Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes

Abstract

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.

Epicardial adipose tissue: at the heart of the obesity complications

“…The term of 'paracardial fat' (also known as extrapericardial or intrathoracic) has been variably used to identify fat located on the outer surface of the fibrous pericardium [13]. EAT has been instead defined as the intrapericardial fat located between the myocardium and visceral pericardium, while the storage of triglycerides within the cardiomyocytes has been termed myocardial fat [12].…”

Epicardial Fat-mediated Inflammation: a Major Player in Cardiovascular Diseases

“…Computed cardiac angiography demonstrated its superiority over cardiac magnetic resonance and traditional echocardiography, being able to quantify with high accuracy global EAT volumes and local volumes of fat surrounding different structures, such as the left and right atrium or the coronary arteries. 5,[22][23][24] But epicardial fat is not the only metabolically active fat involved in the development of inflammatory reactions. Pericardial fat, as well as the fat accumulated in different regions of the body, could also be easily quantified by CT and can express an increased risk for different cardiovascular events.…”

Correlations Between Severity of Coronary Lesions and Epicardial Fat Volume in Patients with Coronary Artery Disease – a Multislice CT-based Study

“…Although the image resolution and accuracy is better on MRI, as compared with CT, currently MRI still remains limited, due to its high costs and low accessibility. 11,12 Recent evidence is suggesting that the EFV measured on MSCT may have a predictive value for coronary artery disease (CAD). 13 MSCT, unlike other imaging methods, is capable of simultaneously visualizing and quantifying the coronary atherosclerotic burden through the Coronary Calcium Score (CCS) and the Syntax Score (SxS), and also the total amount of epicardial adipose volume.…”