Quantification of epicardial fat by computed tomography: why, when and how?

In the past decade, interest has grown in the relation between epicardial fat and cardiovascular disease. Several imaging modalities such as echocardiography, computed tomography, and magnetic resonance imaging can be used to quantify epicardial adipose tissue. Computed tomography provides high spatial resolution and true volume coverage of the heart; therefore, it constitutes an attractive approach to quantifying epicardial fat. An increasing body of evidence has been accumulated which shows a relation between epicardial fat volume and coronary atherosclerosis, cardiovascular outcomes, and even non-atherosclerotic heart disease such as atrial fibrillation. The association of increased epicardial fat volume with cardiac disease remains significant even after correction for weight, body mass index, and traditional cardiovascular risk factors. The mechanisms have not been reliably identified, but metabolic properties of epicardial fat may play a role. At the present time, epicardial fat quantification is not included in recommended algorithms for risk stratification. However, the available data are intriguing enough to warrant further research.

[1]  H. Furukawa,et al.  Relationship Between Epicardial Fat Measured by 64‐Multidetector Computed Tomography and Coronary Artery Disease , 2011, Clinical cardiology.

[2]  L. Sade,et al.  Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. , 2009, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[3]  M. Prokop,et al.  Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. , 2008, Atherosclerosis.

[4]  T Ishii,et al.  The effects of a myocardial bridge on coronary atherosclerosis and ischaemia , 1998, The Journal of pathology.

[5]  M. Yoon,et al.  Relationship of epicardial adipose tissue by echocardiography to coronary artery disease , 2007, Heart.

[6]  Eun Mi Lee,et al.  Echocardiographic epicardial fat thickness and coronary artery disease. , 2007, Circulation journal : official journal of the Japanese Circulation Society.

[7]  Hitoshi Nishizawa,et al.  Reciprocal Association of C-Reactive Protein With Adiponectin in Blood Stream and Adipose Tissue , 2003, Circulation.

[8]  Damini Dey,et al.  Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events. , 2010, JACC. Cardiovascular imaging.

[9]  Udo Hoffmann,et al.  Pericardial Fat, Intrathoracic Fat, and Measures of Left Ventricular Structure and Function: The Framingham Heart Study , 2009, Circulation.

[10]  Udo Hoffmann,et al.  Pericardial Fat, Visceral Abdominal Fat, Cardiovascular Disease Risk Factors, and Vascular Calcification in a Community-Based Sample: The Framingham Heart Study , 2008, Circulation.

[11]  S. Ishibashi,et al.  Hypoadiponectinemia is associated with visceral fat accumulation and insulin resistance in Japanese men with type 2 diabetes mellitus. , 2003, Metabolism: clinical and experimental.

[12]  T. Paavonen,et al.  Association between myocardial infarction and the mast cells in the adventitia of the infarct-related coronary artery. , 1999, Circulation.

[13]  Piotr J. Slomka,et al.  Increased pericardial fat volume measured from noncontrast CT predicts myocardial ischemia by SPECT. , 2010, JACC. Cardiovascular imaging.

[14]  E. Arbustini,et al.  Eccentric atherosclerotic plaques with positive remodelling have a pericardial distribution: a permissive role of epicardial fat? A three-dimensional intravascular ultrasound study of left anterior descending artery lesions. , 2003, European heart journal.

[15]  J. Shirani,et al.  Clinical significance of epicardial fat measured using cardiac multislice computed tomography. , 2008, The American journal of cardiology.

[16]  Y. Yamashita,et al.  Pericardial fat inflammation correlates with coronary artery disease. , 2010, Atherosclerosis.

[17]  F. Shih,et al.  Association of epicardial adipose tissue with coronary atherosclerosis is region-specific and independent of conventional risk factors and intra-abdominal adiposity. , 2011, Atherosclerosis.

[18]  Moyses Szklo,et al.  The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). , 2009, The American journal of clinical nutrition.

[19]  Udo Hoffmann,et al.  Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. , 2008, European heart journal.

[20]  R. Bonser,et al.  Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease , 2006, Cardiovascular diabetology.

[21]  J. Takasu,et al.  Pericardial fat accumulation in men as a risk factor for coronary artery disease. , 2001, Atherosclerosis.

[22]  D. Wilber,et al.  Pericardial fat is independently associated with human atrial fibrillation. , 2010, Journal of the American College of Cardiology.

[23]  Damini Dey,et al.  Threshold for the upper normal limit of indexed epicardial fat volume: derivation in a healthy population and validation in an outcome-based study. , 2011, The American journal of cardiology.

[24]  B. Carlin,et al.  ADIPOSE TISSUE DYSFUNCTION IN OBESITY, DIABETES, AND VASCULAR DISEASES , 2009 .

[25]  Prashanthan Sanders,et al.  Pericardial fat is associated with atrial fibrillation severity and ablation outcome. , 2011, Journal of the American College of Cardiology.

[26]  Kazuo Awai,et al.  Association between epicardial adipose tissue volume and characteristics of non-calcified plaques assessed by coronary computed tomographic angiography. , 2012, International journal of cardiology.

[27]  S. Kihara,et al.  Adipocyte-Derived Plasma Protein Adiponectin Acts as a Platelet-Derived Growth Factor-BB–Binding Protein and Regulates Growth Factor–Induced Common Postreceptor Signal in Vascular Smooth Muscle Cell , 2002, Circulation.

[28]  B. Wajchenberg Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. , 2000, Endocrine reviews.

[29]  S. Kihara,et al.  Adiponectin, an Adipocyte-Derived Plasma Protein, Inhibits Endothelial NF-&kgr;B Signaling Through a cAMP-Dependent Pathway , 2000, Circulation.

[30]  A. Stillman,et al.  EPICARDIAL ADIPOSE TISSUE AND CORONARY ARTERY PLAQUE CHARACTERISTICS , 2010 .

[31]  R. Seibel,et al.  Association of pericoronary fat volume with atherosclerotic plaque burden in the underlying coronary artery: a segment analysis. , 2010, Atherosclerosis.

[32]  Nikolaos Alexopoulos,et al.  Epicardial adipose tissue volume and coronary artery calcium to predict myocardial ischemia on positron emission tomography-computed tomography studies , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[33]  Tetsuya Kitagawa,et al.  Coronary atherosclerosis is associated with macrophage polarization in epicardial adipose tissue. , 2011, Journal of the American College of Cardiology.

[34]  I. Kakadiaris,et al.  Computer-aided non-contrast CT-based quantification of pericardial and thoracic fat and their associations with coronary calcium and Metabolic Syndrome. , 2010, Atherosclerosis.

[35]  D. Fowler,et al.  Adventitial lymphocytic inflammation in human coronary arteries with intimal atherosclerosis. , 2010, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[36]  Maximilian Reiser,et al.  Pericardial Adipose Tissue Determined by Dual Source CT Is a Risk Factor for Coronary Atherosclerosis , 2009, Arteriosclerosis, thrombosis, and vascular biology.

[37]  M. Jinzaki,et al.  Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions. , 2009, Circulation journal : official journal of the Japanese Circulation Society.

[38]  Y. Yamashita,et al.  Association of pericardial fat accumulation rather than abdominal obesity with coronary atherosclerotic plaque formation in patients with suspected coronary artery disease. , 2010, Atherosclerosis.

[39]  Mathias Prokop,et al.  Relation of epicardial and pericoronary fat to coronary atherosclerosis and coronary artery calcium in patients undergoing coronary angiography. , 2008, The American journal of cardiology.

[40]  Domenico Corradi,et al.  Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart , 2005, Nature Clinical Practice Cardiovascular Medicine.

[41]  D. Dey,et al.  Increase in epicardial fat volume is associated with greater coronary artery calcification progression in subjects at intermediate risk by coronary calcium score: a serial study using non-contrast cardiac CT. , 2011, Atherosclerosis.

[42]  Udo Hoffmann,et al.  Prevalence, Distribution, and Risk Factor Correlates of High Pericardial and Intrathoracic Fat Depots in the Framingham Heart Study , 2010, Circulation. Cardiovascular imaging.

[43]  H. Sacks,et al.  Human epicardial adipose tissue: a review. , 2007, American heart journal.

[44]  Y. Saijo,et al.  Relationship between C‐reactive protein and visceral adipose tissue in healthy Japanese subjects , 2004, Diabetes, obesity & metabolism.