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AbstractPurpose Epicardial fat thickness is an interesting parameter of early atherosclerosis. We prospectively assessed whether weight loss following laparoscopic sleeve gastrectomy (LSG) leads to a significant reduction in the epicardial fat thickness (EFT) and the correlation between the decline in the epicardial fat thickness with other clinical parameters.Methods A prospective analysis of 98 cases that were scheduled to undergo LSG and followed up for 12 months was conducted. EFT was assessed using two-dimensional (2 D) echocardiography.Results A total of 98 cases and 70 controls were enrolled. EFT demonstrated a significant reduction at follow-up in the whole group (median 8.9 (1.95) versus 7.65 (1.67) mm, respectively). The degree of reduction was higher in the LSG cohort compared to control cohort 1.3 (0.4) versus 1 (0.4), respectively; p < .001). The univariate regression analysis demonstrated a notable correlation of the EFT with the weight, body mass index (BMI), fasting blood glucose (FBG), and creatinine with a p-value of <.0001, .001, .022, and .018, respectively while the multivariate analysis showed a strong correlation between EFT and weight and creatinine with a p-value of <.0001 and .033 respectively.Conclusion LSG can have a favourable impact on metabolic syndrome aspects, namely EFT, as it can decrease it considerably.