Journal of the American Society of Echocardiography
Volume 22, Issue 12 , Pages 1311-1319 , December 2009

Echocardiographic Epicardial Fat: A Review of Research and Clinical Applications

  • Gianluca Iacobellis, MD, PhD

      Affiliations

    • Department of Medicine, Division of Endocrinology, McMaster University, Hamilton, Ontario, Canada
    • Corresponding Author InformationReprint requests: Gianluca Iacobellis, MD, PhD, St Joseph's Hospital, Department of Medicine, 50 Charlton Avenue East, 5th Fontbonne Building, Hamilton, ON L8N 4A6, Canada
    • ,
  • Howard J. Willens, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida

References 

  1. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2:536–543
  2. Sacks HS, Fain JN. Human epicardial adipose tissue: a review. Am Heart J. 2007;153:907–917
  3. Rabkin RW. Epicardial fat: properties, function and relationship to obesity. Obesity Rev. 2007;8:253–261
  4. Reiner L, Mazzoleni A, Rodriguez FL. Statistical analysis of the epicardial fat weight in human hearts. AMA Arch Pathol. 1955;60:369–373
  5. Schejbal V. Epicardial fatty tissue of the right ventricle: morphology, morphometry and functional significance. Pneumologie. 1989;43:490–499
  6. Iacobellis G, Barbaro G. The double role of epicardial adipose tissue as pro- and anti-inflammatory organ. Horm Metab Res. 2008;40:442–445
  7. Marchington JM, Pond CM. Site specific properties of pericardial and epicardial adipose tissue: the effects of insulin and high-fat feeding on lipogenesis and the incorporation of fatty acids in vivo. Int J Obesity. 1990;14:1013–1022
  8. Sacks HS, Fain JN, Holman B, Cheema P, Chary A, Parks F, et al. Uncoupling protein-1 and related mRNAs in human epicardial and other adipose tissues: epicardial fat functioning as brown fat. J Clin Endocrinol Metab. 2009;94:3611–3615
  9. Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108:2460–2466
  10. Baker AR, Silva NF, Quinn DW, Harte AL, Pagano D, Bonser RS, et al. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol. 2006;13:1
  11. Chaldakov GN, Fiore M, Stankulov IS, Manni L, Hristova MG, Antonelli A, et al. Neurotrophin presence in human coronary atherosclerosis and metabolic syndrome: a role for NGF and BDNF in cardiovascular disease?. Prog Brain Res. 2004;146:279–289
  12. Kremen J, Dolinkova M, Krajickova J, Blaha J, Anderlova K, Lacinova Z, et al. Increased subcutaneous and epicardial adipose tissue production of proinflammatory cytokines in cardiac surgery patients: possible role in postoperative insulin resistance. J Clin Endocrinol Metab. 2006;91:4620–4627
  13. Cheng KH, Chu CS, Lee KT, Lin TH, Hsieh CC, Chiu CC, et al. Adipocytokines and proinflammatory mediators from abdominal and epicardial adipose tissue in patients with coronary artery disease. Int J Obes (Lond). 2008;32:268–274
  14. Fain JN, Sacks HS, Buehrer B, Bahouth SW, Garrett E, Wolf RY, et al. Identification of omentin mRNA in human epicardial adipose tissue: comparison to omentin in subcutaneous, internal mammary artery periadventitial and visceral abdominal depots. Int J Obes (Lond). 2008;32:810–815
  15. Iacobellis G, Pistilli D, Gucciardo M, Leonetti F, Miraldi F, Brancaccio G, et al. Adiponectin expression in human epicardial adipose tissue in vivo is lower in patients with coronary artery disease. Cytokine. 2005;29:251–255
  16. Iacobellis G, di Gioia CR, Cotesta D, Petramala L, Travaglini C, De Santis V, et al. Epicardial adipose tissue adiponectin expression is related to intracoronary adiponectin levels. Horm Metab Res. 2009;41:227–231
  17. Silaghi A, Achard V, Paulmyer-Lacroix O, Scridon T, Tassistro V, Duncea I, et al. Expression of adrenomedullin in human epicardial adipose tissue: role of coronary status. Am J Physiol Endocrinol Metab. 2007;293:E1443–E1450
  18. Iacobellis G, Gioia CR, Di Vito M, Petramala L, Cotesta D, De Santis V, et al. Epicardial adipose tissue and intracoronary adrenomedullin levels in coronary artery disease. Horm Metab Res. In press.
  19. Clark A. Lectures on diseases of the heart: delivered at the college of physicians and surgeons. New York: Bermingham & Company; 1884;142-149
  20. Iacobellis G. Epicardial and pericardial fat: close, but very different. Obesity (Silver Spring). 2009;17:625
  21. Shirani J, Berezowski K, Roberts WC. Quantitative measurement of normal and excessive (cor adiposum) subepicardial adipose tissue, its clinical significance, and its effect on electrocardiographic QRS voltage. Am J Cardiol. 1995;76:414–418
  22. Schoenmackers J, Willmen HR. On lipomatosis cordis, its relations to the efficiency and insufficiency of the right ventricle [article in German]. Arch Kreislaufforsch. 1963;40:251–283
  23. Ho E, Shimada Y. Formation of the epicardium studied with the scanning electron microscope. Dev Biol. 1978;66:579–585
  24. Sons HU, Hoffmann V. Epicardial fat cell size, fat distribution and fat infiltration of the right and left ventricle of the heart. Anat Anz. 1986;161:355–373
  25. Clément K, Basdevant A, Dutour A. Weight of pericardial fat on coronaropathy. Arterioscler Thromb Vasc Biol. 2009;29:615
  26. Nelson AJ, Worthley MI, Psaltis PJ, Carbone A, Dundon BK, Duncan RF, et al. Validation of cardiovascular magnetic resonance assessment of pericardial adipose tissue volume. J Cardiovasc Magn Reson. 2009;11:15–18
  27. Mahabadi AA, Massaro JM, Rosito GA, Levy D, Murabito JM, Wolf PA, et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J. 2009;30:850–856
  28. Fox CS, Gona P, Hoffmann U, Porter SA, Salton CJ, Massaro JM, et al. Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham Heart Study. Circulation. 2009;119:1586–1591
  29. Marchington JM, Mattacks CA, Pond CM. Adipose tissue in the mammalian heart and pericardium; structure, foetal development and biochemical properties. Comp Biochem Physiol. 1989;94B:225–232
  30. Moore KL, Persaud TVN. The developing human. Clinically oriented embryology. 7th ed.. Philadelphia, PA: Saunders; 2003;189
  31. Corradi D, Maestri R, Callegari S, Pastori P, Goldoni M, Luong TV, et al. The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts. Cardiovasc Pathol. 2004;13:313–316
  32. Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 2008;117:605–613
  33. Ding J, Hsu FC, Harris TB, Liu Y, Kritchevsky SB, Szklo M, et al. The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2009;90:499–504
  34. Greif M, Becker A, von Ziegler F, Lebherz C, Lehrke M, Broedl UC, et al. Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis. Arterioscler Thromb Vasc Biol. 2009;29:781–786
  35. Taguchi R, Takasu J, Itani Y, Yamamoto R, Yokoyama K, Watanabe S, et al. Pericardial fat accumulation in men as a risk factor for coronary artery disease. Atherosclerosis. 2001;157:203–209
  36. Wheeler GL, Shi R, Beck SR, Langefeld CD, Lenchik L, Wagenknecht LE, et al. Pericardial and visceral adipose tissues measured volumetrically with computed tomography are highly associated in type 2 diabetic families. Invest Radiol. 2005;40:97–101
  37. Silaghi A, Piercecchi-Marti MD, Grino M, Leonetti G, Alessi MC, Clement K, et al. Epicardial adipose tissue extent: relationship with age, body fat distribution, and coronaropathy. Obesity (Silver Spring). 2008;16:2424–2430
  38. Gorter PM, de Vos AM, van der Graaf Y, Stella PR, Doevendans PA, Meijs MF, et al. Relation of epicardial and pericoronary fat to coronary atherosclerosis and coronary artery calcium in patients undergoing coronary angiography. Am J Cardiol. 2008;102:380–385
  39. de Vos AM, Prokop M, Roos CJ, Meijs MF, van der Schouw YT, Rutten A. Peri-coronary epicardial adipose tissue is related to cardiovascular risk factors and coronary artery calcification in post-menopausal women. Eur Heart J. 2007;29:777–783
  40. Wang CP, Hsu HL, Hung WC, Yu TH, Chen YH, Chiu CA, et al. Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis. Clin Endocrinol (Oxf). 2009;70:876–882
  41. Djaberi R, Schuijf JD, van Werkhoven JM, Nucifora G, Jukema JW, Bax JJ. Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol. 2008;102:1602
  42. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. INTERHEART Study Investigators Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–952
  43. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48
  44. Iacobellis G. Imaging of visceral adipose tissue: an emerging diagnostic tool and therapeutic target. Curr Drug Targets Cardiovasc Haematol Disord. 2005;5:345–353
  45. Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res. 2003;11:304–310
  46. Iacobellis G, Willens HJ, Barbaro G, Sharma AM. threshold values of high-risk echocardiographic epicardial fat thickness. Obesity (Silver Spring). 2008;16:887–892
  47. Sade LE, Eroglu S, Bozbaş H, Ozbiçer S, Hayran M, Haberal A, et al. Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. Atherosclerosis. 2009;204:580–585
  48. Jeong JW, Jeong MH, Yun KH, Oh SK, Park EM, Kim YK. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J. 2007;71:536–539
  49. Natale F, Tedesco MA, Mocerino R, de Simone V, Di Marco GM, Aronne L, et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiogr. 2009;10:549–555
  50. Saura D, Oliva MJ, Rodríguez D, Pascual-Figal DA, Hurtado JA, Pinar E, et al. Reproducibility of echocardiographic measurements of epicardial fat thickness. Int J Cardiol. In press.
  51. Wang TD, Lee WJ, Shih FY, Huang CH, Chang YC, Chen WJ, et al. Relations of epicardial adipose tissue measured by multidetector computed tomography to components of the metabolic syndrome are region-specific and independent of anthropometric indexes and intraabdominal visceral fat. J Clin Endocrinol Metab. 2009;94:662–669
  52. Sarin S, Wenger C, Marwaha A, Qureshi A, Go BD, Woomert CA, et al. Clinical significance of epicardial fat measured using cardiac multislice computed tomography. J Cardiol. 2008;102:767–771
  53. Abbara S, Desai JC, Cury RC, Butler J, Nieman K, Reddy V. Mapping epicardial fat with multi-detector computed tomography to facilitate percutaneous transepicardial arrhythmia ablation. Eur J Radiol. 2006;57:417–422
  54. Iacobellis G, Sharma AM. Adiposity of the heart. Ann Intern Med. 2006;145:554–555
  55. Kankaanpaa M, Lehto HR, Parkka J Komu P, Viljanen A, Ferrannini E, et al. Myocardial triglyceride content and epicardial adipose mass in human obesity: relationship to left ventricular function and serum free fatty acid levels. J Clin Endocrinol Metab. 2006;91:4689–4695
  56. Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab. 2003;88:5163–5168
  57. Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab. 2005;90:6300–6302
  58. Iacobellis G, Barbaro G, Gerstein HC. Relationship of epicardial fat thickness and fasting glucose. Int J Cardiol. 2008;128:424–426
  59. Malavazos AE, Ermetici F, Cereda E, Coman C, Locati M, Morricone L, et al. Epicardial fat thickness: relationship with plasma visfatin and plasminogen activator inhibitor-1 levels in visceral obesity. Nutr Metab Cardiovasc Dis. 2008;18:523–530
  60. Ahn SG, Lim HS, Joe DY, Kang SJ, Choi BJ, Choi SY. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart. 2008;94:e7
  61. Iacobellis G, Pellicelli AM, Grisorio B, Barbarini G, Leonetti F, Sharma AM, et al. Relation of epicardial fat and alanine aminotransferase in subjects with increased visceral fat. Obesity (Silver Spring). 2008;16:179–183
  62. Eroglu S, Sade LE, Yildirir A, Bal U, Ozbicer S, Ozgul AS, et al. Epicardial adipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease. Nutr Metab Cardiovasc Dis. 2009;19:211–217
  63. Iacobellis G, Gao YJ, Sharma AM. Do cardiac and perivascular adipose tissue play a role in atherosclerosis?. Curr Diab Rep. 2008;8:20–24
  64. Iacobellis G, Pellicelli AM, Sharma AM, Grisorio B, Barbarini G, Barbaro G. Relation of subepicardial adipose tissue to carotid intima-media thickness in patients with human immunodeficiency virus. Am J Cardiol. 2007;99:1470–1472
  65. Iacobellis G, Sharma AM, Pellicelli AM, Grisorio B, Barbarini G, Barbaro G. Epicardial adipose tissue is related to carotid intima-media thickness and visceral adiposity in HIV-infected patients with highly active antiretroviral therapy-associated metabolic syndrome. Curr HIV Res. 2007;5:275–279
  66. Iacobellis G, Ribaudo MC, Zappaterreno A, Iannucci CV, Leonetti F. Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol. 2004;94:1084–1087
  67. Iacobellis G, Pond CM, Sharma AM. Different “weight” of cardiac and general adiposity in predicting left ventricle morphology. Obesity (Silver Spring). 2006;14:1679–1684
  68. Iacobellis G, Leonetti F, Singh N, Sharma AM. Relationship of epicardial adipose tissue with atrial dimensions and diastolic function in morbidly obese subjects. Int J Cardiol. 2007;115:272–273
  69. Iacobellis G, Ribaudo MC, Leto G, Zappaterreno A, Vecci E, Di Mario U, et al. Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes Res. 2002;10:767–773
  70. Iacobellis G, Singh N, Wharton S, Sharma AM. Substantial changes in epicardial fat thickness after weight loss in severely obese subjects. Obesity (Silver Spring). 2008;16:1693–1697
  71. Willens HJ, Byers P, Chirinos JA, Labrador E, Hare JM, de Marchena E. Effects of weight loss after bariatric surgery on epicardial fat measured using echocardiography. Am J Cardiol. 2007;99:1242–1245
  72. Kim MK, Tomita T, Kim MJ, Sasai H, Maeda S, Tanaka K. Aerobic exercise training reduces epicardial fat in obese men. J Appl Physiol. 2009;106:5–11
  73. Lanes R, Soros A, Flores K, Gunczler P, Carrillo E, Bandel J. Endothelial function, carotid artery intima-media thickness, epicardial adipose tissue, and left ventricular mass and function in growth hormone-deficient adolescents: apparent effects of growth hormone treatment on these parameters. J Clin Endocrinol Metab. 2005;90:3978–3982
  74. Iacobellis G, Sharma AM. Epicardial adipose tissue as new cardio-metabolic risk marker and potential therapeutic target in the metabolic syndrome. Curr Pharm Des. 2007;13:2180–2184
  75. Willens HJ, Gómez-Marín O, Chirinos JA, Goldberg R, Lowery MH, Iacobellis G. Comparison of epicardial and pericardial fat thickness assessed by echocardiography in African American and non-Hispanic white men: a pilot study. Ethn Dis. 2008;18:311–316
  76. Chaowalit N, Somers VK, Pellikka PA, Rihal CS, Lopez-Jimenez F. Subepicardial adipose tissue and the presence and severity of coronary artery disease. Atherosclerosis. 2006;186:354–359
  77. Perseghin G, Lattuada G, De Cobelli F, Esposito A, Belloni E, Natali G, et al. Increased mediastinal fat and impaired left ventricular energy metabolism in young men with newly found fatty liver. Hepatology. 2008;47:51–58

PII: S0894-7317(09)00996-1

doi: 10.1016/j.echo.2009.10.013

Journal of the American Society of Echocardiography
Volume 22, Issue 12 , Pages 1311-1319 , December 2009

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