MON-692 - Visceral Adiposity Index Predicts Epicardial Fat Thickness in Metabolic Syndrome

Background: Epicardial adipose tissue is a visceral fat depot associated with cardiometabolic risk, yet echocardiography is not universally available. The visceral adiposity index (VAI), derived from waist circumference, body mass index, triglycerides, and HDL cholesterol, is an accessible estimate of visceral adiposity dysfunction.

Objective: To assess the association between VAI and epicardial fat thickness (EFT) in adults with metabolic syndrome.

Methods: Cross-sectional study of 53 adults with metabolic syndrome defined by International Diabetes Federation criteria, recruited from outpatient internal medicine care. Screening identified 99 candidates; 28 were excluded for incomplete laboratory or echocardiographic evaluation and 18 for exclusion criteria (renal failure, thyroid disease, hepatic insufficiency, malignancy, cardiovascular or cerebrovascular events in the prior 6 months, and alcohol/drug abuse), yielding 53 participants for analysis. Mean age was 58.09±12.80 years and 64.2% were women; diabetes was present in 77.4%, hypertension in 69.8%, and dyslipidemia in 69.8%. Fasting (12-hour) blood samples were obtained for glucose and lipid profile; LDL cholesterol was estimated by the Friedewald formula when triglycerides were < 400 mg/dL and directly measured otherwise. VAI was calculated using the validated sex-specific formula. EFT (mm) was measured by transthoracic 2D echocardiography as the echo-free space between the outer myocardial wall and the visceral pericardium at the right ventricular free wall at end-systole, averaging three cardiac cycles from the parasternal view. Measurements were performed by two echocardiographers blinded to study objectives. Normality was assessed with Kolmogorov–Smirnov. The association between VAI and EFT was evaluated using Spearman correlation. Multiple linear regression assessed independent predictors of EFT including age, height, waist circumference, fasting glucose, HDL cholesterol, triglycerides, and VAI; internal validation was performed using bootstrap resampling (1,000 iterations).

Results: VAI correlated positively with EFT (Spearman ρ=0.603; p< 0.001; n=53). In multivariable regression, VAI remained the only independent predictor of EFT (B=0.165 mm per 1-unit increase; 95% CI 0.056–0.274; p=0.004). The overall model was statistically significant (F(7,44)=5.408; p< 0.001) and explained 46.2% of EFT variability (R²=0.462; adjusted R²=0.377; standard error of estimate=0.754 mm). A parsimonious equation was derived: EFT=3.898+0.165×VAI.

Conclusions: In adults with metabolic syndrome, higher VAI is independently associated with greater epicardial fat thickness. VAI may provide a practical, non-invasive approach to estimate epicardial adiposity in settings without echocardiography, supporting cardiometabolic risk stratification. External validation is warranted.

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