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Cardiac CT for Quantification of Epicardial Fat: Where to Measure and Why?

  • Cardiac Computed Tomography (TC Villines, Section Editor)
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Abstract

Epicardial adipose tissue has been attracting increasing attention over the last decade with a large body of evidence pointing towards significant associations between the volume of epicardial fat and atherosclerotic and non-atherosclerotic heart diseases. On the other hand, recent data from relatively large studies question the hypothesis of epicardial fat as an independent risk factor for atherosclerosis. This article reviews the available literature concerning imaging and quantification of epicardial adipose tissue and its potential clinical significance.

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References

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  1. Marwan M, Achenbach S. Quantification of epicardial fat by computed tomography: why, when and how? J Cardiovasc Comput Tomogr. 2013;7(1):3–10.

    Article  PubMed  Google Scholar 

  2. Cavalcante JL, Tamarappoo BK, Hachamovitch R, Kwon DH, Alraies MC, Halliburton S, et al. Association of epicardial fat, hypertension, subclinical coronary artery disease, and metabolic syndrome with left ventricular diastolic dysfunction. Am J Cardiol. 2012;110(12):1793–8. Role of epicardial adipose tissue on left ventricular diastolic dysfunction.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bucher AM, Joseph Schoepf U, Krazinski AW, Silverman J, Spearman JV, De Cecco CN, et al. Influence of technical parameters on epicardial fat volume quantification at cardiac CT. Eur J Radiol. 2015. doi:10.1016/j.ejrad.2015.03.018.

    PubMed  Google Scholar 

  4. Nakazato R, Shmilovich H, Tamarappoo BK, Cheng VY, Slomka PJ, Berman DS, et al. Interscan reproducibility of computer-aided epicardial and thoracic fat measurement from noncontrast cardiac CT. J Cardiovasc Comput Tomogr. 2011;5(3):172–9.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Thanassoulis G, Massaro JM, Hoffmann U, Mahabadi AA, Vasan RS, O'Donnell CJ, et al. Prevalence, distribution, and risk factor correlates of high pericardial and intrathoracic fat depots in the Framingham heart study. Circ Cardiovasc Imaging. 2010;3(5):559–66.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Cheng VY, Dey D, Tamarappoo B, Nakazato R, Gransar H, Miranda-Peats R, et al. Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events. JACC Cardiovasc Imaging. 2010;3(4):352–60.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Tamarappoo B, Dey D, Shmilovich H, Nakazato R, Gransar H, Cheng VY, et al. Increased pericardial fat volume measured from noncontrast CT predicts myocardial ischemia by SPECT. JACC Cardiovasc Imaging. 2010;3(11):1104–12.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Shmilovich H, Dey D, Cheng VY, Rajani R, Nakazato R, Otaki Y, 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. Am J Cardiol. 2011;108(11):1680–5.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2(10):536–43.

    Article  PubMed  Google Scholar 

  10. Sacks HS, Fain JN. Human epicardial adipose tissue: a review. Am Heart J. 2007;153(6):907–17.

    Article  CAS  PubMed  Google Scholar 

  11. Konishi M, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Matsubara J, et al. Association of pericardial fat accumulation rather than abdominal obesity with coronary atherosclerotic plaque formation in patients with suspected coronary artery disease. Atherosclerosis. 2010;209(2):573–8.

    Article  CAS  PubMed  Google Scholar 

  12. Alexopoulos N, McLean DS, Janik M, Arepalli CD, Stillman AE, Raggi P. Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis. 2010;210(1):150–4.

    Article  CAS  PubMed  Google Scholar 

  13. Rajani R, Shmilovich H, Nakazato R, Nakanishi R, Otaki Y, Cheng VY, et al. Relationship of epicardial fat volume to coronary plaque, severe coronary stenosis, and high-risk coronary plaque features assessed by coronary CT angiography. J Cardiovasc Comput Tomogr. 2013;7(2):125–32. Relationship between epicardial adipose tissue and potentially vulnerable plaques.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Yerramasu A, Dey D, Venuraju S, Anand DV, Atwal S, Corder R, et al. Increased volume of epicardial fat is an independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis. Atherosclerosis. 2012;220(1):223–30.

    Article  CAS  PubMed  Google Scholar 

  15. Hartiala O, Magnussen CG, Bucci M, Kajander S, Knuuti J, Ukkonen H, Saraste A, Rinta-Kiikka I, Kainulainen S, Kahonen M, Hutri-Kahonen N, Laitinen T, Lehtimaki T, Viikari JS, Hartiala J, Juonala M, Raitakari OT. Coronary heart disease risk factors, coronary artery calcification and epicardial fat volume in the Young Finns Study. Eur Heart J Cardiovasc Imaging 2015. Recent prospective study with a long follow-up

  16. Tanami Y, Jinzaki M, Kishi S, Matheson M, Vavere AL, Rochitte CE, et al. Lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population: results from the CORE320 multicenter study. Circ Cardiovasc Imaging. 2015;8(3):e002676. Relatively large patient sample performed in a multi-center setting with information regarding epicardial fat and several CAD parameters.

    Article  PubMed  Google Scholar 

  17. Oka T, Yamamoto H, Ohashi N, Kitagawa T, Kunita E, Utsunomiya H, et al. Association between epicardial adipose tissue volume and characteristics of non-calcified plaques assessed by coronary computed tomographic angiography. Int J Cardiol. 2012;161(1):45–9.

    Article  PubMed  Google Scholar 

  18. Harada K, Amano T, Uetani T, Tokuda Y, Kitagawa K, Shimbo Y, et al. Cardiac 64-multislice computed tomography reveals increased epicardial fat volume in patients with acute coronary syndrome. Am J Cardiol. 2011;108(8):1119–23.

    Article  PubMed  Google Scholar 

  19. 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(3):499–504.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Mahabadi AA, Berg MH, Lehmann N, Kalsch H, Bauer M, Kara K, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf recall study. J Am Coll Cardiol. 2013;61(13):1388–95. Data from a well-designed prospective study on the prognostic relevance of epicardial fat.

    Article  PubMed  Google Scholar 

  21. Forouzandeh F, Chang SM, Muhyieddeen K, Zaid RR, Trevino AR, Xu J, et al. Does quantifying epicardial and intrathoracic fat with noncontrast computed tomography improve risk stratification beyond calcium scoring alone? Circ Cardiovasc Imaging. 2013;6(1):58–66.

    Article  PubMed  Google Scholar 

  22. Stojanovska J, Kazerooni EA, Sinno M, Gross BH, Watcharotone K, Patel S, et al. Increased epicardial fat is independently associated with the presence and chronicity of atrial fibrillation and radiofrequency ablation outcome. Eur Radiol. 2015. doi:10.1007/s00330-015-3643-1.

    PubMed  Google Scholar 

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Conflict of Interest

Mohamed Marwan and Stephan Achenbach declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Cardiology Department, University Hospital Erlangen, Erlangen, Germany

    Mohamed Marwan & Stephan Achenbach

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  1. Mohamed Marwan
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  2. Stephan Achenbach
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Correspondence to Mohamed Marwan.

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This article is part of the Topical Collection on Cardiac Computed Tomography

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Marwan, M., Achenbach, S. Cardiac CT for Quantification of Epicardial Fat: Where to Measure and Why?. Curr Cardiovasc Imaging Rep 8, 39 (2015). https://doi.org/10.1007/s12410-015-9354-9

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  • DOI: https://doi.org/10.1007/s12410-015-9354-9

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