Epicardial fat and coronary artery disease: Role of cardiac imaging

Abstract

Epicardial adipose tissue (EAT) represents the fat depot located between the myocardium and the visceral pericardial layer. Far from being an inert tissue, EAT has been recognized as secreting a large amount of bioactive molecules called adipokines, which have numerous exocrine and paracrine effects. Recent evidence demonstrates that pericoronary adipose tissue (PCAT) -the EAT directly surrounding the coronary arterieshas a complex bidirectional interaction with the underlying vascular wall. While in normal conditions this mutual cross-talk helps maintain the homeostasis of the vascular wall, dysfunctional PCAT produces deleterious proinflammatory adipokines involved in atherogenesis. Importantly, PCAT inflammation has been associated with coronary artery disease (CAD) and major cardiovascular events.This review aims to provide an overview of the imaging techniques used to assess EAT, with a specific focus on cardiac computed tomography (CCT), which has become the key modality in this field. In contrast to echocardiography and cardiac magnetic resonance (CMR), CCT is not only able to visualize and precisely quantify EAT, but also to assess the coronary arteries and the PCAT simultaneously. In recent years, several papers have shown the utility of using CCT-derived PCAT attenuation as a surrogate measure of coronary inflammation. This noninvasive imaging biomarker may potentially be used to monitor patient responses to new antinflammatory drugs for the treatment of CAD.

Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: A review

“…The used definitions of the anatomical fat compartments in adjacent to the heart (i.e. especially epicardial adipose tissue (EAT), pericardial and paracardial) vary in the literature, although the epicardial fat compartment is often defined as the presence fat in the heart located between the myocardium and the visceral (inner) layer of pericardium [158], [159], [160]. We will briefly review the quantification of EAT using CT given the fact that EAT is biologically active tissue [161] and its radiological quantification has been of special interest [160] with respect to cardiovascular health [160].…”

Can We Decrease Epicardial and Pericardial Fat in Patients With Diabetes?

“…Measuring EAT and PAT, using different imaging modalities, is described in greater detail elsewhere. 29,52 -56…”

Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

“… [78] CCTA can measure lipid rich plaque, [79] as well as perivascular fat and inflammation. [ 80 , 81 ]…”

“… [85] Additional risk factors for CCTA contrast induced nephropathy beyond renal insufficiency (i.e., estimated glomerular filtration rate <45 ml min / 1.73m 2 ) include severe heart disease, dehydration, diabetes mellitus, multiple iodinated doses in a short time interval (<24 h) and use of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs and diuretics. [86] Sentinel Guidelines and References 2021 Epicardial fat and coronary artery disease: Role of cardiac imaging [81] 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: Recommendations for cardiovascular imaging [29] 2018 Coronary CT Angiography and 5-Year Risk of Myocardial Infarction [84] 2015 Outcomes of anatomical versus functional testing for coronary artery disease [87] 2015 Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations [88] …”