The association between varicocele and epicardial fat thickness: a cross-sectional study

La asociación entre el varicocele y el espesor de la grasa epicárdica: un estudio transversal

Background: Varicocele is a vascular disorder defined by anomalous dilatation of the pampiniform plexus and the presence of tortuous veins. Despite numerous hypotheses advanced to clarify its pathophysiology, the foundational processes involved remain incompletely understood. Epicardial adipose tissue, located between the myocardium and visceral epicardium, functions as a metabolically active endocrine organ and has been linked to systemic inflammation, endothelial dysfunction, oxidative stress, and atherosclerosis. We aimed to investigate the relationship between echocardiographically measured epicardial fat thickness (EFT) and the presence and severity of varicocele. Methods: In this cross-sectional study, 50 patients with high-grade varicocele, 50 patients with low-grade varicocele, and 100 group-matched healthy controls based on age and body mass index were enrolled. All participants underwent comprehensive urological evaluation, followed by referral to the cardiology department for cardiac assessment and echocardiographic measurement of EFT. Results: EFT was significantly higher in the varicocele group in comparison to controls (p = 0.048), whereas other study variables did not exhibit significant difference across the groups (p ≥ 0.05). In the three-group comparison (controls, low-grade varicocele, and high-grade varicocele), EFT differed significantly only between controls and the high-grade varicocele group (p = 0.037). Multivariable logistic regression analysis identified EFT as an independent predictor of high-grade varicocele (odds ratio: 1.853; 95% confidence interval: 1.155–2.973; p = 0.011). Conclusions: These results suggest that EFT may be associated with progression rather than initiation of varicocele. A multidisciplinary approach integrating cardiovascular and urological perspectives may be beneficial for identifying factors that contribute to varicocele progression.

Resumen

Antecedentes: El varicocele es un trastorno vascular caracterizado por la dilatación anormal del plexo pampiniforme y la presencia de venas tortuosas. Aunque se han propuesto varias teorías para explicar su fisiopatología, los mecanismos subyacentes siguen sin comprenderse completamente. El tejido adiposo epicárdico, situado entre el miocardio y el epicardio visceral, funciona como un órgano endocrino metabólicamente activo y se ha relacionado con la inflamación sistémica, la disfunción endotelial, el estrés oxidativo y la aterosclerosis. Nuestro objetivo fue investigar la relación entre el espesor de la grasa epicárdica (EGE), medido ecocardiográficamente, y la presencia y gravedad del varicocele. Métodos: En este estudio transversal, se reclutaron 50 pacientes con varicocele de grado alto, 50 pacientes con varicocele de grado bajo, y 100 controles sanos emparejados por grupo en función de la edad y el índice de masa corporal. Todos los participantes se sometieron a una evaluación urológica exhaustiva, seguida de una derivación al departamento de cardiología para la evaluación cardíaca y la medición ecocardiográfica del EGE. Resultados: El EGE fue significativamente mayor en el grupo de varicocele en comparación con los controles (p = 0.048), mientras que otras variables del estudio no mostraron diferencias significativas entre los grupos (p ≥ 0.05). En la comparación de tres grupos (controles, varicocele de grado bajo y varicocele de grado alto), el EGE difirió significativamente solo entre los controles y el grupo de varicocele de grado alto (p = 0.037). El análisis de regresión logística multivariable identificó el EGE como un predictor independiente de varicocele de grado alto (razón de probabilidades: 1.853; intervalo de confianza del 95%: 1.155–2.973; p = 0.011). Conclusións: Estos resultados sugieren que el EGE podría estar asociado con la progresión más que con la iniciación del varicocele. Un enfoque multidisciplinario que integre las perspectivas cardiovascular y urológica podría ser beneficioso para identificar los factores que contribuyen a la progresión del varicocele.

Varicocele; Epicardial fat thickness; Oxidative stress

Palabras Clave

Varicocele; Espesor de la grasa epicárdica; Estrés oxidativo

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