{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:03:49Z","timestamp":1777957429430,"version":"3.51.4"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obstructive sleep apnea syndrome (OSAS) is linked to pulmonary hypertension and cardiovascular risk, yet simple echocardiographic indices related to cardiopulmonary hemodynamics and cardiometabolic burden are limited. We evaluated ePLAR and epicardial adipose tissue (EAT) thickness as complementary, noninvasive echocardiographic markers associated with OSAS presence and severity in newly diagnosed patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross\u2010sectional study, 63 polysomnography\u2010confirmed OSAS patients and 63 controls with a similar distribution of age, sex, and major comorbidities underwent transthoracic echocardiography. OSAS severity was classified as mild, moderate, or severe. ePLAR (TRVmax\/E\/e\u2032) and EAT were measured. Diagnostic performance was assessed by ROC analysis (apparent discrimination), and prediction models for severe OSAS were fitted using Firth penalized logistic regression with bootstrap optimism correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      OSAS patients had higher EAT (0.62\u00a0\u00b1\u00a00.11\u00a0vs. 0.53\u00a0\u00b1\u00a00.06\u00a0cm) and ePLAR (0.37\u00a0\u00b1\u00a00.09\u00a0vs. 0.23\u00a0\u00b1\u00a00.04 m\/s) than controls (both\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Within OSAS, both measures increased stepwise with severity (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). In internally validated models, adding ePLAR and\/or EAT to age\/sex\/BMI improved discrimination for severe OSAS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EPLAR and EAT were associated with OSAS presence and severity and showed good apparent discrimination for severe OSAS in this cohort; these findings are hypothesis\u2010generating and require external validation in clinically representative populations before any clinical implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>This study was observational and cross\u2010sectional in design and was not registered in a clinical trial registry because it was not an interventional clinical trial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70425","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:31:38Z","timestamp":1774449098000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Echocardiographic Pulmonary\u2013Left Atrial Ratio and Epicardial Adipose Tissue as Noninvasive Markers of Obstructive Sleep Apnea"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0443-1014","authenticated-orcid":false,"given":"Yemlihan","family":"Ceylan","sequence":"first","affiliation":[{"name":"Department of Cardiology Faculty of Medicine, Van Yuzuncu Yil University  Van Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6437-1730","authenticated-orcid":false,"given":"Mehmet Hakan","family":"Bilgin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Diseases Faculty of Medicine, Van Yuzuncu Yil University  Van Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"issue":"9","key":"e_1_2_7_2_1","article-title":"Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article","volume":"12","author":"Rana D.","year":"2020","journal-title":"Cureus"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40885-024-00276-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02258-2020"},{"issue":"10","key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"2961","DOI":"10.3390\/jcm13102961","article-title":"Obstructive Sleep Apnea and Pulmonary Hypertension: A Chicken\u2010and\u2010Egg Relationship","volume":"13","author":"Balcan B.","year":"2024","journal-title":"Journal of Clinical Medicine: Multidisciplinary Digital Publishing Institute (MDPI)"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.03.035"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9010247"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2020.03.016"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.06.011"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.6506"},{"key":"e_1_2_7_11_1","volume-title":"Medical Management of Type 2 Diabetes","author":"Meneghini L. 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