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Abstract
<p class="first" id="d6965295e118">Epicardial adipose tissue (EAT) represents the
fat depot located between the myocardium
and the visceral pericardial layer. Far from being an inert tissue, EAT has been recognized
as secreting a large amount of bioactive molecules called adipokines, which have numerous
exocrine and paracrine effects. Recent evidence demonstrates that pericoronary adipose
tissue (PCAT) - the EAT directly surrounding the coronary arteries - has a complex
bidirectional interaction with the underlying vascular wall. While in normal conditions
this mutual cross-talk helps maintain the homeostasis of the vascular wall, dysfunctional
PCAT produces deleterious pro-inflammatory adipokines involved in atherogenesis. Importantly,
PCAT inflammation has been associated with coronary artery disease (CAD) and major
cardiovascular events. This review aims to provide an overview of the imaging techniques
used to assess EAT, with a specific focus on cardiac computed tomography (CCT), which
has become the key modality in this field. In contrast to echocardiography and cardiac
magnetic resonance (CMR), CCT is not only able to visualize and precisely quantify
EAT, but also to assess the coronary arteries and the PCAT simultaneously. In recent
years, several papers have shown the utility of using CCT-derived PCAT attenuation
as a surrogate measure of coronary inflammation. This noninvasive imaging biomarker
may potentially be used to monitor patient responses to new antinflammatory drugs
for the treatment of CAD.
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