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OBJECTIVE: The metabolic syndrome involves both metabolic and cardiovascular risk factors and is associated with cardiovascular mortality. Epicardial fat tissue plays a crucial role in deleterious effects of metabolic syndrome on the heart, including myocardial fibrosis. The fragmented QRS reflects heterogeneous depolarization of the myocardium and occurs as a result of fibrosis. Thus, we aimed to investigate whether there is an association between fragmented QRS and epicardial fat tissue in patients with metabolic syndrome. METHODS: This study enrolled 140 metabolic syndrome patients, of whom 35 patients with fragmented QRS (+) and 105 patients with fragmented QRS (-). The two groups were compared with respect to clinical, laboratory, electrocardiographic, and echocardiographic indexes. RESULTS: Fragmented QRS (+) patients had higher waist circumference, red cell distribution width, creatinine, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, QRS duration, and epicardial fat tissue compared with fragmented QRS (-) patients. Waist circumference, red cell distribution width, QRS duration, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, and epicardial fat tissue were significantly associated with the presence of fragmented QRS. The QRS duration and epicardial fat tissue were independently associated with the presence of fragmented QRS on surface electrocardiographic in metabolic syndrome patients. CONCLUSIONS: Epicardial fat tissue and QRS duration were independently associated with the presence of fragmented QRS. Basic echocardiographic and electrocardiographic parameters might be used for the risk stratification in metabolic syndrome patients.

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OBJECTIVE: Fragmented QRS (fQRS) has been shown to be related to coronary heart disease, heart failure, hypertension, cardiac arrhythmia, and metabolic syndrome. Although fQRS in lateral leads is shown to be associated with a poor outcome in patients with a known cardiac disease, the knowledge about the significance and prevalence of fQRS in inferior leads is scarce. This study aimed to investigate the prevalence and predictors of fQRS in inferior leads in healthy young men. METHODS: A total of 1,155 men underwent electrocardiography (ECG), hepatic ultrasonography, and routine biochemical tests. A total of 210 eligible men with fQRS in inferior leads (group 1) and 770 eligible men without fQRS in inferior leads (group 2) were compared with each other in terms of clinical, demographic, and laboratory parameters. RESULTS: The prevalence of fQRS in inferior leads was found to 21.4%. Body mass index (BMI), systolic blood pressure (BP), creatinine, and alanine aminotransferase levels; non-alcoholic fatty liver disease (NAFLD) percentage; and interventricular septum thickness (IVST) were significantly greater in group 1 than those in group 2. BMI, IVST, NAFLD, creatinine, ALT, and systolic BP were entered in a model of multiple regression analyses to predict fQRS, a dependent variable. NAFLD was the best independent predictor of fQRS (ß=6.115, p=0.001). BMI (ß=1.448, p=0.014) and IVST (ß=1.058, p=0.029) were the other independent predictors of fQRS in inferior leads. CONCLUSION: This study demonstrated the association of fQRS in inferior leads with NAFLD, BMI, and IVST in young men.

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SUMMARY OBJECTIVE: The metabolic syndrome involves both metabolic and cardiovascular risk factors and is associated with cardiovascular mortality. Epicardial fat tissue plays a crucial role in deleterious effects of metabolic syndrome on the heart, including myocardial fibrosis. The fragmented QRS reflects heterogeneous depolarization of the myocardium and occurs as a result of fibrosis. Thus, we aimed to investigate whether there is an association between fragmented QRS and epicardial fat tissue in patients with metabolic syndrome. METHODS: This study enrolled 140 metabolic syndrome patients, of whom 35 patients with fragmented QRS (+) and 105 patients with fragmented QRS (−). The two groups were compared with respect to clinical, laboratory, electrocardiographic, and echocardiographic indexes. RESULTS: Fragmented QRS (+) patients had higher waist circumference, red cell distribution width, creatinine, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, QRS duration, and epicardial fat tissue compared with fragmented QRS (−) patients. Waist circumference, red cell distribution width, QRS duration, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, and epicardial fat tissue were significantly associated with the presence of fragmented QRS. The QRS duration and epicardial fat tissue were independently associated with the presence of fragmented QRS on surface electrocardiographic in metabolic syndrome patients. CONCLUSIONS: Epicardial fat tissue and QRS duration were independently associated with the presence of fragmented QRS. Basic echocardiographic and electrocardiographic parameters might be used for the risk stratification in metabolic syndrome patients.

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OBJECTIVE: Hyperbilirubinemia is associated with protection against various oxidative stress-mediated diseases. We aimed to investigate the association between bilirubin and novel electrocardiography (ECG)-based ventricular repolarization parameters. METHODS: We enrolled 201 healthy men with mild hyperbilirubinemia (group 1) and 219 healthy men with normal bilirubin levels (group 2). The Tpeak-Tend (Tp-e) interval (defined as the interval from the peak of the T wave to the end of the T wave), corrected (c) Tp-e interval, QT interval, cQT interval, and Tp-e interval/QT interval ratio were measured from leads V5 and V6 with 20 mm/mV amplitude and 50 mm/second rate. RESULTS: The Tp-e interval, cTp-e interval, and Tp-e interval/QT interval ratio were significantly lower in group 1 compared with group 2. The cTp-e interval showed a significant negative correlation with total bilirubin, conjugated bilirubin, and unconjugated bilirubin. The cTp-e interval (odds ratio [OR], 0.900; P =.002) and Tp-e interval/QT interval ratio (OR, 0.922; P =.04) were significantly associated with mild hyperbilirubinemia. CONCLUSION: We showed the association of mild hyperbilirubinemia with decreased novel ECG-based ventricular repolarization parameters.

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BACKGROUND: T-wave inversion in lead III was linked to displacement of the base of the heart due to abdominal adipose tissue in early electrocardiography (ECG) trials. The observation of T-wave inversion in lead III in some of the pathological and physiological conditions other than obesity suggests the possibilities of different mechanisms. We aimed to investigate the prevalence and correlates of T-wave inversion in lead III in non-obese men. METHOD: A total of 1240 men underwent ECG, blood pressure measurement, hepatic ultrasonography, and biochemical tests from January 2019 to December 2019. We excluded 220 subjects due to predetermined criteria. The eligible 105 non-obese men with T-wave inversion in lead III and 915 non-obese men without T-wave inversion in lead III were compared with each other in terms of clinical, demographic and laboratory parameters. RESULTS: The mean age was 27.9 years with a range of 20 to 46 years. The prevalence of T-wave inversion in lead III was 10.3%. Body mass index (BMI), blood urea nitrogen, creatinine, alanine aminotransferase, hematocrit, and the percentage of non-alcoholic fatty liver disease (NAFLD) were significantly higher in Group with T-wave inversion while alkaline phosphatase was significantly higher in Group without T-wave inversion. In multivariable analysis, NAFLD was the best independent correlate of inverted T-wave in lead III (ß = 6.215, p < 0.0001). BMI (ß = 1.448, p < 0.001) and hematocrit (ß = 1.179, p = 0.021) were the other independent correlates of T-wave inversion in lead III. CONCLUSION: We demonstrated the association of T-wave inversion in lead III with NAFLD, BMI, and hematocrit in non-obese men.

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OBJECTIVES: The aim was to investigate the microbiological characteristics and complications of infective endocarditis (IE) in 119 patients treated in our center for IE, diagnosed by modified Duke criteria. STUDY DESIGN: The archive records of 119 patients (82 [69%] males; 37 [31%] females; mean age 39 ± 16 years) with a definite diagnosis of IE between January 1997 and November 2004 were systematically reviewed for clinical and microbiological properties and complications. RESULTS: The most common complaint of the patients was fever and malaise (102 patients, 85.7%, each). Culture was negative in 68 patients (57.1%), while Staphylococcus aureus was the most common etiological agent in culture positive cases. The aortic valve was the most common region of vegetation (43 patients, 36.1%). The frequency of surgical operation for valvular insufficiency due to IE was 75.6%, and the frequency of congestive heart failure was 53.8% (64 patients). CONCLUSION: IE is still an important disease considering its high morbidity and mortality rates, increased life expectancy of the patients, and increased number of valve replacement procedures.

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INTRODUCTION: The formation and collapse of vapor-filled bubbles near a mechanical heart valve is called cavitation. Microbubbles can be detected in vivo by doppler ultrasonography (USG) as HITS (high intensity transient signals) in cranial circulation. We investigated the relationship between exercise induced heart rate increase and HITS formation in cranial circulation. MATERIAL AND METHODS: Thirty-nine mechanical heart valve implanted (8 aortic valve replacement (AVR) + mitral valve replacement (MVR), 9 AVR, 22 MVR) patients aged 18-80 years old were included in our study. Microbubbles were counted in the left ventricular cavity via transthoracic echocardiography at rest per cardiac cycle. Afterwards transcranial Doppler USG was performed and HITS were counted in each patient's middle cerebral artery at 5 min duration. Subsequently an exercise test according to the Bruce protocol was performed. After achieving maximal heart rate, microbubbles in the left ventricle and HITS were counted again. RESULTS: Microbubbles in the left ventricle and transcranial HITS increased after exercise significantly compared to resting values (15.79 ±10.91 microbubbles/beat vs. 26.51 ±18.00 microbubbles/beat, p < 0.001; 6.13 ±8.07 HITS/5 min vs. 13.15 ±15.87 HITS/5 min, p = 0.001). There was a significant correlation between microbubbles and HITS counts after peak exercise (r = 0.55, p < 0.001). CONCLUSIONS: In our study, we found that the microbubbles were increasing as the heart rate increased and more HITS were propelled to the cerebral circulation. As previously shown, HITS can alter cognitive functions. Therefore heart rate control is essential in mechanical heart valve patients to protect neurocognitive functions.

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BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has been considered as a benign disease often associated with central obesity and insulin resistance and, in general, with factors of the metabolic syndrome. Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate the heart rate recovery index in patients with NAFLD. MATERIAL AND METHODS: The study population included 59 patients with NAFLD (mean age=42.3±9.3 years) and 22 healthy subjects as controls (mean age=40.7±6.5 years). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed on all patients and controls. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate at the 1st minute (HRR1), 2nd minute (HRR2), 3rd minute (HRR3), and 5th minute (HRR5) after stopping exercise stress testing. RESULTS: There were significant differences in HRR1 and HRR2 indices between patients with ED and the control group (19.9±8.2 vs. 34.1±9.6; p<0.001 and 24.3±5.4 vs. 40.5±9.1; p=0.006, respectively). Similarly, HRR indices after the 3rd and 5th minutes of the recovery period were significantly lower in patients with NAFLD compared with those indices in the control group (32.3±8.5 vs. 58.4±6.5; p=0.001 and 58±18.2 vs. 75.1±15.8; p<0.001). Effort capacity was markedly lower (11±1.9 vs. 12.5±1.5 METs; p=0.001) among the patients with NAFLD. CONCLUSIONS: The heart rate recovery index is deteriorated in patients with NAFLD. When the prognostic significance of the heart rate recovery index is considered, these results may help explain the increased occurrence of cardiac death. It points to the importance of the heart rate recovery index in the identification of high-risk patients.

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BACKGROUND: SYNTAX score (SXscore) has been developed to assess the severity and complexity of coronary artery disease. The aim of this study was to evaluate whether baseline SXscore was associated with contrast induced nephropathy (CIN) after primary percutaneous coronary intervention (p-PCI) in patients with ST-elevation myocardial infarction (STEMI). Secondarily we aimed to investigate the relation of the severity of CIN to long term prognosis. METHODS: We retrospectively enrolled 1893 patients with STEMI treated by p-PCI. We prospectively followed up the patients for a mean duration of 45 months. The patients were grouped according to the development of no nephropathy (grade 0, n: 1634), mild nephropathy (grade 1, n: 153) or severe nephropathy (grade 2, n: 106). RESULTS: SXscore was significantly higher (19.4±5.9 vs 15.6±4.8, p<0.001) in patients with CIN (grades 1 and 2) compared to those without CIN. SXscore was higher in patients with grade 2 CIN compared to those with grade 1 CIN (18.5±5.7 vs 20.7±5.9, p<0.001). In the multivariate analysis, SXscore was identified as an independent predictor of CIN (for one unit increment, OR: 1.06, 95% CI: 1.01-1.14, p=0.006). At long-term follow-up, death (p<0.001), stroke (p=0.006), reinfarction (p=0.024) and permanent HD requirement (p<0.001) were most frequent in grade 2 nephropathy group. HD was associated with very high in-hospital (60%) and long-term (83.3%) mortality rates. CONCLUSIONS: SXscore is an independent predictor of development and severity of CIN after p-PCI. CIN is associated with poor prognosis during both early and late postinfarction period.

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OBJECTIVE: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. METHODS: Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload. RESULTS: Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p=0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p<0.001), indeterminate axis (OR-0.11, 95% CI 0.02-0.44, p=0.001 0.11), incomplete right bundle branch block (OR-4.2, 95% CI, 1.1-15.4, p=0.02), late R in aVR (OR-8.4, 95% CI 2.1-33.2, p=0.001), qR in V1 lead (OR-8.3, 95% CI 1.2-74.8, p=0.03) were found to be the independent predictors of chronic RV pressure overload. CONCLUSION: Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload.

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Visceral fat tissue is an important predictor of cardio-metabolic diseases, carrying more risk than general fat accumulation. Epicardial fat, a particular form of visceral fat deposited around the heart, is considered an important cardiovascular risk predictor, in view of producing and releasing several adipo-cytokines. There is growing evidence about the physiological and metabolic importance of epicardial fat. Epicardial fat thickness and volume have both strong correlation between obesity, impaired fasting glucose, insulin resistance, metabolic syndrome, hypertension, diabetes mellitus, and atherosclerosis. Epicardial fat can be assessed by transthoracic echocardiography, cardiac magnetic resonance imaging, and computed tomography. In this article, we reviewed the anatomy, physiology, function, and the methods of assessment of epicardial fat tissue. We also have tried to discuss its relationship to metabolic syndrome and coronary atherosclerosis in the lights of recent findings.

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BACKGROUND: Some recent trials reported that, low admission low-density lipoprotein-cholesterol (LDL-C) levels were associated with increased mortality in patients with acute coronary syndromes. We aimed to compare the effect of very low admission LDL-C levels on prognosis in statin-pretreated and statin-naive patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. METHODS: The study population consisted of 1808 patients with acute STEMIs who underwent primary angioplasty. The patients were categorized into four groups as: statin-pretreated/LDL-C<70 mg/dl (n=128), statin-pretreated/LDL-C ≥ 70 mg/dl (n=290), statin-naive/LDL-C <70 mg/dl (n=146), statin-naive/LDL-C ≥ 70 mg/dl (n=1244). The median follow-up was 40 months. RESULTS: The incidences of diabetes mellitus, hypertension, renal insufficiency, anemia, cardiogenic shock on presentation and the mean age were significantly higher in the statin-naive/LDL-C < 70 mg/dl group. In-hospital (2.3% vs 2.4% vs 12.3% vs 3.9%, respectively p<0.001) and long-term mortalities (6.3% vs 7.3% vs 25.9% vs 11.3% respectively, p<0.001) were significantly lower in the "statin-pretreated/LDL-C<70" group. Statin pretreatment was independently predicting lower long-term mortality irrespective of LDL-C level [for the subgroup with LDL-C < 70 mg/dl, Hazard Ratio (HR) 0.24, 95% CI 0.10-0.59, p=0.013; for the subgroup with LDL-C ≥ 70 mg/dl, HR 0.31, 95% CI 0.14-0.83, p=0.022]. LDL-C levels on admission had no independent predictive role on long-term mortality. CONCLUSIONS: Statin induced low LDL-C levels on admission are associated with better short- and long-term outcomes in patients with STEMI and independently predict lower long-term mortality. However, spontaneously low admission LDL-C levels were associated with increased short- and long-term mortalities.

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Drug eluting stents are being used frequently because of their less restenotic properties. However, their effect on preventing neo-intimal hyperplasia may cause many adverse effects such as coronary artery aneurysm (CAA). We report a case that presented with a CAA which was the latest developed CAA after the implantation of drug eluting stents in literature so far. A 57-year-old male presented with dyspnea and typical angina on effort. Coronary angiography was performed. A large CAA was detected at the site of a drug eluting stent which was implanted in the LAD artery 5.5 years ago. It was treated with a coronary stent graft successfully.

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BACKGROUND: Atrial electromechanical delay (EMD) parameters predict the development of atrial fibrillation. We investigated the effect of telmisartan treatment on atrial EMD parameters in patients with newly diagnosed essential hypertension. METHODS: Thirty-six patients with essential hypertension were treated with telmisartan (80 mg/day) for 6 months. Baseline electrocardiographic P-wave measurements and echocardiographic atrial EMD parameters were compared with the 6-month follow-up. RESULTS: Pmax and Pd were significantly decreased (108.4 ± 6.1 vs 93.9 ± 6.2 milliseconds, 33.4 ± 8.6 vs 19.5 ± 7.0 milliseconds, respectively, P = .0001 for each) after 6-month telmisartan therapy. The atrial EMD parameters were decreased from baseline (mitral EMD, 68.9 ± 4.9 vs 53.8 ± 4.9 milliseconds; septum EMD, 51.6 ± 7.1 vs 42.6 ± 7. milliseconds1; tricuspid EMD, 48 ± 6.9 vs 39 ± 6.9 milliseconds; interatrial EMD, 20.9 ± 5.5 vs 14.8 ± 5.7 milliseconds; P = .0001 for each parameter). The reduction of interatrial EMD was correlated with the reduction in systolic BP nighttime and the increase in mitral E wave velocity/mitral A wave velocity ratio. CONCLUSION: Telmisartan decreased the atrial EMD parameters in patients with newly diagnosed essential hypertension.

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OBJECTIVE: Epicardial fat tissue reflects visceral adiposity and is a suggested cardiometabolic risk factor. Patients with abdominal obesity have an increased prevalence of the non-dipper blood pressure (BP) pattern, but it is unclear whether the same is true of patients with increased epicardial fat thickness (EFT). The association between EFT and circadian BP changes in patients with recently diagnosed essential hypertension was examined. METHODS: Sixty hypertensive patients underwent echocardiography, treadmill stress testing, and 24 hours of ambulatory BP monitoring. Epicardial fat thickness and left ventricular mass (LVM) index were measured by using transthoracic echocardiography. The patients were categorized into two groups according to their BP pattern (group 1, non-dippers; group 2, dippers). RESULTS: The mean EFT and LVM of patients in group 1 (n = 24) (EFT, 7.6 ± 2.1 mm; LVM, 130 ± 31.2 g/m(2)) were significantly greater than those of group 2 (n = 36) (EFT, 5.5 ± 1.2 mm, P = .0001; LVM, 107 ± 23.7 g/m(2), P = .002). The average systolic BP over 24 hours (BP(s) 24) and average diastolic BP over 24 hours (BP(d) 24) of group 1 (BP(s) 24, 151.1 ± 17.6 mm Hg; BP(d) 24, 94.1 ± 16.5 mm Hg) were significantly higher than those of group 2 (BP(s) 24, 136.7 ± 11.9 mm Hg, P = .0001; BP(d) 24, 84.6 ± 10.6 mm Hg; P = .008). Multivariate backward logistic regression analysis demonstrated that the non-dipper BP pattern was associated with EFT (standardized ß coefficient = 0.87, P = .005) and LVM (standardized ß coefficient = 0.43, P = .016). An EFT ≥ 7 mm was associated with the non-dipper BP pattern with 44% sensitivity and 94% specificity (receiver operating characteristic area under curve of 0.72, 95% CI [0.59-0.83], P = .0007). CONCLUSIONS: Epicardial fat thickness was above average in newly diagnosed, untreated hypertensive patients with non-dipper BP pattern. The echocardiographic measurement of EFT may be used to indicate increased risk of hypertension-related adverse cardiovascular events.

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OBJECTIVES: Heart failure (HF) is a major public health problem responsible for high morbidity and mortality rates. Thus, the importance of survival predictors in directing the treatment of HF is gradually increasing. In some recently published studies, plasma homocysteine has been presented as a newly recognized risk factor for development of HF. In the present study, we investigated the value of serum homocysteine levels in predicting the survival of patients with HF. STUDY DESIGN: Seventy HF patients (44 males, 26 females; mean age 60±12; range 28 to 83 years) with left ventricle ejection fractions <35% were included in our study. Clinical, echocardiographic, and biochemical parameters were measured at baseline, and all patients were followed. Cardiac death was established as the end point of the study. RESULTS: At the end of the 12 month follow-up period, 14 patients (20%) had died. Serum homocysteine levels were significantly higher in the deceased patients compared to the patients who survived (20.8±5.8 vs. 16.9±5.1 µmol/l, p=0.029). A serum homocysteine level of >17.45 µmol/l predicted death at the end of the first year with 71.4% specificity and 67.9% sensitivity (ROC area under curve: 0.855, CI 95% 0.792-0.965, p<0.001). Multivariate Cox regression analysis showed that the serum homocysteine level was the only parameter predicting survival. CONCLUSION: Serum homocysteine level may be an important predictor of mid-term mortality in patients with HF.

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BACKGROUND: Acute alcohol consumption can cause atrial fibrillation in patients with, and without, heart disease. Increased atrial electromechanical delay (EMD) has been associated with atrial fibrillation. We evaluated the atrial conduction properties by tissue Doppler imaging (TDI) echocardiography in healthy men following acute alcohol intake. METHODS: Thirty healthy male volunteers were included in this study. Baseline ECG, heart rate, blood pressure, and TDI echocardiographic findings were compared to readings taken one hour after drinking six 12-oz cans of beer (76.8 g of ethanol). RESULTS: Although the blood pressure and heart rate remained similar before and one hour after alcohol intake, Pmax and Pd values were significantly prolonged (114.2 ± 10.4 vs 100.8 ± 10.6, p = 0.002; 50.6 ± 9.6 vs 34.5 ± 8.8, p < 0.0001). Interatrial EMD was significantly increased after drinking alcohol compared to the baseline (19.8 ± 9.2 vs 14.0 ± 5.5 ms, p < 0.0002). CONCLUSIONS: Acute moderate alcohol intake was associated with an increased interatrial EMD obtained by TDI echocardiography. This finding may help explain how these patients express increased susceptibility to atrial fibrillation.

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BACKGROUND: Carotid intima-media thickness (CIMT) is a potential indicator of subclinical atherosclerosis in patients with metabolic syndrome (MetS). Epicardial fat thickness (EFT) is suggested as a new cardiometabolic risk factor. We investigated the association between EFT and CIMT in patients with MetS. METHODS: Forty patients with MetS were compared with 40 age- and sex-matched subjects without MetS in terms of echocardiographic EFT, CIMT, anthropometric measurements, and metabolic profile in this cross-sectional study. RESULTS: The waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolics and diastolic blood pressure levels, hs-CRP, and homeostasis model assessment index for insulin resistance (HOMA-IR) were significantly increased in patients with MetS. The EFT and CIMT were also increased significantly in patients with MetS compared to controls (7.2 ± 2 mm vs. 5.7 ± 1.9 mm; P = 0.001, 0.74 ± 0.1 mm vs. 0.59 ± 0.1 mm; P < 0.01, respectively). Echocardiographic EFT was the only independent predictor of CIMT in the multivariate analysis (standardized ß coefficient = 0.74, P < 0.001). CONCLUSION: EFT is associated with increased CIMT in patients with MetS.

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