Association of epicardial adipose tissue thickness and left ventricular functions in children with primary dyslipidemia

Abstract Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules . To evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and left ventricular function. 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. 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. What is Known: • Epicardial adipose tissue is associated with cardiovascular risk factors in adults. • Children with primary dyslipidemia may develop early cardiac dysfunction. What is New: • This study demonstrates a signifi cant association between epicardial adipose tissue thickness and left ventricular function in children. • It highlights the potential role of epicardial fat as an early marker of cardiac involvement in pediatric dyslipidemia.