Pericardial fat and its influence on cardiac diastolic function

Abstract

Background: Pericardial fat (PF) has been suggested to directly act on cardiomyocytes, leading to diastolic dysfunction. The aim of this study was to investigate whether a higher PF volume is associated with a lower diastolic function in healthy subjects. Methods: 254 adults (40-70 years, BMI 18-35 kg/m 2 , normal left ventricular ejection fraction), with (a)typical chest pain (otherwise healthy) from the cardiology outpatient clinic were retrospectively included in this study. All patients underwent a coronary computed tomographic angiography for the measurement of pericardial fat volume, as well as a transthoracic echocardiography for the assessment of diastolic function parameters. To assess the independent association of PF and diastolic function parameters, multivariable linear regression analysis was performed. To maximize differences in PF volume, the group was divided in low (lowest quartile of both sexes) and high (highest quartile of both sexes) PF volume. Multivariable binary logistic analysis was used to study the associations within the groups between PF and diastolic function, adjusted for age, BMI, and sex. Results: Significant associations for all four diastolic parameters with the PF volume were found after adjusting for BMI, age, and sex. In addition, subjects with high pericardial fat had a reduced left atrial volume index (p = 0.02), lower E/e (p < 0.01) and E/A (p = 0.01), reduced e′ lateral (p < 0.01), reduced e′ septal p = 0.03), compared to subjects with low pericardial fat. Conclusion: These findings confirm that pericardial fat volume, even in healthy subjects with normal cardiac function, is associated with diastolic function. Our results suggest that the mechanical effects of PF may limit the distensibility of the heart and thereby directly contribute to diastolic dysfunction.

A prospective randomized study comparing effects of empagliflozin to sitagliptin on cardiac fat accumulation, cardiac function, and cardiac metabolism in patients with early-stage type 2 diabetes: the ASSET study

“…Considering these previous studies, 12 weeks might have been insufficient to improve cardiac function and structure; furthermore, since cardiac function and structure were well-preserved at baseline in this study, no further improvement may have been detectable following empagliflozin treatment. In addition, a recent study reported that pericardial fat volume was associated with diastolic function even in healthy subjects with normal cardiac function [16], which supports our results showing that no reduction in pericardial fat volume or improvement in diastolic function was observed in parallel. Interestingly, although there was no difference in cardiac function between the groups, sitagliptin significantly decreased LVEF and %FS from baseline to 12 weeks.…”

“…It has been suggested that cardiac fat accumulation causes excessive release of proinflammatory cytokines and free fatty acids, resulting in myocardial intracellular lipotoxicity, myocardial fibrosis, and cardiac dysfunction [11][12][13][14][15][16][17]. Although both SGLT2 inhibitors and DPP-4 inhibitors reduce epicardial fat [18][19][20][21][22], no clinical studies have been performed to compare the effectiveness of these inhibitors on pericardial and epicardial fat, as well as myocardial triglyceride content.…”

Measurement of Epicardial Fat Using Non-contrast Routine Chest-CT: A Consideration of Threshold Adjusting for Fatty Attenuation

“…When using the same threshold of (-190HU, -30HU), both EFV and EFA measurement correlated well with each other (r2= 0.974, 0.516) (Figure 2a, 3a). Bland-Altman analysis showed the mean difference (95% LoA) of EFV and EFV N30 was -15.2 (-29.7 to -0.6) cm 3 , which suggesting an overestimate about 15.2% in RCCT compared with CCTA using the same threshold (Figure 2c). While the agreement of EFA between CCTA and RCCT was good, the mean difference (95% LoA) of EFA and EFA N30 was 0 (-6.1 to 6.2)HU (Figure 3c) .…”

“…The visceral fat located between the myocardial surface and the visceral layer of pericardium known as epicardial fat (EF) is well known as an important imaging indicator for cardiovascular risk strati cation [1]. Evidence during the last two decades show that EF play various regulating roles relating to cardiac biology including atherosclerosis progression, atrial brillation and heart failure [2][3][4][5]. EF also acts as a paracrine or vasocrine organ by locally releasing bioactive cytokines into the adjacent interstitium of the myocardium and coronary arteries [6].…”

Cardiac Adiposity and Arrhythmias: The Role of Imaging

“…Cardiac CT has been increasingly used for assessment of EAT/PAT ( Figure 2 ) [ 15 ]. A radiodensity threshold, of −190 to −30 Hounsfield (HU) units on non-contrast scans and −190 to −3 HU on contrast enhanced CT scans is accurate and reproducible for diagnosis and quantification of EAT volume [ 16 ].…”