46;9<span class="elsevierStyleHsp" style=""></span>mm had 85&#37; sensitivity and 75&#37; specificity for predicting insulin resistance &#40;HOMA-IR index<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&#46;6&#41;&#46; These results are similar to those found in our study&#44; which may possibly be due to the fact that the Cuban and Venezuelan populations belong to the same ethnic group &#40;Hispanic&#41;&#46; It should be noted&#44; however&#44; that both studies are not fully comparable&#44; because not all subjects with MS show insulin resistance&#46; Moreover&#44; Reaven<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> makes a marked contrast between the terms&#44; in that insulin resistance is considered not as identifying a particular clinical diagnosis&#44; but as representing the biochemical expression of a pathophysiological process that increases the risk of experiencing such diverse diseases as essential hypertension&#44; polycystic ovary syndrome&#44; obstructive sleep apnea&#44; and even certain forms of cancer&#44; while MS is considered as a diagnostic tool rather than as a pathophysiological concept&#44; and serves to identify a group of individuals &#40;some of them insulin-resistant&#41; at high cardiovascular risk&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The cut-off values of epicardial fat associated with other conditions have been defined&#46; Thus&#44; Ahn et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> showed that EAT thickness &#8805;3&#46;0<span class="elsevierStyleHsp" style=""></span>mm was independently associated with the presence of coronary artery disease in both Korean men and women&#44; and Natale et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> similarly reported that EAT thickness &#8805;7&#46;0<span class="elsevierStyleHsp" style=""></span>mm was associated with the presence of subclinical atherosclerosis in both European men and women&#46; Moreover&#44; a lower EAT thickness &#40;4&#46;5<span class="elsevierStyleHsp" style=""></span>mm&#41; showed a good sensitivity and specificity for detecting a low coronary flow reserve in Turkish women&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> while EAT values &#8805;6&#46;5<span class="elsevierStyleHsp" style=""></span>mm predicted the occurrence of a hypertensive response in normotensive subjects undergoing a stress test in the same population&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">On the other hand&#44; Iacobellis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> have shown that obese subjects have greater left ventricular mass than normal subjects&#46; This finding&#44; also made in our study&#44; is possibly due to an adaptive response of the left ventricle to diffuse fat deposition in subjects with MS&#46; In addition&#44; a significant correlation between EAT and left ventricular mass has been shown in subjects from Ciudad Bol&#237;var&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Several mechanisms may explain this association&#44; including the following&#58; &#40;a&#41; excess EAT represents a load for the heart&#44; which may lead to compensatory cardiac remodeling&#59;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;b&#41; an increase in EAT is associated with a greater myocardial lipid content&#44; and thus with myocardial steatosis and lipotoxicity&#44; which may cause adverse structural and functional adaptations&#44; including cardiomyopathy&#59;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> and &#40;c&#41; EAT may affect heart morphology through the local and systemic effects of the adipocytokines it synthesizes&#44; because some of them are able to induce cardiac remodeling&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;25</span></a> Moreover&#44; at the systemic level&#44; EAT may induce insulin resistance&#44; which could act as an intermediary between visceral fat and left ventricular hypertrophy through the direct mitogenic action of insulin on myocardial cells&#44; the activation of the sympathetic nervous system&#44; and the renin&#8211;angiotensin system&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">AC measurement is undoubtedly the most practical and inexpensive marker of visceral fat&#46; However&#44; this measurement may overestimate the individual risk in each subject because it includes subcutaneous adipose tissue&#44; which is not associated with increased cardiometabolic risk&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> while echocardiographic EAT measurement is an objective&#44; noninvasive measurement of a visceral fat deposit which has also been shown to reflect intra-abdominal visceral fat contents irrespective of the degree of obesity and age&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> EAT measurement has also been shown to be of value not only as a diagnostic tool&#44; but also as a therapeutic target of different interventions&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#8211;31</span></a> and since echocardiographic studies are routinely performed on subjects with cardiovascular risk&#44; EAT may be measured at no additional cost because it requires no special preparation and can be done in the echocardiographic views &#40;long parasternal or short parasternal&#41; used to assess other traditional cardiac parameters&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">All echocardiographic EAT measurements in this study were performed by a single observer&#44; but most studies have shown an excellent inter-observer agreement &#40;range&#44; 0&#46;90&#8211;0&#46;98&#41;&#44; which suggests the good reproducibility and reliability of the procedure&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;18&#44;32</span></a> Despite this&#44; echocardiographic EAT measurement is only a linear measurement at a single location&#44; and may therefore not reflect the total epicardial fat volume&#44; which should be measured using other imaging techniques such as computed tomography or magnetic resonance imaging&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion&#44; the main contribution of this study is that it provides helpful tools for predicting MS in the Venezuelan population through the echocardiographic measurement of EAT&#46; However&#44; prospective studies that allow for assessing the occurrence of cardiovascular events in subjects with EAT &#8805;5<span class="elsevierStyleHsp" style=""></span>mm are needed&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors state that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Anthropometric and clinical variables"
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              "titulo" => "Biochemical variables"
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              "titulo" => "Echocardiographic variables"
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    "fechaRecibido" => "2012-12-30"
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          "clase" => "keyword"
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            0 => "Epicardial adipose tissue"
            1 => "Epicardial fat"
            2 => "Metabolic syndrome"
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          "palabras" => array:4 [
            0 => "Tejido adiposo epic&#225;rdico"
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            2 => "S&#237;ndrome metab&#243;lico"
            3 => "Hispanos"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To define an echocardiographically assessed cut-off point for epicardial adipose tissue &#40;EAT&#41; thickness associated to metabolic syndrome &#40;MS&#41; components in Venezuelan subjects&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fifty-two subjects aged 20&#8211;65 years diagnosed with MS according to International Diabetes Federation criteria and 45 sex- and age-matched controls were selected&#46; Blood glucose and plasma lipids were tested&#59; EAT thickness and left ventricular mass were measured by echocardiography&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No significant age and sex differences were found between the two groups&#46; Body weight&#44; body mass index&#44; waist circumference&#44; and systolic and diastolic blood pressure were significantly higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; in the MS group&#46; This group showed significantly higher levels of fasting blood glucose &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; total cholesterol &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#44; LDL-C &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#44; non-HDL-C &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; triglycerides &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; Tg-HDL-C ratio &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; and lower HDL-C levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; as compared to the control group&#46; EAT thickness &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and left ventricular mass &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41; were significantly higher in the MS group&#46; The ROC curve showed an AUC of 0&#46;852 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; with a power of the test of 0&#46;99&#46; A 5-mm EAT thickness showed a sensitivity of 84&#46;62&#37; &#40;95&#37; CI&#58; 71&#46;9&#8211;93&#46;1&#41; and a specificity of 71&#46;11&#37; &#40;95&#37; CI&#58; 55&#46;7&#8211;83&#46;6&#41; for predicting MS&#46; The odds ratio of this population for experiencing MS due to an EAT &#8805;5<span class="elsevierStyleHsp" style=""></span>mm was 8&#46;25 &#40;95&#37; CI&#58; 3&#46;15&#8211;21&#46;56&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An EAT value &#8805;5<span class="elsevierStyleHsp" style=""></span>mm has good sensitivity and specificity for predicting MS in the Venezuelan population&#46;</p>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Definir un punto de corte de espesor de tejido adiposo epic&#225;rdico &#40;TAE&#41; medido por ecocardiograf&#237;a asociado con los componentes del s&#237;ndrome metab&#243;lico &#40;SM&#41; en sujetos venezolanos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron 52<span class="elsevierStyleHsp" style=""></span>sujetos de entre 20 y 65<span class="elsevierStyleHsp" style=""></span>a&#241;os con diagn&#243;stico de SM seg&#250;n la Federaci&#243;n Internacional de Diabetes y 45<span class="elsevierStyleHsp" style=""></span>controles&#44; comparables en edad y sexo&#46; Se midieron glucemia y l&#237;pidos plasm&#225;ticos&#46; Se determinaron el espesor del TAE y la masa del ventr&#237;culo izquierdo mediante ecocardiograf&#237;a&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No hubo diferencias significativas en edad y sexo entre ambos grupos&#44; y el peso&#44; el &#237;ndice de masa corporal&#44; la circunferencia abdominal&#44; la presi&#243;n arterial sist&#243;lica y la diast&#243;lica fueron significativamente m&#225;s altos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; en el grupo con SM&#46; Este grupo present&#243; niveles significativamente m&#225;s altos de glucemia en ayunas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; colesterol total &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; c-LDL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#44; c-noHDL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; triglic&#233;ridos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; cociente triglic&#233;ridos&#47;c-HDL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y m&#225;s bajos de c-HDL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; que el grupo control&#46; El espesor del TAE &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y la masa del ventr&#237;culo izquierdo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; fueron significativamente mayores en el grupo con SM&#46; La curva operador receptor &#40;COR&#41; demostr&#243; un AUC de 0&#44;852 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; con un poder del test de 0&#44;99&#46; El valor de 5<span class="elsevierStyleHsp" style=""></span>mm de TAE mostr&#243; una sensibilidad del 84&#44;62&#37; &#40;IC 95&#37;&#58; 71&#44;9&#8211;93&#44;1&#41; y una especificidad del 71&#44;11&#37; &#40;IC 95&#37;&#58; 55&#44;7&#8211;83&#44;6&#41; para predecir SM&#46; La odds ratio de presentar SM en esta poblaci&#243;n por tener un espesor de TAE &#8805;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm fue de 8&#44;25 &#40;IC 95&#37;&#58; 3&#44;15&#8211;21&#44;56&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Un valor de TAE &#8805;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm presenta una buena sensibilidad y especificidad para predecir SM en poblaci&#243;n venezolana&#46;</p>"
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                  \t\t\t\t">39&#46;22<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>9&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;585&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;64&#46;4&#41;&#47;16 &#40;35&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;59&#46;6&#41;&#47;21 &#40;40&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;679&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">67&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">34&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">80&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">112&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">83&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">88&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">170&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">193&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>44&#46;21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">LDL-C &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113&#46;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-HDL-C &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">118&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triglycerides &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>46&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>85&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tg&#47;HDL-C ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epicardial fat &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LV mass &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab457218.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Biochemical and echocardiographic variables of the control and study &#40;patients with metabolic syndrome&#41; groups&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Data are percentages &#40;95&#37; CI&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">EAT thickness &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Specificity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Youden index&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;93&#46;2&#8211;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;78 &#40;8&#46;0&#8211;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#46;15 &#40;86&#46;8&#8211; 99&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;11 &#40;35&#46;8&#8211;66&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;62 &#40;71&#46;9&#8211;93&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;11 &#40;55&#46;7&#8211;83&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;557&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;85 &#40;39&#46;5&#8211;67&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;11 &#40;78&#46;8&#8211;97&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;450&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;92 &#40;15&#46;6&#8211;41&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;78 &#40;88&#46;2&#8211;99&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;247&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;46 &#40;5&#46;6&#8211;25&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;92&#46;1&#8211;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab457217.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Sensitivity and specificity of different values of epicardial adipose tissue &#40;EAT&#41; thickness measured by echocardiography for predicting metabolic syndrome based on analysis of the receiver operating curve&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Data are n &#40;&#37;&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Control group n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Study group n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Odds ratio&#58; 8&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EAT thickness &#60;5<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 21735093
Original language: English

DOI:10.1016/j.endoen.2013.12.007

The statistics are updated each day

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2017 August	16	5	21
2017 July	10	4	14
2017 June	18	4	22
2017 May	24	5	29
2017 April	16	8	24
2017 March	18	1	19
2017 February	32	5	37
2017 January	13	1	14
2016 December	17	7	24
2016 November	16	8	24
2016 October	23	7	30
2016 September	19	3	22
2016 August	19	1	20
2016 July	18	3	21
2016 June	12	7	19
2016 May	12	4	16
2016 April	17	7	24
2016 March	23	8	31
2016 February	18	7	25
2016 January	17	9	26
2015 December	8	9	17
2015 November	20	6	26
2014 October	2	0	2

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Now is Endocrinología, Diabetes y Nutrición (English ed.). More information

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Now is Endocrinología, Diabetes y Nutrición (English ed.). More information

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