Rheumatology International

, Volume 39, Issue 7, pp 1191–1200 | Cite as

Epicardial adipose tissue thickness in systemic sclerosis patients without overt cardiac disease

  • Duygu Temiz KaradagEmail author
  • Tayfun Sahin
  • Senem Tekeoglu
  • Ozlem Ozdemir Isik
  • Ayten Yazici
  • Ayse Cefle
Observational Research


Systemic sclerosis is associated with an increased prevalence/incidence of coronary artery disease. The aim of this study was to investigate epicardial adipose tissue (EAT) thickness which may contribute to cardio-metabolic risk in systemic sclerosis (SSc) patients without overt cardiac disease. EAT thickness was measured by transthoracic conventional Doppler echocardiography and compared in SSc patients (n = 47) and age- and sex-matched healthy controls (n = 36). The relationships between EAT thickness and markers of cardio-metabolic risk in SSc were examined. EAT thickness was significantly greater in patients with SSc compared to healthy controls (6 [7–5] vs 5 [6.75–3.25], p = 0.041). Compared to controls, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocyte, neutrophil, B-type natriuretic protein (BNP), fasting plasma insulin and HOMA-IR were elevated (18 [31–10] vs 8.5 [18–4], p < 0.001; 0.4 [0.67–0.18] vs 0.21 [0.48–0.09], p = 0.012; 7510 [8731–5990] vs 6435 [7360–5195], p = 0.002; 4350 [5440–3570] vs 3390 [4168–2903], p < 0.001; 111 [185–74] vs 70 [127–70], p = 0.010; 6.7 [10.5–4.7] vs 4.7 [6.8–4.1], p = 0.008; 1.7 [2.6–1] vs 1.1 [1.7–0.9], p = 0.015, respectively). The total and low-density lipoprotein (LDL)-cholesterol were decreased in SSc patients (197 ± 45 vs 284 ± 36, p = 0.005; 118 [148–84] vs 140 [180–115], p = 0.003, respectively). In patients with SSc, the EAT thickness correlated positively with age, ESR, CRP, insulin, hemoglobin A1c and total and LDL-cholesterol (r = 0.574, p < 0.001; r = 0.352, p = 0.015; r = 0.334, p = 0.022; r = 0.290, p = 0.048; r = 0.317, p = 0.030; r = 0.396, p = 0.006 and r = 0.349, p = 0.016, respectively). Our study confirms that EAT thickness is greater in SSc patients compared to healthy controls using echocardiographic measurements. The results of our study suggest that EAT thickness is a candidate for atherosclerotic risk assessment in SSc.


Cardiovascular disease Echocardiography Epicardial adipose tissue thickness Systemic sclerosis 



The authors are grateful to Mr. Jeremy Jones of the Academic Writing Department of Kocaeli University, Izmit, Turkey, for his assistance in editing the English used and for his help and advice concerning the contents of this manuscript.

Author contributions

The authors certify that they take responsibility for the entire work, and they agree that any questions related to the work in the future are appropriately and fully investigated. DTK acquired the clinical data, contributed to the design of the work, performed all the statistical analysis and drafted the manuscript. TS acquired the echocardiography data, data interpretation and revised the work for important intellectual content. ST, OOI, and AY contributed to data interpretation and critical revision of the data and the manuscript AC coordinated the study, data interpretation and contributed to the revision of the data and the drafting of the manuscript.


This study had no financial support.

Compliance with ethical standards

Conflict of interest

None of the authors has financial or non-financial conflicts of interest to disclose.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by Kocaeli University School of Medicine Ethics Committee for noninvasive clinical trials with protocol number 178 in 16th June 2015 (KOU KAEK 2015/178). The data of this study were derived during a previous study entitled “Evaluation of the ventricular dysfunction by two-dimensional speckle tracking echocardiography in SSc patients without pulmonary hypertension”.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicineKocaeli University School of MedicineUmuttepe-İzmitTurkey
  2. 2.Division of CardiologyKocaeli University School of MedicineUmuttepe-İzmitTurkey

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