Correlation between Epicardial Fat Thickness by Echocardiography with the Severity of Coronary Artery Disease: A Hospital-Based Observational Study Using Friesinger Score

Open Access

Abstract

Background: Epicardial fat thickness (EFT) is a metabolically active visceral adipose tissue that is increasingly recognized as an important marker of cardiovascular risk and inflammation. Echocardiographic measurement of EFT is simple, non-invasive, reproducible and relatively inexpensive. However, evidence regarding the association between EFT and angiographic severity of coronary artery disease (CAD) remains limited in the Bangladeshi population. Objective: To evaluate the relationship between echocardiographically measured epicardial fat thickness and the angiographic severity of coronary artery disease assessed using the Friesinger score among patients with angiographically confirmed CAD. Methods & Materials: This observational cross-sectional study was conducted in the Department of Cardiology, 250 Bedded Mohammad Ali Hospital, Bogura, Bangladesh over a period of one year from January 2025 to December 2025. A total of 200 patients with confirmed CAD by coronary angiography were enrolled purposively. Demographic, anthropometric and clinical data were recorded. EFT was measured by transthoracic echocardiography from the parasternal long-axis view at end-systole over the right ventricular free wall. Coronary angiographic severity was assessed using the Friesinger score and patients were categorized into mild, moderate and severe CAD groups. Results: The mean age was 56.8±10.7 years and 72.0% of participants were male. Mean EFT was significantly greater in severe CAD than in moderate and mild CAD (8.1±1.3, 6.4±1.2 and 4.8±1.1 mm, respectively; p<0.001). EFT showed a strong positive correlation with Friesinger score (r=0.712, p<0.001). Diabetes, hypertension, smoking and obesity were significantly associated with increased EFT. Multivariate regression demonstrated that EFT was an independent predictor of severe CAD (β=0.61, p<0.001). Conclusion: Echocardiographic EFT is significantly associated with angiographic CAD severity and may provide a useful non-invasive marker for identifying patients at increased risk of severe CAD, particularly in resource-limited settings.