***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background : Epicardial adipose tissue ( EAT ) is the ectopic visceral fat surrounding the heart , which plays an important role in atherosclerosis of the coronary arteries via endothelial damage . Several studies have also suggested that vasospasm with angina ( VSA ) causes endothelial dysfunction in the coronary arteries . The aim of this study was to evaluate the thickness of EAT in the anterior interventricular groove ( EAT‐AIG ) using echocardiography in patients who had no obstructive coronary artery disease and were suspected of having VSA . Methods : Sixty‐five patients who underwent intracoronary acetylcholine provocation testing for clinical indications were prospect ively enrolled . VSA was diagnosed by coronary artery stenosis increase of > 90 % and the presentation of chest pain with ischemic changes on electrocardiography . Results : Subjects were divided into two groups , with and without significant coronary spasm ( VSA group , 30 patients ; non‐VSA group , 35 patients ) , consistent with acetylcholine provocation testing . EAT‐AIG thickness was significantly greater in the VSA group than in the non‐VSA group ( 8.2 ± 2.7 vs 6.1 ± 2.5 mm , P = .002 ) . By receiver operating characteristic analysis , EAT‐AIG thickness had a high C statistic ( area under the curve = 0.81 , P < .001 ) after adjustment for conventional risk factors ( smoking , diabetes mellitus , and dyslipidemia ) . EAT‐AIG thickness had incremental diagnostic value over other conventional risk factors ( area under the curve = 0.81 vs 0.64 , P for comparison = .020 ) . Conclusions : EAT‐AIG thickness , which is noninvasively and easily measured using transthoracic echocardiography , can be one of multiple clinical variables associated with VSA . HighlightsTo the best of our knowledge , this is the first report of echocardiographic EAT‐AIG thickness to help diagnose VSA in patients with chest pain or discomfort . EAT‐AIG thickness is noninvasively and easily measured using transthoracic echocardiography and can be one of multiple clinical variables associated with VSA.EAT‐AIG thickness may be useful as a risk factor and for follow‐up of patients with presumptive VSA Background and objective Contrast-induced nephropathy ( CIN ) is an acute major complication following intravascular administration of iodinated contrast agents ; however , the best approach for preventing CIN is not clear . Remote ischemic pre-conditioning ( RIPC ) is a new , non-pharmacological method that has been considered for the prevention of CIN following coronary angiography . This study assessed the effects of RIPC with four brief episodes of upper limb ischemia and reperfusion in the prevention of contrast-induced nephropathy ( CIN ) after coronary angiography and /or angioplasty . Methods In this double-blind r and omized clinical trial , we enrolled 51 patients with chronic stable angina and non-ST elevation acute coronary syndrome ( NSTE.ACS ) , and they underwent coronary angiography and /or angioplasty . St and ard fluid therapy with normal saline was prescribed for all patients before and after the procedure . The patients were divided into two groups , i.e. , a study group of patients who had undergone RIPC intervention and a control group of patients who had not undergone RIPC . One hour before the procedure , a sphygmomanometer cuff was placed around one arm and inflated up to 50 mmHg above the systolic pressure for five minutes ; then , the cuff was deflated for another five minutes , and this cycle was repeated four times . The patients ’ serum creatinine levels were measured at baseline and 48 hours after the procedure , and the incidence of CIN was calculated . Results Twenty-one males and 30 females were studied in two groups , i.e. , an RIPC intervention group ( n = 25 ) and a control group ( n = 26 ) that were homogenous considering baseline characteristics . No significant difference was observed in the mean level of serum creatinine between the two groups at a post-intervention time of 48 hours ( RICP : 1.74 ± 0.70 mg/dL vs. Control : 1.75 ± 0.87 mg/dL ; P = 0.64 ) . However , a lower incidence rate of CIN was observed 48 hours after the administration of the contrast medium in the RIPC group , but it was not statistically significant ( RIPC : 23.1 % vs. Control : 12.0 % ; P = 0.30 ) . Conclusion It seems that adequate fluid therapy is still the most effective strategy for preventing CIN and that RIPC might have additional protective effects in very high risk patients , such as those with severe renal insufficiency and heart failure Objective Epicardial adipose tissue ( EAT ) is suggested to correlate with metabolic risk factors and to promote plaque development in the coronary arteries . We sought to determine whether EAT thickness was associated or not with the presence and extent of angiographic coronary artery disease ( CAD ) . Methods We measured epicardial fat thickness by computed tomography and assessed the presence and extent of CAD by  coronary angiography in participants from the prospect i ve EVASCAN study . The association of EAT thickness with cardiovascular risk factors , coronary artery calcification scoring and angiographic CAD was assessed using multivariate regression analysis . Results Of 970 patients ( age 60.9 years , 71 % male ) , 75 % ( n = 731 ) had CAD . Patients with angiographic CAD had thicker EAT on the left ventricle lateral wall when compared with patients without CAD ( 2.74±2.4 mm vs. 2.08±2.1 mm ; p = 0.0001 ) . The adjusted odds ratio ( OR ) for a patient with a LVLW EAT value ≥2.8 mm to have CAD was OR = 1.46 [ 1.03–2.08 ] , p = 0.0326 after adjusting for risk factors . EAT also correlated with the number of diseased vessels ( p = 0.0001 for trend ) . By receiver operating characteristic curve analysis , an EAT value ≥2.8 mm best predicted the presence of>50 % diameter coronary artery stenosis , with a sensitivity and specificity of 46.1 % and 66.5 % respectively ( AUC:0.58 ) . Coronary artery calcium scoring had an AUC of 0.76 . Conclusion Although left ventricle lateral wall EAT thickness correlated with the presence and extent of angiographic CAD , it has a low performance for the diagnosis of CAD Background Obesity is an important risk factor for atherosclerotic cardiovascular disease ( ASCVD ) . Estimation of visceral adipose tissue is important and several methods are available as its surrogate . Although correlation of epicardial adipose tissue ( EAT ) with visceral adipose tissue as estimated by magnetic resonance imaging ( MRI ) and /or CT is excellent , it is costlier and cumbersome . EAT can be accurately measured by two-dimensional ( 2D ) echocardiography . It tends to be higher in patients with acute coronary syndrome than in subjects without coronary artery disease ( CAD ) and in those with stable angina . It also carries advantage as index of high cardiometabolic risk as it is a direct measure of visceral fat rather than anthropometric measurements . The present study evaluated the relationship of EAT to the presence and severity of CAD in clinical setting . Methods In this prospect i ve , single-center study conducted in the Department of Cardiology , LPS Institute of Cardiology , Kanpur , India , 549 consecutive patients with acute coronary syndrome or chronic stable angina were enrolled . Sensitivity , specificity , and receiver operating characteristic ( ROC ) curve were estimated to find cut-off value of EAT thickness for diagnosing CAD using coronary angiographic findings as gold st and ard . Results Patients were diagnosed as CAD group ( n = 464 , 60.30 ± 8.36 years ) and non-CAD group ( n = 85 , 54.42 ± 11.93 years ) after assessing coronary angiograms . The EAT was measured at end-systole from the PLAX views of three cardiac cycles on the free wall of the right ventricle . Lesion was significant if > 50 % in left main and > 70 % in other coronary arteries . The mean EAT thickness in CAD group was 5.10 ± 1.06 and in non-CAD group was 4.36 ± 1.01 which was significant ( P = 0.003 ) . Significant correlation was demonstrated between EAT thickness and presence of CAD ( P < 0.003 ) . Higher EAT was associated with severe CAD and presence of multivessel disease . By ROC analysis , EAT > 4.65 mm predicated the presence of significant coronary stenosis by 71.6 % sensitivity and 73.1 % specificity . Conclusion EAT thickness measured using transthoracic echocardiography ( TTE ) significantly correlates with the presence and severity of CAD . It is sensitive , easily available , and cost-effective and assists in the risk stratification and may be an additional marker on classical risk factors for CAD BACKGROUND Although epicardial adipose tissue ( EAT ) volume is associated with increased incidence of coronary artery disease ( CAD ) , its role in myocardial systolic dysfunction is unclear . The present study aim ed to identify independent determinants of EAT volume in patients without obstructive CAD , and to evaluate the association between EAT volume ( vs other measures of obesity ) and myocardial systolic strain analysis . METHODS We prospect ively recruited 130 patients without obstructive CAD on contrast-enhanced cardiac computed tomography imaging and normal left ventricular ejection fraction on 3-dimensional ( 3D ) echocardiography .  EAT volume  was quantified from cardiac computed tomography imaging , and 3D multidirectional ( longitudinal , circumferential , radial , and area ) strain were measured . RESULTS The mean EAT volume was 97.5 ± 43.7 cm3 . In multivariable analysis , measures of obesity ( body mass index [ P = 0.007 ] and waist/hip ratio [ P = 0.001 ] ) were independently associated with larger EAT volume . EAT volume was correlated with 3D global longitudinal ( r = 0.601 ; P < 0.001 ) , circumferential ( r = 0.375 ; P < 0.001 ) , radial ( r = -0.546 ; P < 0.001 ) , and area ( r = 0.558 ; P < 0.001 ) strain . In multivariable analyses , epicardial fat volume was the strongest predictor of 3D global longitudinal ( st and ardized β = 0.512 ; P < 0.001 ) , circumferential ( st and ardized β = 0.242 ; P = 0.006 ) , radial ( st and ardized β = -0.422 ; P < 0.001 ) , and area ( st and ardized β = 0.428 ; P < 0.001 ) strain . In contrast , other measures of obesity including body mass index and waist/hip ratio were not independent determinants of 3D multidirectional global strain ( all P > 0.05 ) . CONCLUSIONS EAT volume is independently associated with impaired myocardial systolic function despite preserved 3D left ventricular ejection fraction and absence of obstructive CAD , and might play a significant role in the pathophysiology of diabetic , obesity , and metabolic heart disease BACKGROUND The relationship between epicardial adipose tissue ( EAT ) and coronary artery disease ( CAD ) has recently attracted a great deal of attention in the medical community . The objective of this study was to determine whether measuring EAT thickness in the anterior interventricular groove ( AIG ) using echocardiography is feasible and whether this index can be a marker of CAD . METHODS A total of 311 patients ( mean age , 67 ± 11 years ; 208 men ) who underwent coronary angiography between December 2011 and December 2013 were prospect ively enrolled . EAT-AIG thickness and EAT thickness on the free wall of the right ventricle ( RV ) were measured in systole using a high-frequency linear probe . Seventy-one patients who underwent multidetector-row computed tomography  were enrolled to vali date the method for measuring EAT thickness using echocardiography . Subjects were divided into two groups , those with and without significant coronary stenosis , on the basis of findings on coronary angiography ( ≥ 75 % luminal narrowing ) . RESULTS EAT-AIG thickness measured using echocardiography was vali date d by computed tomography . EAT-AIG thickness was strongly correlated with EAT volume ( r = 0.714 , P < .001 ) . The CAD group had thicker EAT-AIG than the non-CAD group ( 8.3 ± 3.0 vs 6.3 ± 2.5 mm , P < .001 ) . EAT-RV thickness was greater in the CAD group than in the non-CAD group ( 5.0 ± 2.1 vs 4.4 ± 2.3 mm , P = .009 ) as well . The area under the curve on receiver operating characteristic curve analysis of 
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Conclusion According to the findings of this meta- analysis , the echocardiographic EFT in the subjects with CAD was significantly higher than that of those without CAD .
The measurement of echocardiographic EFT seems to be an acceptable strategy for risk stratification of heart diseases considering ease of use , cost-effectiveness and non-exposure characteristics , compared to other imaging interventions