The Role of Epicardial Adipose Tissue in Heart Disease

Abstract

Recent studies focused on epicardial fat, formerly relatively neglected component of the heart, have elucidated some of its key roles. It possesses several properties that can distinguish it from other adipose tissue depots. Its unique anatomical location in the heart predisposes the epicardial fat to be an important player in the physiological and biochemical regulation of cardiac homeostasis. Obesity is associated with an increase in epicardial fat mass. Excess of cardiac fat can contribute to greater left ventricular mass and work, diastolic dysfunction and attenuated septal wall thickening. Imbalance in adipokines levels secreted in autocrine or paracrine fashion by epicardial fat can contribute to the activation of the key atherogenic pathways in the setting of metabolic syndrome. Epicardial fat has also been identified as an important source of pro-inflammatory mediators worsening endothelial dysfunction, eventually leading to coronary artery disease. Increased production of pro-inflammatory factors by epicardial fat can also contribute to systemic insulin resistance in patients undergoing cardiac surgery. Here we review the most important roles of epicardial fat with respect to heart disease in the context of other underlying pathologies such as obesity and type 2 diabetes mellitus.

Cardio-renal Correlations and Epicardial Adipose Tissue in Patients with Type 2 Diabetes

“…hyperglycemia/insulin resistance, fatty acid overload with increased β oxidation and OS), endocrine/paracrine, and inflammatory pathways. 4,23 This could also be true for CKD, as our data, as well as data from another recent paper in patients with/without CKD, indicated correlation between EAT accumulation and eGFR (r = −0.34, p <0.01). 7 Additional putative factors/ pathological mechanisms suggested to correlate EAT with heart disease and/or CKD were microangiopathy/endothelial dysfunction, pro-atherogenic mediators, and adipokines (increased leptin, resistin, decreased adiponectin).…”

“…The epicardial adipose tissue (EAT) is a metabolically active visceral fat deposit surrounding the heart, associated with detrimental or cardioprotective effects. 4 In patients with type 2 diabetes (T2D), EAT volume was shown to be higher and EAT thickness (EATT) to correlate with fasting glucose. 5,6 A recent paper suggested that higher EAT volume is also associated with CKD, showing a good correlation between EAT and the estimated glomerular filtration rate (eGFR).…”

Effect of parathyroidectomy on epicardial fat thickness as a cardiovascular risk factor in patients with primary hyperparathyroidism

“…Adipose tissue is not just considered a primary site for fat storage; it also serves as an endocrine organ by secreting several hormones and adipokines including leptin, adiponectin, and tumor necrosis factor-α (TNF-α), which have proinflammatory, proatherogenic, or protective effects and lead to negative metabolic and cardiovascular outcomes [13,14]. Extraabdominal deposition of fat as epicardial and intraabdominal visceral adiposity are now suggested as markers of CVD risk [15][16][17]. Epicardial fat can synthesize and release adipokines and bioactive factors that may extend into the myocardium through vasocrine and/or paracrine pathways.…”

Associations Between Homeostasis Model Assessment (HOMA) and Routinely Examined Parameters in Individuals With Metabolic Syndrome

“…Obesity is a major clinical problem in developed societies. It is well known that obesity and MS are associated with increased morbidity and mortality (Matloch et al 2016). According to some definitions, visceral obesity, as measured by waist circumference (WC), is stressed over other components of MS (Kassi et al 2011).…”