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      Epicardial and Pericardial Fat Volume Correlate with the Severity of Coronary Artery Stenosis

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          Abstract

          Introduction: Epicardial fat volume (EFV) has been reported to correlate with the severity of coronary artery disease (CAD). Pericardial fat volume (PFV) has recently been reported to be strongly associated with CAD severity and presence. We aimed to investigate the relationship between EFV and PFV with severity of coronary artery stenosis in patients undergoing 64-slice multi-slice computed tomography (MSCT).

          Methods: One hundred and fifty one patients undergoing MSCT for suspected CAD were enrolled. Non-enhanced images were acquired to assess calcium score. Contrast enhanced images were used to quantify EFV, PFV and severity of luminal stenosis.

          Results: Coronary artery stenosis was mild in 25 cases (16.6%), moderate in 58 cases (38.4%) and severe in 68 cases (45%). With increase in severity of coronary artery stenosis, there was significant increase in PFV, EFV as well as epicardial fat thickness in right ventricle free wall in basal view and epicardial fat thickness in left ventricle posterior wall in mid and apical view. There was significant linear correlation between PFV with coronary calcification score (r=0.18, P=0.02), between coronary artery stenosis severity and PFV (r=0.75, P<0.001), EFV (r=0.79, P<0.001), apical epicardial fat thickness in right ventricle free wall (r=0.29, P<0.001), Mid (r=0.28, P<0.001) and basal (r=0.23, P=0.004) epicardial fat thickness in left ventricle posterior wall.

          Conclusion: PFV, EFV and regional epicardial thickness are correlated with severity of CAD and could be used as a reliable marker in predicting CAD severity.

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          Human epicardial adipose tissue is a source of inflammatory mediators.

          Tomasz Mazurek, LiFeng Zhang, Andrew Zalewski … (2003)
          Inflammatory mediators that originate in vascular and extravascular tissues promote coronary lesion formation. Adipose tissue may function as an endocrine organ that contributes to an inflammatory burden in patients at risk of cardiovascular complications. In this study, we sought to compare expression of inflammatory mediators in epicardial and subcutaneous adipose stores in patients with critical CAD. Paired samples of epicardial and subcutaneous adipose tissues were harvested at the outset of elective CABG surgery (n=42; age 65+/-10 years). Local expression of chemokine (monocyte chemotactic protein [MCP]-1) and inflammatory cytokines (interleukin [IL]-1beta, IL-6, and tumor necrosis factor [TNF]-alpha) was analyzed by TaqMan real-time reverse transcription-polymerase chain reaction (mRNA) and by ELISA (protein release over 3 hours). Significantly higher levels of IL-1beta, IL-6, MCP-1, and TNF-alpha mRNA and protein were observed in epicardial adipose stores. Proinflammatory properties of epicardial adipose tissue were noted irrespective of clinical variables (diabetes, body mass index, and chronic use of statins or ACE inhibitors/angiotensin II receptor blockers) or plasma concentrations of circulating biomarkers. In a subset of samples (n=11), global gene expression was explored by DNA microarray hybridization and confirmed the presence of a broad inflammatory reaction in epicardial adipose tissue in patients with coronary artery disease. The above findings were paralleled by the presence of inflammatory cell infiltrates in epicardial adipose stores. Epicardial adipose tissue is a source of several inflammatory mediators in high-risk cardiac patients. Plasma inflammatory biomarkers may not adequately reflect local tissue inflammation. Current therapies do not appear to eliminate local inflammatory signals in epicardial adipose tissue.
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            Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study.

            Guido A. Rosito, Joseph Massaro, Udo Hoffmann … (2008)
            Pericardial fat may be an important mediator of metabolic risk. Correlations with cardiovascular disease risk factors and vascular calcification in a community-based sample are lacking. We sought to examine associations between pericardial fat, metabolic risk factors, and vascular calcification. Participants free of cardiovascular disease from the Framingham Heart Study (n=1155, mean age 63 years, 54.8% women) who were part of a multidetector computed tomography study underwent quantification of intrathoracic fat, pericardial fat, visceral abdominal fat (VAT), coronary artery calcification, and aortic artery calcification. Intrathoracic and pericardial fat volumes were examined in relation to body mass index, waist circumference, VAT, metabolic risk factors, coronary artery calcification, and abdominal aortic calcification. Intrathoracic and pericardial fat were directly correlated with body mass index (r=0.41 to 0.51, P 0.05). Pericardial fat, but not intrathoracic fat, was associated with coronary artery calcification after multivariable and VAT adjustment (odds ratio 1.21, 95% confidence interval 1.005 to 1.46, P=0.04), whereas intrathoracic fat, but not pericardial fat, was associated with abdominal aortic calcification (odds ratio 1.32, 95% confidence interval 1.03 to 1.67, P=0.03). Pericardial fat is correlated with multiple measures of adiposity and cardiovascular disease risk factors, but VAT is a stronger correlate of most metabolic risk factors. However, intrathoracic and pericardial fat are associated with vascular calcification, which suggests that these fat depots may exert local toxic effects on the vasculature.
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              Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart.

              Gianluca Iacobellis, Domenico Corradi, Arya M. Sharma (2005)
              A growing amount of evidence suggests that regional fat distribution plays an important part in the development of an unfavorable metabolic and cardiovascular risk profile. Epicardial fat is a metabolically active organ that generates various bioactive molecules, which might significantly affect cardiac function. This small, visceral fat depot is now recognized as a rich source of free fatty acids and a number of bioactive molecules, such as adiponectin, resistin and inflammatory cytokines, which could affect the coronary artery response. The observed increases in concentrations of inflammatory factors in patients who have undergone coronary artery bypass grafting remain to be confirmed in healthy individuals. Furthermore, epicardial adipose mass might reflect intra-abdominal visceral fat. Therefore, we propose that echocardiographic assessment of this tissue could serve as a reliable marker of visceral adiposity. Epicardial adipose tissue is also clinically related to left ventricular mass and other features of the metabolic syndrome, such as concentrations of LDL cholesterol, fasting insulin and adiponectin, and arterial blood pressure. Echocardiographic assessment of epicardial fat could be a simple and practical tool for cardiovascular risk stratification in clinical practice and research. In this paper, we briefly review the rapidly emerging evidence pointing to a specific role of epicardial adipose tissue both as a cardiac risk marker and as a potentially active player in the development of cardiac pathology.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Thorac Res
                Journal ID (iso-abbrev): J Cardiovasc Thorac Res
                Journal ID (publisher-id): J Cardiovasc Thorac Res
                Journal ID (pmc): JCVTR
                Journal ID (publisher-id): TBZMED
                Title: Journal of Cardiovascular and Thoracic Research
                Publisher: Tabriz University of Medical Sciences
                ISSN (Print): 2008-5117
                ISSN (Electronic): 2008-6830
                Publication date (Print): 2014
                Publication date (Electronic): 30 December 2014
                Volume: 6
                Issue: 4
                Pages: 235-239
                Affiliations
                1Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
                2Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
                3Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
                Author notes
                [* ] Corresponding author: Elgar Enamzadeh, elgar_enamzadeh@ 123456yahoo.com
                Article
                DOI: 10.15171/jcvtr.2014.018
                PMC ID: 4291602
                SO-VID: 23c75844-c9ac-4199-aaa9-452fd30990c7
                Copyright © © 2014 The Author(s)
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 August 2014
                Date accepted : 19 December 2014
                Page count
                Tables: 3, References: 32, Pages: 5
                Categories
                Subject: Original Article

                Keywords: epicardial fat volume,pericardial fat volume,coronary artery disease,multi slice computed tomography
                Data availability:
                Keywords: epicardial fat volume, pericardial fat volume, coronary artery disease, multi slice computed tomography

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