Association of Epicardial Adipose Tissue Thickness and Left Ventricular Functions in Children with Primary Dyslipidemia

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Hassan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8540741/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Introduction: Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules . Objective: To evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and left ventricular function. Methodology: This prospective case–control study was conducted at Assiut University Children’s Hospital between September 2023 and August 2025. Twenty-one children with familial dyslipidemia and twenty-one age-, sex-, and BMI-matched healthy controls underwent clinical evaluation, lipid profile assessment, and transthoracic echocardiography, including measurement of epicardial fat thickness and left ventricular systolic and diastolic function according to American Society of Echocardiography guidelines. Results: Dyslipidemic patients showed significantly higher total cholesterol (332.9 ± 222.3 mg/dL), triglycerides (391.4 ± 251.6 mg/dL), and LDL (154.3 ± 130.4 mg/dL) than controls (p < 0.001). Mixed hyperlipidemia was the most common type (47.6%). Echocardiography revealed increased epicardial fat thickness (2.88 ± 0.94 mm vs. 2.29 ± 0.57 mm; p = 0.018), larger left atrial (21.45 ± 3.86 mm; p = 0.031) and aortic diameters (17.54 ± 3.12 mm; p = 0.013). Triglyceride level was the only independent predictor of epicardial fat thickness (β = 0.437, p = 0.028). Conclusion: Echocardiography revealed increased epicardial fat thickness and early cardiac remodeling. Serum triglycerides were the only independent predictor of EFT, suggesting its key role in subclinical cardiovascular risk among dyslipidemic children. Dyslipidemia Epicardial Fat children left ventricular function Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Dyslipidemias can result from primary lipoprotein metabolism changes due to different genetic causes (primary dyslipidemias) or as a consequence of exogenous factors or other pathologies (secondary dyslipidemias) [1]. Primary dyslipidemia can be due to familial disorders as well. Autosomal dominant mutations cause most cases of familial hypercholesterolemia in LDL receptors, which causes an elevation in LDL-C levels. Other mutations in the cholesterol pathway have been identified but are less common [2]. Visceral adiposity, defined as fat deposition around internal organs, is metabolically active and represents an important risk factor for developing metabolic syndrome [3,4,5]. The heart and vessels are surrounded by layers of adipose tissue, which is a complex organ composed of adipocytes, stromal cells, macrophages, and a neuronal network, all nourished by a rich microcirculation. These layers of adipose tissue surrounding the heart can be subdivided into intra- and extra-pericardial fat. Their thicknesses and volumes can be quantified by echocardiography, CT, or magnetic resonance imaging [6,7,8]. Epicardial fat is located between the outer wall of the myocardium and the visceral layer of pericardium. Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules [9,10]. Studies in adults suggest that increased EAT results in greater cytokine production in the fat directly surrounding coronary vessels, including tumor necrosis factor-α and several interleukins. These cytokines contribute to atherosclerosis by increasing lipolysis, inflammation, and endothelial dysfunction. Endothelial dysfunction coupled with migration of macrophages and other immune cells further exacerbates plaque formation and may eventually cause disruption of the intima and flow within the lumen [6,8]. Aim of the study: To evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and to detect and classify common types of familial dyslipidemia. Methodology This study is a prospective case control study was conducted at Assiut University Children’s Hospital, Assiut, Egypt, between Sep 2023 to Aug 2025. In this study, we investigated 21 patients-aged more than 1 month and till age of 18 years with a diagnosis of familial dyslipidemia. Another 21 apparently healthy volunteers were enrolled in the study as the control group. However, patients who had poor echo window: chest deformities, chronic lung disease, pericardial and/or pleural effusion on transthoracic echocardiography, chronic kidney disease congenital heart diseases, Diabetes that cause 2ry dyslipidemia and liver diseases that cause 2ry dyslipidemia were excluded in the study. The control group included asymptomatic healthy children matched by age, sex, and body mass index (BMI) from the pediatric cardiology outpatient clinic of our Pediatric Department, selected from children who were sent for functional heart murmurs and whose echocardiography was normal. All children enrolled in the study were subjected to a full history taking for demographic as Age - Sex (female/male), Social history would include tobacco use or specific details about diet & Family history. clinical examination with special emphasis on Xanthomas is deposits of lipids on the skin and sometimes subcutaneous tissue, weight, height, BMI (kg/m2), Waist circumference (cm), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Total cholesterol (TC), Low-density lipoprotein cholesterol (LDL-C), High- density lipoprotein cholesterol (HDL-C), and Serum Triglyceride (TG) were recorded for all children enrolled in the study [11] . Dyslipidemia was considered present if one or more of lipid or lipoprotein levels are abnormal. Transthoracic echocardiographic examination with a simultaneous ECG tracing was performed for all children included in the study in both supine and left lateral position using a commercially available device Philips Envisor ultrasound system (Philips Medical Systems, Andover, MA, USA; monitor module manufactured in Saronno, Italy; Model No. MCMD02AA, Type No. M2540-66500) equipped with 21350A PHILIPS HP S8 sector array transducer (2–8 MHz), (Andover, MA, USA Serial number: US503086425)according to the American Society of Echocardiography recommendations. Two experienced pediatric echocardiographers blinded to the children’s clinical picture measured the EFT and the echocardiographic parameters . Conventional 2D-guided M-mode echocardiography was done for the measurement of the cardiac dimensions (wall thickness and chamber size) and left ventricular (LV) circumferential systolic function [ejection fraction (EF) and fractional shortening (FS)]. Conventional pulsed-wave Doppler echocardiography was used for evaluation of LV diastolic function through mitral inflow velocities obtained in the apical four-chamber view [peak early diastolic filling velocity ( E ), peak late diastolic filling velocity ( A ), the E / A ratio, and deceleration time (DT) of early mitral flow] [12] . Echocardiographic measurement of EFT was performed for all subjects included in the study according to the guidelines of American Society of Echocardiography [8]. Standard parasternal long-axis and short-axis views from 2D images, with optimal cursor beam orientation in each view, were obtained for the most accurate measurement of EFT on the right ventricle. EFT was measured perpendicularly on the free wall of the right ventricle at end systole, using the aortic annulus as an anatomic landmark. For midventricular parasternal short-axis assessment, maximum EFT was measured on the right ventricular free wall along the midline of the ultrasound beam perpendicular to the interventricular septum at midchordal and tip of the papillary muscle level, as anatomic landmarks. The average value of 3 cardiac cycles from each echocardiographic view was determined. Statistical analysis: Data were analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Qualitative data were presented as numbers and percentages, while quantitative data were expressed as mean ± standard deviation. Statistical tests included the Chi-square test for categorical variables, independent-sample t-test for continuous variables, and Pearson’s correlation to assess relationships between epicardial fat thickness (EFT) and lipid or echocardiographic parameters. Multivariable linear regression was performed to identify independent predictors of EFT after adjusting for age, sex, BMI, and HDL-C. A p-value < 0.05 was considered statistically significant. Ethical considerations : This study was conducted in accordance with the ethical standards of the Assiut Medical Ethical Review Board (IRB No. 04-2023-200448) and in accordance with the Declaration of Helsinki. All patients included in this study received their medical care free of charge. Refusal to participate in the study did not affect the quality of medical care provided. Written informed consent was obtained from the parents or legal guardians of all participants, and confidentiality of the collected data was ensured. An official written administrative approval was obtained from the Dean of the Faculty of Medicine, Assiut University Hospital. The title and objectives of the study were explained to ensure full cooperation. Results A total of 42 participants were included in the study, divided equally into two groups : 21 patients with dyslipidemia and 21 age- and sex-matched healthy controls . All participants underwent thorough clinical evaluation, including laboratory assessment of lipid profile parameters (cholesterol, triglycerides, HDL, and LDL) and echocardiographic examination, with a specific focus on measuring epicardial fat thickness (EFT) in both the parasternal long axis (PSLAX) and parasternal short axis (PSSAX) views . The case group demonstrated significantly higher epicardial fat thickness (EFT) measured by echocardiography (p = 0.018), larger left atrial diameter (LA) (p = 0.031), and larger ascending aortic diameter (AAO) (p = 0.013) compared to the control group. No statistically significant differences were observed between the two groups regarding mitral E velocity, mitral E/A ratio, pulmonary artery diameter, interventricular septum thickness, left ventricular end-systolic diameter, left ventricular posterior wall thickness, or fractional shortening (p > 0.05 for all). These findings indicate selective structural cardiac changes in the case group as shown in Table (1), Table (1): Echocardiographic data among the studied groups for each group Variables parameters Case Group (N=21) Control Group (N=21) P- value EFT BY ECHO (mm) Mean ± SD 2.879±0.935 2.288±0.574 0.018* Min-max 1.750-4.450 1.100+2.900 MITRAL E (cm/s) Mean ± SD 120.571+38.373 113.571+31.494 0.687 Min-max 73-190 73-198 MITRAL A (cm/s) Mean ± SD 70.71 ± 18.87 65.95 ± 16.62 0.402 Min-max 73-103 40-101 MITRAL E/A Mean ± SD 1.7 ± 0.391 1.756±0.359 0.860 Min-max 1.02 - 2.7 1.3-2.6 PA (mm) Mean ± SD 14.986 ± 2.767 14.424+2.829 0.434 Min-max 11.3 - 19.1 11.3+20.2 LA (mm) Mean ± SD 21.452 ± 3.862 18.029+5.226 0.031* Min-max 16.8 – 28 10.2-25 AO (mm) Mean ± SD 17.538 ± 3.123 14.338+3.322 0.013* Min-max 11.7 - 21.6 5.5-19.5 RV (mm) Mean ± SD 8.98 ± 2.97 9.21 ± 3.11 0.8 Min-max 3.04- 14.92 3.00 - 15.42 IVSD (mm) Mean ± SD 6.381+2.847 35.195+129.828 0.226 Min-max 2-13 2-601 LVEDD (mm) Mean ± SD 29.010+7.411 34.995+14.648 0.279 Min-max 18.7-38 17-72 LVESD (mm) Mean ± SD 20.457+3.252 16.362+7.754 0.070 Min-max 11.7-24.6 2.5-26.6 LVPWD (mm) Mean ± SD 5.167+1.346 4.471+1.216 0.226 Min-max 3.1-7.7 2.3-7.1 LVFS (%) Mean ± SD 41.5+5.310 39.810+4.397 0.433 Min-max 32-51 33-46 As presented in Table (2), the case group showed significantly higher levels of cholesterol , triglycerides (TG) , and low-density lipoprotein (LDL) compared to the control group (p < 0.001 for all), indicating a markedly altered lipid profile. Although high-density lipoprotein (HDL) was lower in the case group, the difference did not reach statistical significance (p = 0.059). These findings suggest that dyslipidemia is more prominent among the case group, which may have clinical implications for cardiovascular risk. Table (2): lipid profile data among the studied groups for each group Variables Parameters case Group (N=21) Control Group (N=21) P- value Total cholesterol (mg/dL) Mean ± SD 332.952+222.320 42.095+5.251 <0.001* Min-max 139-832 32.8-49.1 Triglycerides (mg/dL) Mean ± SD 391.381+251.558 114.181+22.238 <0.001* Min-max 100-844 76.9-149.6 High- Density Lipoprotein cholesterol (mg/dL) Mean ± SD 44.467+27.690 50.786+6.503 0.059 Min-max 20-123 42.6+63.2 Low- Density Lipoprotein cholesterol (mg/dL) Mean ± SD 154.347+130.361 68.129+13.198 <0.001* Min-max 75.8-634 50.3-90.8 Among the case group (n = 21), mixed hyperlipidemia was the most prevalent diagnosis, accounting for 47.61% of cases, followed by hypertriglyceridemia at 28.57% and hypercholesterolemia at 23.81%. No significant correlations were found between epicardial fat thickness (EFT) and any component of the lipid profile among the case group. However, a weak negative correlation was observed between EFT and HDL levels, which approached significance and may suggest a potential inverse relationship worth exploring in larger studies. Correlations with total cholesterol, triglycerides, and LDL were weak and not statistically significant. Table (3): Correlation between EFT measured by ECHO and lipid profile among the case group Lipid profile R -value P- value Total cholesterol (mg/dL) 0.243 0.121 Triglycerides (mg/dL) 0.235 0.134 High-Density Lipoprotein cholesterol (mg/dL) -0.288 0.064 Low-Density Lipoprotein cholesterol (mg/dL) 0.183 0.258 Epicardial fat thickness (EFT) measured by echocardiography showed no significant correlations were observed between EFT and fractional shortening (FS) (r = –0.283, p = 0.214) or mitral E/A ratio (r = 0.147, p = 0.525). Table (4): Correlation between EFT by ECHO and FS and Mitral E\A among the case group R -value P- value FS -0.283 0.214 MITRAL E/A 0.147 0.525 In the multivariable linear regression analysis assessing the relationship between lipid profile parameters and epicardial fat thickness (EFT) adjusted for age, sex and BMI. The level of significance in this study was set to P value less than 0.05 Among the case group, triglyceride (TG) level was the only significant predictor of EFT (B = 0.002, p = 0.028), indicating that higher TG levels are independently associated with increased EFT. Cholesterol, HDL, and LDL levels did not show statistically significant associations with EFT (p > 0.05). Among all predictors, TG also had the highest standardized beta coefficient (β = 0.437), reflecting its relatively stronger contribution to the model. Table (5): Multivariable linear regression of lipid profile in Relation to EFT by ECHO among the case group Variable B (Unstandardized) Beta (Standardized) T P 95% CI (Intercept) 2.164 - 3.681 < 0.001* 0.97 - 3.35 Total cholesterol 0.001 0.253 1.102 0.276 - 0.008 - 0.003 Triglycerides (TG) 0.002 0.437 2.288 0.028* 0.0001 - 0.003 High-Density Lipoprotein cholesterol - 0.005 - 0.127 - 0.396 0.695 - 0.032 - 0.022 Low-Density Lipoprotein cholesterol < 0.001 0.065 0.165 0.870 - 0.006 - 0.007 Discussion A total of 42 participants were included in the study, divided equally into two groups: 21 patients with dyslipidemia and 21 age, sex and BMI-matched healthy controls. All participants underwent thorough clinical evaluation, including laboratory assessment of lipid profile parameters (cholesterol, triglycerides, HDL, and LDL) and echocardiographic examination, with a specific focus on measuring epicardial fat thickness (EFT) in both the parasternal long axis (PSLAX) and parasternal short axis (PSSAX) views. In this single-center case–control study of children more than 1 month and till age of 18 years that attended Assiut University Children Hospital, no significant differences were found between cases and controls in terms of age, sex, BMI, hemodynamic or anthropometric parameters. This baseline equivalence strengthened the validity of EFT comparisons and reduces confounders. Recent pediatric reviews confirmed EFT can differ independently of BMI, making matched groups essential [ 13 ]. Regarding Epicardial Fat Thickness (EFT) and Cardiac Structures, EFT was significantly higher in dyslipidemic children (mean 2.879 mm) vs. controls (2.288 mm), p = 0.018. Additionally, LA and aortic root dimensions were larger in cases, while systolic and diastolic functions remained similar. Multiple pediatric studies reported elevated EAT/EFT in children with cardiometabolic risk factors, including obesity and type 1 diabetes, corroborating our findings. Moreover, EFT measured by echocardiography (PSLAX/PSSAX) remained a validated, non-invasive proxy for cardiac visceral fat. Structural changes preceding functional impairment echo reports of early remodeling with preserved ventricular performance [ 14 , 15 , 16 ]. In the present study, with familial dyslipidemia, epicardial fat thickness (EFT) measured by echocardiography was significantly higher in dyslipidemic patients than in age- and sex-matched controls, despite comparable anthropometrics and hemodynamics. This primary finding was consistent with recent pediatric literature identifying epicardial adipose tissue (EAT) as an early, echocardiographically accessible marker of cardiometabolic risk in youth, across a spectrum of metabolic states (obesity, diabetes, and dyslipidemia). Multiple contemporary reviews and cohorts showed that increased EAT/EFT in children associates with adverse risk phenotypes and subclinical cardiac adaptation, supporting its use as a non-invasive risk stratifier [ 17 ]. Dyslipidemic children had significantly higher total cholesterol, triglycerides, and LDL-C (p < 0.001), though HDL was non-significantly lower (p = 0.059). These findings were in strong agreement with Dönmez and Bulut. reported that EFT was significantly higher in FH patients compared to controls (6.30 ± 2.31 mm vs. 4.94 ± 0.94 mm, p < 0.001), and identified LDL-C as the only independent predictor of EFT in multivariate analysis. This parallels our results, highlighting LDL-C as the most influential lipid fraction associated with EFT increase [ 18 ]. Mixed hyperlipidemia was most prevalent (47.6%), followed by hypertriglyceridemia (28.6%) and hypercholesterolemia (23.8%). The dominance of mixed dyslipidemia mirrors recent pediatric trends, which indicate combined lipid abnormalities are increasingly common and linked with ectopic fat deposition (inc. EAT) [ 15 , 19 ]. In the present study, no significant correlations were observed between epicardial fat thickness (EFT) and total cholesterol (TC), triglycerides (TG), or low-density lipoprotein cholesterol (LDL-C). However, a borderline inverse correlation was noted with high-density lipoprotein cholesterol (HDL-C) (r = − 0.288, p = 0.064). This finding suggested that EFT may not consistently reflect traditional lipid fractions but could be more closely associated with the protective role of HDL against visceral fat accumulation. These results diverged from observations in familial hypercholesterolemia (FH) populations, where EFT has shown strong positive correlations with LDL-C, likely reflecting the pronounced atherogenic lipid burden characteristic of FH patients [ 20 ]. The borderline inverse trend with HDL observed in our cohort is consistent with evidence that reduced HDL levels are associated with greater visceral adiposity and impaired cardiometabolic protection. Similarly, Ferrara et al. , highlighted that reduced HDL impairs its protective anti-inflammatory and antioxidant functions, thereby facilitating ectopic fat accumulation and increasing cardiovascular risk. They also noted that dyslipidemia, particularly the combination of low HDL and elevated triglycerides, is strongly associated with dysfunctional adipose tissue signaling. This supports the interpretation that HDL may play a central regulatory role in the relationship between ectopic fat depots, dyslipidemia, and cardiovascular disease [ 21 ]. In the current study, there was no significant correlation between EFT and functional indices (FS, E/A). Abd ElBaky et al. , reported children with Type 1 diabetes had increased EFT associated with early predictors of dysfunction; yet conventional FS and E/A were often similar to controls, suggesting subclinical changes not detected by basic indices. And this reinforced that metabolic disease in children can elevate EFT and produce structural signs before FS/E-A abnormalities [ 22 ] Conclusion The study found that children with dyslipidemia had significantly higher total cholesterol, triglycerides, and LDL levels than matched healthy controls, with mixed hyperlipidemia being the most common pattern. Echocardiography showed increased epicardial fat thickness (EFT) and larger left atrial and aortic diameters, indicating early cardiac remodeling. Multivariable analysis identified serum triglycerides as the only independent predictor of EFT. Although no significant correlations were found with other lipid parameters, a negative trend with HDL was noted. Overall, EFT appears to be a sensitive marker for early cardiovascular risk in dyslipidemic children, primarily influenced by triglyceride levels. Declarations Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution All authors carefully examined and gave their approval to the final version of the manuscript. The research study was planned and structured by MM, who was also responsible for assessing the patients, collecting the data, analyzing the information, and interpreting the results. The overall conception and design of the study, the review of relevant literature, and the revisions made to the manuscript were joint efforts undertaken by KMA, MM, FAA and MAH. Every author contributed to enhancing the manuscript by providing revisions and ultimately endorsed the final draft. Acknowledgement not available References Berberich AJ, Hegele RA. The complex molecular genetics of familial hypercholesterolaemia. Nature Reviews Cardiology. 2019 Jan;16(1):9-20. Doi: 10.1038/s41569-018-0052-6. Defesche JC, Gidding SS, Harada-Shiba M, et al., Familial hypercholesterolaemia. Nature reviews Disease primers. 2017 Dec 7;3(1):1-20. https://doi.org/10.1038/NRDP.2017.93. Eroglu S, Sade LE, Yildirir A, et al., Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutrition, metabolism and cardiovascular diseases. 2009 Mar 1;19(3):211-7. doi: 10.5114/aoms.2017.65479. Rexrode KM, Buring JE, Manson JE. 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Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 Mar, 2026 Reviewers agreed at journal 17 Feb, 2026 Reviews received at journal 17 Feb, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviewers invited by journal 26 Jan, 2026 Editor assigned by journal 25 Jan, 2026 Submission checks completed at journal 25 Jan, 2026 First submitted to journal 07 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8540741","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582025210,"identity":"3d3469b2-b242-444d-95e5-40a1ecf1ea96","order_by":0,"name":"Khaled Mohammed Allam","email":"","orcid":"","institution":"assuit university","correspondingAuthor":false,"prefix":"","firstName":"Khaled","middleName":"Mohammed","lastName":"Allam","suffix":""},{"id":582025211,"identity":"f491e2bc-1c26-4b3e-ba9a-01c45a276d41","order_by":1,"name":"Mina Mamdouh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDCCA/wfQBRjgwTzASAtIUOEFgYDqBa2BJAWHlK08IAZhLXwHW9I/MCYs022X7rn86sbNRY8DOyHj27Ap0XyzIHDEozbbhvPnHN2m3XOMaDDeNLSbuDTYnAjsQGkJXHDjdxtxjlsQC0SPGYEtCQz/4BoyXlmnPOPKC1pbFBbcpgf57YRoUXyzBk2i0SQX2akmTHn9knwsBHyC9/xHuYbH7fdlu2XSH78OedbnRw/++FjeLWAQQKEYpMAkwSVIwHmD6SoHgWjYBSMgpEDACktTgTaLUUPAAAAAElFTkSuQmCC","orcid":"","institution":"assuit university","correspondingAuthor":true,"prefix":"","firstName":"Mina","middleName":"","lastName":"Mamdouh","suffix":""},{"id":582025212,"identity":"5d49078e-4c3a-4bbb-88de-e7aabbba02f3","order_by":2,"name":"Faisal Alkhateeb Ahmed","email":"","orcid":"","institution":"assuit university","correspondingAuthor":false,"prefix":"","firstName":"Faisal","middleName":"Alkhateeb","lastName":"Ahmed","suffix":""},{"id":582025213,"identity":"2f3efc15-89c7-4c11-b10f-b67aeff1be5f","order_by":3,"name":"Mohamed A. Hassan","email":"","orcid":"","institution":"assuit university","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"A.","lastName":"Hassan","suffix":""}],"badges":[],"createdAt":"2026-01-07 11:23:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8540741/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8540741/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101404752,"identity":"c880e2a6-cb7a-47f3-af9f-5e1892f0b428","added_by":"auto","created_at":"2026-01-29 10:37:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16500,"visible":true,"origin":"","legend":"\u003cp\u003eDiagnosis of hyperlipidemia among the case group\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8540741/v1/7a450c9f0e28d62d1158d6b7.png"},{"id":101751451,"identity":"130f798a-e27f-44f9-9efd-e14dbce25bdd","added_by":"auto","created_at":"2026-02-03 10:20:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":229127,"visible":true,"origin":"","legend":"\u003cp\u003ecorrelation between EFT By ECHO and lipid profile\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTG \u003c/em\u003etriglycerides, \u003cem\u003eTC \u003c/em\u003etotal cholesterol, \u003cem\u003eLDL \u003c/em\u003elow-density lipoprotein cholesterol, \u003cem\u003eHDL \u003c/em\u003ehigh-density lipoprotein cholesterol,\u003cem\u003e EFT \u003c/em\u003eepicardial fat thickness\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8540741/v1/4031f7b38697d3f940601f8f.png"},{"id":101751503,"identity":"83371782-9e6a-4bfd-93c3-5e85ae516425","added_by":"auto","created_at":"2026-02-03 10:20:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":110869,"visible":true,"origin":"","legend":"\u003cp\u003ecorrelation between EFT by ECHO and Mitral E\\A\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eE \u003c/em\u003emitral peak early diastolic filling velocity, \u003cem\u003eA \u003c/em\u003emitral peak late diastolic filling velocity, \u003cem\u003eEFT \u003c/em\u003eepicardial fat thickness\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8540741/v1/cc69e1a1725bea3bdacb0edb.png"},{"id":101404749,"identity":"1d022594-a5e1-478f-aae4-5323a2bea72d","added_by":"auto","created_at":"2026-01-29 10:37:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":118978,"visible":true,"origin":"","legend":"\u003cp\u003ecorrelation between EFT by ECHO and FS\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFS Fractional Shortening, EFT \u003c/em\u003eepicardial fat thickness\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8540741/v1/507046ecc5015e317b509cf6.png"},{"id":101754988,"identity":"2fa38d4f-6322-4659-98b4-9658ff336ff1","added_by":"auto","created_at":"2026-02-03 10:48:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1359260,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8540741/v1/63ac55c5-14c5-4659-b641-6473225eb521.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of Epicardial Adipose Tissue Thickness and Left Ventricular Functions in Children with Primary Dyslipidemia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDyslipidemias can result from primary lipoprotein metabolism changes due to different genetic causes (primary dyslipidemias) or as a consequence of exogenous factors or other pathologies (secondary dyslipidemias)\u003cstrong\u003e[1].\u003c/strong\u003ePrimary dyslipidemia can be due to familial disorders as well. Autosomal dominant mutations cause most cases of familial hypercholesterolemia in LDL receptors, which causes an elevation in LDL-C levels. Other mutations in the cholesterol pathway have been identified but are less common\u003cstrong\u003e [2].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVisceral adiposity, defined as fat deposition around internal organs, is metabolically active and represents an important risk factor for developing metabolic syndrome \u003cstrong\u003e[3,4,5].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe heart and vessels are surrounded by layers of adipose tissue, which is a complex organ composed of adipocytes, stromal cells, macrophages, and a neuronal network, all nourished by a rich microcirculation. These layers of adipose tissue surrounding the heart can be subdivided into intra- and extra-pericardial fat. Their thicknesses and volumes can be quantified by echocardiography, CT, or magnetic resonance imaging\u003cstrong\u003e [6,7,8].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEpicardial fat is located between the outer wall of the myocardium and the visceral layer of pericardium. Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules \u003cstrong\u003e[9,10].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies in adults suggest that increased EAT results in greater cytokine production in the fat directly surrounding coronary vessels, including tumor necrosis factor-α and several interleukins. These cytokines contribute to atherosclerosis by increasing lipolysis, inflammation, and endothelial dysfunction. Endothelial dysfunction coupled with migration of macrophages and other immune cells further exacerbates plaque formation and may eventually cause disruption of the intima and flow within the lumen \u003cstrong\u003e[6,8].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e \u003cu\u003eAim of the study:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and to detect and classify common types of familial dyslipidemia.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study is a prospective case control study was conducted at Assiut University Children’s Hospital, Assiut, Egypt, between Sep 2023 to Aug 2025. In this study, we investigated 21 patients-aged more than 1 month and till age of 18 years with a diagnosis of familial dyslipidemia. Another 21 apparently healthy volunteers were enrolled in the study as the control group. However, patients who had poor echo window: chest deformities, chronic lung disease, pericardial and/or pleural effusion on transthoracic echocardiography, chronic kidney disease congenital heart diseases, Diabetes that cause 2ry dyslipidemia and liver diseases that cause 2ry dyslipidemia were excluded in the study. The control group included asymptomatic healthy children matched by age, sex, and body mass index (BMI) from the pediatric cardiology outpatient clinic of our Pediatric Department, selected from children who were sent for functional heart murmurs and whose echocardiography was normal.\u003c/p\u003e\n\u003cp\u003eAll children enrolled in the study were subjected to a full history taking for demographic as Age - Sex (female/male), Social history would include tobacco use or specific details about diet \u0026amp; Family history. clinical examination with special emphasis on Xanthomas is deposits of lipids on the skin and sometimes subcutaneous tissue, weight, height, BMI (kg/m2), Waist circumference (cm), systolic blood pressure (SBP), and diastolic blood pressure (DBP). \u003c/p\u003e\n\u003cp\u003eTotal cholesterol (TC), Low-density lipoprotein cholesterol (LDL-C), High- density lipoprotein cholesterol (HDL-C), and Serum Triglyceride (TG) were recorded for all children enrolled in the study\u003cstrong\u003e [11]\u003c/strong\u003e. Dyslipidemia was considered present if one or more of lipid or lipoprotein levels are abnormal. \u003c/p\u003e\n\u003cp\u003eTransthoracic echocardiographic examination with a simultaneous ECG tracing was performed for all children included in the study in both supine and left lateral position using a commercially available device Philips Envisor ultrasound system (Philips Medical Systems, Andover, MA, USA; monitor module manufactured in Saronno, Italy; Model No. MCMD02AA, Type No. M2540-66500) equipped with 21350A PHILIPS HP S8 sector array transducer (2–8 MHz), (Andover, MA, USA Serial number: US503086425)according to the American Society of Echocardiography recommendations. Two experienced pediatric echocardiographers blinded to the children’s clinical picture measured the EFT and the echocardiographic parameters\u003cstrong\u003e. \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConventional 2D-guided M-mode echocardiography was done for the measurement of the cardiac dimensions (wall thickness and chamber size) and left ventricular (LV) circumferential systolic function [ejection fraction (EF) and fractional shortening (FS)]. Conventional pulsed-wave Doppler echocardiography was used for evaluation of LV diastolic function through mitral inflow velocities obtained in the apical four-chamber view [peak early diastolic filling velocity (\u003cem\u003eE\u003c/em\u003e), peak late diastolic filling velocity (\u003cem\u003eA\u003c/em\u003e), the \u003cem\u003eE\u003c/em\u003e/\u003cem\u003eA \u003c/em\u003eratio, and deceleration time (DT) of early mitral flow] \u003cstrong\u003e[12]\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eEchocardiographic measurement of EFT was performed for all subjects included in the study according to the guidelines of American Society of Echocardiography \u003cstrong\u003e[8].\u003c/strong\u003e Standard parasternal long-axis and short-axis views from 2D images, with optimal cursor beam orientation in each view, were obtained for the most accurate measurement of EFT on the right ventricle. EFT was measured perpendicularly on the free wall of the right ventricle at end systole, using the aortic annulus as an anatomic landmark. For midventricular parasternal short-axis assessment, maximum EFT was measured on the right ventricular free wall along the midline of the ultrasound beam perpendicular to the interventricular septum at midchordal and tip of the papillary muscle level, as anatomic landmarks. The average value of 3 cardiac cycles from each echocardiographic view was determined.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Qualitative data were presented as numbers and percentages, while quantitative data were expressed as mean ± standard deviation. Statistical tests included the Chi-square test for categorical variables, independent-sample t-test for continuous variables, and Pearson’s correlation to assess relationships between epicardial fat thickness (EFT) and lipid or echocardiographic parameters. Multivariable linear regression was performed to identify independent predictors of EFT after adjusting for age, sex, BMI, and HDL-C. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e:\u003cbr\u003e This study was conducted in accordance with the ethical standards of the Assiut Medical Ethical Review Board (IRB No. 04-2023-200448) and in accordance with the Declaration of Helsinki. All patients included in this study received their medical care free of charge. Refusal to participate in the study did not affect the quality of medical care provided. Written informed consent was obtained from the parents or legal guardians of all participants, and confidentiality of the collected data was ensured.\u003c/p\u003e\n\u003cp\u003eAn official written administrative approval was obtained from the Dean of the Faculty of Medicine, Assiut University Hospital. The title and objectives of the study were explained to ensure full cooperation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 42 participants were included in the study, divided equally into two groups\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e21 patients with dyslipidemia and 21 age- and sex-matched healthy controls\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAll participants underwent thorough clinical evaluation, including laboratory assessment of lipid profile parameters (cholesterol, triglycerides,\u0026nbsp;HDL,\u0026nbsp;and\u0026nbsp;LDL)\u0026nbsp;and\u0026nbsp;echocardiographic\u0026nbsp;examination,\u0026nbsp;with\u0026nbsp;a specific focus on measuring epicardial fat thickness (EFT) in both the parasternal\u0026nbsp;long\u0026nbsp;axis\u0026nbsp;(PSLAX)\u0026nbsp;and\u0026nbsp;parasternal\u0026nbsp;short\u0026nbsp;axis\u0026nbsp;(PSSAX)\u0026nbsp;views\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case group demonstrated significantly higher epicardial fat thickness (EFT) measured by echocardiography (p = 0.018), larger left atrial diameter (LA) (p = 0.031), and larger ascending aortic diameter (AAO) (p = 0.013) compared to the control group. No statistically significant differences were observed between the two groups regarding mitral E velocity, mitral E/A ratio, pulmonary artery diameter, interventricular septum thickness, left ventricular end-systolic diameter, left ventricular posterior wall thickness, or fractional shortening (p \u0026gt; 0.05 for all). These findings indicate selective structural cardiac changes in the case group as shown in Table (1),\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (1):\u0026nbsp;\u003c/strong\u003eEchocardiographic data among the studied groups for each group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"632\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eparameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eGroup (N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eGroup (N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEFT\u0026nbsp;BY ECHO\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.879\u0026plusmn;0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.288\u0026plusmn;0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.750-4.450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.100+2.900\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMITRAL E\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(cm/s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e120.571+38.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e113.571+31.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e73-190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e73-198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMITRAL A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(cm/s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e70.71\u0026nbsp;\u0026plusmn; 18.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e65.95\u0026nbsp;\u0026plusmn; 16.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e73-103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e40-101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMITRAL E/A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.7 \u0026plusmn; 0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.756\u0026plusmn;0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.02\u0026nbsp;- 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.3-2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePA (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e14.986\u0026nbsp;\u0026plusmn; 2.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e14.424+2.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11.3\u0026nbsp;-\u0026nbsp;19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11.3+20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLA (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e21.452\u0026nbsp;\u0026plusmn; 3.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e18.029+5.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e16.8\u0026nbsp;\u0026ndash; 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e10.2-25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAO (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e17.538\u0026nbsp;\u0026plusmn; 3.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e14.338+3.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11.7\u0026nbsp;-\u0026nbsp;21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e5.5-19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRV (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8.98\u0026nbsp;\u0026plusmn; 2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e9.21\u0026nbsp;\u0026plusmn; 3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3.04- 14.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3.00\u0026nbsp;- 15.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIVSD (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e6.381+2.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e35.195+129.828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2-13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2-601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLVEDD (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e29.010+7.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e34.995+14.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e18.7-38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e17-72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLVESD (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e20.457+3.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e16.362+7.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11.7-24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.5-26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLVPWD (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e5.167+1.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e4.471+1.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3.1-7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.3-7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLVFS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e41.5+5.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e39.810+4.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e32-51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e33-46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAs presented in Table (2), the case group showed significantly higher levels of cholesterol\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003etriglycerides (TG)\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eand low-density lipoprotein (LDL) compared to the control group (p \u0026lt; 0.001 for all), indicating a markedly altered lipid profile. Although high-density lipoprotein (HDL) was lower in the case group, the difference did not reach statistical significance\u0026nbsp;(p\u0026nbsp;=\u0026nbsp;0.059).\u0026nbsp;These\u0026nbsp;findings\u0026nbsp;suggest\u0026nbsp;that\u0026nbsp;dyslipidemia\u0026nbsp;is\u0026nbsp;more prominent among the case group, which may have clinical implications for cardiovascular risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2):\u0026nbsp;\u003c/strong\u003elipid profile data among the studied groups for each group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"646\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecase\u0026nbsp;Group (N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003echolesterol\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e332.952+222.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e42.095+5.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e139-832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e32.8-49.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e391.381+251.558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e114.181+22.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e100-844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e76.9-149.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh-\u003c/strong\u003e\u003cstrong\u003eDensity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLipoprotein\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003echolesterol (mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e44.467+27.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e50.786+6.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20-123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42.6+63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow-\u003c/strong\u003e\u003cstrong\u003eDensity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLipoprotein\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003echolesterol (mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e154.347+130.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e68.129+13.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75.8-634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50.3-90.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAmong the case group (n = 21), mixed hyperlipidemia was the most prevalent diagnosis, accounting for 47.61% of cases, followed by hypertriglyceridemia at 28.57% and hypercholesterolemia at 23.81%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo significant correlations were found between epicardial fat thickness (EFT) and any component of\u0026nbsp;the lipid\u0026nbsp;profile\u0026nbsp;among\u0026nbsp;the\u0026nbsp;case\u0026nbsp;group.\u0026nbsp;However,\u0026nbsp;a\u0026nbsp;weak\u0026nbsp;negative correlation was observed between EFT and HDL levels, which approached significance and may suggest a potential inverse relationship worth exploring in larger studies. Correlations with total cholesterol, triglycerides, and LDL were weak and not statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(3):\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCorrelation between EFT measured by ECHO and lipid profile among the case group\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"589\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLipid profile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u0026nbsp;-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;cholesterol (mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh-Density\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eLipoprotein\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003echolesterol\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e-0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow-Density\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eLipoprotein\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003echolesterol\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEpicardial fat thickness (EFT) measured by echocardiography showed no significant correlations were observed between\u0026nbsp;EFT\u0026nbsp;and\u0026nbsp;fractional\u0026nbsp;shortening\u0026nbsp;(FS)\u0026nbsp;(r\u0026nbsp;=\u0026nbsp;\u0026ndash;0.283,\u0026nbsp;p\u0026nbsp;=\u0026nbsp;0.214)\u0026nbsp;or mitral E/A ratio (r = 0.147, p = 0.525).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(4):\u0026nbsp;\u003c/strong\u003eCorrelation between EFT by ECHO and FS and Mitral E\\A among the case group\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u0026nbsp;-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMITRAL E/A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn the multivariable linear regression analysis assessing the relationship between lipid profile parameters and epicardial fat thickness (EFT) adjusted for age, sex and BMI.\u003c/p\u003e\n\u003cp\u003eThe level of significance in this study was set to \u003cem\u003eP\u0026nbsp;\u003c/em\u003evalue less than 0.05 Among the case group, triglyceride (TG) level was the only significant predictor of EFT (B = 0.002, p = 0.028), indicating that higher TG levels are independently associated with increased EFT. Cholesterol, HDL, and LDL levels did not show statistically significant associations with EFT (p \u0026gt; 0.05). Among all predictors, TG also had the highest standardized beta coefficient (\u0026beta; = 0.437), reflecting its relatively stronger contribution to the model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5):\u0026nbsp;\u003c/strong\u003eMultivariable linear regression of lipid profile in Relation to EFT by ECHO among the case group\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB (Unstandardized)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeta\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Standardized)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(Intercept)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e3.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.97 -\u003c/p\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal cholesterol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-\u0026nbsp;0.008 -\u003c/p\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(TG)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.0001 -\u003c/p\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh-Density\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eLipoprotein\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003echolesterol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- 0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- 0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- 0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-\u0026nbsp;0.032 -\u003c/p\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow-Density\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eLipoprotein cholesterol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.870\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-\u0026nbsp;0.006 -\u003c/p\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eA total of 42 participants were included in the study, divided equally into two groups: 21 patients with dyslipidemia and 21 age, sex and BMI-matched healthy controls. All participants underwent thorough clinical evaluation, including laboratory assessment of lipid profile parameters (cholesterol, triglycerides, HDL, and LDL) and echocardiographic examination, with a specific focus on measuring epicardial fat thickness (EFT) in both the parasternal long axis (PSLAX) and parasternal short axis (PSSAX) views.\u003c/p\u003e \u003cp\u003eIn this single-center case\u0026ndash;control study of children more than 1 month and till age of 18 years that attended Assiut University Children Hospital, no significant differences were found between cases and controls in terms of age, sex, BMI, hemodynamic or anthropometric parameters. This baseline equivalence strengthened the validity of EFT comparisons and reduces confounders. Recent pediatric reviews confirmed EFT can differ independently of BMI, making matched groups essential [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding Epicardial Fat Thickness (EFT) and Cardiac Structures, EFT was significantly higher in dyslipidemic children (mean 2.879 mm) vs. controls (2.288 mm), p\u0026thinsp;=\u0026thinsp;0.018. Additionally, LA and aortic root dimensions were larger in cases, while systolic and diastolic functions remained similar. Multiple pediatric studies reported elevated EAT/EFT in children with cardiometabolic risk factors, including obesity and type 1 diabetes, corroborating our findings. Moreover, EFT measured by echocardiography (PSLAX/PSSAX) remained a validated, non-invasive proxy for cardiac visceral fat. Structural changes preceding functional impairment echo reports of early remodeling with preserved ventricular performance [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, with familial dyslipidemia, epicardial fat thickness (EFT) measured by echocardiography was significantly higher in dyslipidemic patients than in age- and sex-matched controls, despite comparable anthropometrics and hemodynamics. This primary finding was consistent with recent pediatric literature identifying epicardial adipose tissue (EAT) as an early, echocardiographically accessible marker of cardiometabolic risk in youth, across a spectrum of metabolic states (obesity, diabetes, and dyslipidemia). Multiple contemporary reviews and cohorts showed that increased EAT/EFT in children associates with adverse risk phenotypes and subclinical cardiac adaptation, supporting its use as a non-invasive risk stratifier [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDyslipidemic children had significantly higher total cholesterol, triglycerides, and LDL-C (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), though HDL was non-significantly lower (p\u0026thinsp;=\u0026thinsp;0.059). These findings were in strong agreement with \u003cb\u003eD\u0026ouml;nmez and Bulut.\u003c/b\u003e reported that EFT was significantly higher in FH patients compared to controls (6.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31 mm vs. 4.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and identified LDL-C as the only independent predictor of EFT in multivariate analysis. This parallels our results, highlighting LDL-C as the most influential lipid fraction associated with EFT increase [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMixed hyperlipidemia was most prevalent (47.6%), followed by hypertriglyceridemia (28.6%) and hypercholesterolemia (23.8%).\u003c/p\u003e \u003cp\u003eThe dominance of mixed dyslipidemia mirrors recent pediatric trends, which indicate combined lipid abnormalities are increasingly common and linked with ectopic fat deposition (inc. EAT) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, no significant correlations were observed between epicardial fat thickness (EFT) and total cholesterol (TC), triglycerides (TG), or low-density lipoprotein cholesterol (LDL-C). However, a borderline inverse correlation was noted with high-density lipoprotein cholesterol (HDL-C) (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.288, p\u0026thinsp;=\u0026thinsp;0.064). This finding suggested that EFT may not consistently reflect traditional lipid fractions but could be more closely associated with the protective role of HDL against visceral fat accumulation. These results diverged from observations in familial hypercholesterolemia (FH) populations, where EFT has shown strong positive correlations with LDL-C, likely reflecting the pronounced atherogenic lipid burden characteristic of FH patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe borderline inverse trend with HDL observed in our cohort is consistent with evidence that reduced HDL levels are associated with greater visceral adiposity and impaired cardiometabolic protection.\u003c/p\u003e \u003cp\u003eSimilarly, \u003cb\u003eFerrara et al.\u003c/b\u003e, highlighted that reduced HDL impairs its protective anti-inflammatory and antioxidant functions, thereby facilitating ectopic fat accumulation and increasing cardiovascular risk. They also noted that dyslipidemia, particularly the combination of low HDL and elevated triglycerides, is strongly associated with dysfunctional adipose tissue signaling. This supports the interpretation that HDL may play a central regulatory role in the relationship between ectopic fat depots, dyslipidemia, and cardiovascular disease [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the current study, there was no significant correlation between EFT and functional indices (FS, E/A). \u003cb\u003eAbd ElBaky et al.\u003c/b\u003e, reported children with Type 1 diabetes had increased EFT associated with early predictors of dysfunction; yet conventional FS and E/A were often similar to controls, suggesting subclinical changes not detected by basic indices. And this reinforced that metabolic disease in children can elevate EFT and produce structural signs before FS/E-A abnormalities [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study found that children with dyslipidemia had significantly higher total cholesterol, triglycerides, and LDL levels than matched healthy controls, with mixed hyperlipidemia being the most common pattern. Echocardiography showed increased epicardial fat thickness (EFT) and larger left atrial and aortic diameters, indicating early cardiac remodeling. Multivariable analysis identified serum triglycerides as the only independent predictor of EFT. Although no significant correlations were found with other lipid parameters, a negative trend with HDL was noted. Overall, EFT appears to be a sensitive marker for early cardiovascular risk in dyslipidemic children, primarily influenced by triglyceride levels.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors carefully examined and gave their approval to the final version of the manuscript. The research study was planned and structured by MM, who was also responsible for assessing the patients, collecting the data, analyzing the information, and interpreting the results. The overall conception and design of the study, the review of relevant literature, and the revisions made to the manuscript were joint efforts undertaken by KMA, MM, FAA and MAH. Every author contributed to enhancing the manuscript by providing revisions and ultimately endorsed the final draft.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003enot available\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBerberich AJ, Hegele RA. The complex molecular genetics of familial hypercholesterolaemia. Nature Reviews Cardiology. 2019 Jan;16(1):9-20. Doi: 10.1038/s41569-018-0052-6.\u003c/li\u003e\n \u003cli\u003eDefesche JC, Gidding SS, Harada-Shiba M, et al., Familial hypercholesterolaemia. Nature reviews Disease primers. 2017 Dec 7;3(1):1-20. https://doi.org/10.1038/NRDP.2017.93.\u003c/li\u003e\n \u003cli\u003eEroglu S, Sade LE, Yildirir A, et al., Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. 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Journal of Ultrasound. 2019 Sep 1;22(3):309-14. https://doi.org/10.1007/s40477-019-00368-3.\u003c/li\u003e\n \u003cli\u003eMastebhakti B, Garg S, Gupta N, et al., Epicardial adipose tissue thickness as a reliable marker of increased cardiovascular risk in patients with type 2 diabetes mellitus. Journal of Endocrinology and Metabolism. 2020 Dec 22;10(6):173-81. doi: https://doi.org/10.14740/jem710.\u003c/li\u003e\n \u003cli\u003eChristensen JJ, Narverud I, Ruuth M, et al., Children with familial hypercholesterolemia display changes in LDL and HDL function: A cross‐sectional study. Journal of internal medicine. 2021 Nov;290(5):1083-97. https://doi.org/10.1111/joim.13383.\u003c/li\u003e\n \u003cli\u003eFerrara D, Montecucco F, Dallegri F, et al., Impact of different ectopic fat depots on cardiovascular and metabolic diseases. Journal of cellular physiology. 2019 Dec;234(12):21630-41. https://doi.org/10.1002/jcp.28821.\u003c/li\u003e\n \u003cli\u003eAbd ElBaky AM, Ismail NA, AbdelRahman AM, et al., Role of epicardial fat thickness and irisin levels in early prediction of cardiac dysfunction in children and adolescents with type 1 diabetes mellitus. Pediatria Polska-Polish Journal of Paediatrics. 2023;98(4):278-84. DOI: https://doi.org/10.5114/polp.2023.133530.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Dyslipidemia, Epicardial Fat, children, left ventricular function","lastPublishedDoi":"10.21203/rs.3.rs-8540741/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8540741/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eEpicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and left ventricular function.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e This prospective case–control study was conducted at Assiut University Children’s Hospital between September 2023 and August 2025. Twenty-one children with familial dyslipidemia and twenty-one age-, sex-, and BMI-matched healthy controls underwent clinical evaluation, lipid profile assessment, and transthoracic echocardiography, including measurement of epicardial fat thickness and left ventricular systolic and diastolic function according to American Society of Echocardiography guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Dyslipidemic patients showed significantly higher total cholesterol (332.9 ± 222.3 mg/dL), triglycerides (391.4 ± 251.6 mg/dL), and LDL (154.3 ± 130.4 mg/dL) than controls (p \u0026lt; 0.001). Mixed hyperlipidemia was the most common type (47.6%). Echocardiography revealed increased epicardial fat thickness (2.88 ± 0.94 mm vs. 2.29 ± 0.57 mm; p = 0.018), larger left atrial (21.45 ± 3.86 mm; p = 0.031) and aortic diameters (17.54 ± 3.12 mm; p = 0.013). Triglyceride level was the only independent predictor of epicardial fat thickness (β = 0.437, p = 0.028).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Echocardiography revealed increased epicardial fat thickness and early cardiac remodeling. Serum triglycerides were the only independent predictor of EFT, suggesting its key role in subclinical cardiovascular risk among dyslipidemic children.\u003c/p\u003e","manuscriptTitle":"Association of Epicardial Adipose Tissue Thickness and Left Ventricular Functions in Children with Primary Dyslipidemia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 10:37:38","doi":"10.21203/rs.3.rs-8540741/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-12T14:48:02+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"222983957867372590403532343504340009396","date":"2026-02-18T03:30:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T15:18:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155411887538613758253996141918991026771","date":"2026-01-27T15:49:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-26T18:15:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-26T03:56:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-26T01:30:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Pediatrics","date":"2026-01-07T11:13:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dbe6b109-c12e-4fc3-97e5-9822ba3f9806","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T19:09:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-29 10:37:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8540741","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8540741","identity":"rs-8540741","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}