Epicardial fat (EF) is a visceral fat deposit, located between the heart and the
pericardium, which shares many of the pathophysiological properties of other visceral
fat deposits, It also potentially causes local inflammation and likely has direct
effects on coronary atherosclerosis. Echocardiography, computed tomography and
magnetic resonance imaging have been used to evaluate EF, but variations between
methodologies limit the comparability between these modalities.We performed a systematic review of the literature finding associations of EF with
metabolic syndrome and coronary artery disease. The summarization of these
associations is limited by the heterogeneity of the methods used and the populations
studied, where most of the subjects were at high cardiovascular disease risk.EF is also associated with other known factors, such as obesity, diabetes mellitus,
age and hypertension, which makes the interpretation of its role as an independent
risk marker intricate. Based on these data, we conclude that EF is a visceral fat
deposit with potential implications in coronary artery disease. We describe the
reference values of EF for the different imaging modalities, even though these have
not yet been validated for clinical use. It is still necessary to better define
normal reference values and the risk associated with EF to further evaluate its role
in cardiovascular and metabolic risk assessment in relation to other criteria
currently used.
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