Letter to the Editor
Epicardial fatty tissue in association with adipocytokines as prognostic factors of cardiovascular disease in patients with advanced chronic kidney desease and hemodialysis
Tejido graso epicárdico en asociación con adipocitocinas como factores pronósticos de enfermedad cardiovascular en pacientes con enfermedad renal crónica avanzada y hemodiálisis
Lucía Pimentel-Ramos
, Fernan Molina
Corresponding author
Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Ica, Perú
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"Lucía Pimentel-Ramos, Fernan Molina" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Lucía" "apellidos" => "Pimentel-Ramos" "email" => array:1 [ 0 => "luciadelosangeles05@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Fernan" "apellidos" => "Molina" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Ica, Perú" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tejido graso epicárdico en asociación con adipocitocinas como factores pronósticos de enfermedad cardiovascular en pacientes con enfermedad renal crónica avanzada y hemodiálisis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the article by Cano Megías et al., which set out to ascertain whether epicardial adipose tissues (EAT) and mediastinal tissue are related to increased mortality and cardiovascular events in patients with advanced chronic kidney disease and on haemodialysis. They reported that a greater thickness of these adipose tissues is related to increased mortality and that measuring epicardial and mediastinal fatty tissue by synchronised multi-helical computed tomography could be regarded as a cardiovascular prognostic tool in patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">They highlighted, as the strengths of this study, the use of new technologies, such as synchronised multi-helical computed tomography, which permits the indirect and non-invasive measurement of the accumulation of these adipose tissues in the heart, and established a relationship with the risk of cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However, in our opinion, the weak points of the study were the fact that it is single-centre and <span class="elsevierStyleItalic">post hoc</span>, whereby the results should be regarded as preliminary and cause-effect relationships cannot be established.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Moreover, the study sample size is small, namely 104 patients.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Within the biochemical parameters, it would be important to quantify dysfunctional adipose tissue markers, such as leptin and adiponectin, associated with cardiometabolic risk factors, since other studies have demonstrated that both adipocytokines, measured in serum and in epicardial fatty tissue, increase the risk of cardiovascular events and arterial calcification.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Furthermore, other studies have found that the adiponectin-leptin ratio could be regarded as a biomarker for determining the severity and the extent of coronary diseases, and there are even reports that leptin alone would be a serum marker with better predictive capacity.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Epicardial adipose tissue is regarded as an organ with an active metabolic function since it secretes different cytokines that modify cardiac morphology and function. These cytokines, in pathological conditions, play a pro-inflammatory and pro-atherogenic role and are considered to be a risk factor for coronary diseases, inflammation of the myocardium and left ventricular hypertrophy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Since the main cause of death in patients with chronic kidney disease on haemodialysis is cardiovascular disease, it would be interesting to establish prognostic factors to reduce mortality, since there are no specific guidelines established in regard with the thickness of adipose epicardial tissue and the early detection of these conditions in this group of patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no potential conflicts of interest with this letter to the editor.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tejido graso epicárdico, calcificación arterial coronaria y mortalidad en pacientes con enfermedad renal crónica avanzada y hemodiálisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. 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