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2011 | 6 | 3 | 251-262
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Epicardial adipose tissue and relationship with coronary artery disease

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Epicardial adipose tissue (EAT) is metabolically active tissue that accumulates around the coronary arteries. Epicardial fat is a rich source of free fatty acids and may contribute to local inflammatory load by increased synthesis of inflammatory cytokines. Direct passage of bioactive molecules into the coronary arteries due to close contact with the vascular wall and the lack of fascia may contribute to the pathogenesis of coronary artery disease. Direct correlation between visceral fat and EAT defines the latter as an indirect marker of intra-abdominal visceral adiposity. EAT is related to anthropometric and clinical features of the metabolic syndrome (MS) and to hepatic transaminases as markers of steatohepatitis. An increase in EAT thickness is related to an increase in left ventricular mass and is correlated with atrial enlargement and impairment in diastolic filling in obesity. Echocardiographic study of EAT is an easy and reliable imaging indicator of visceral adiposity and cardiovascular risk. EAT is an independent factor strongly correlated with significant coronary stenosis. A level of EAT above an established average value can be considered a predictive marker of cardiovascular risk. We review the most recent studies proving the specific active role of EAT in the development of cardiac disease.
Physical description
1 - 6 - 2011
8 - 4 - 2011
  • Department of Endocrinology, County Clinic Emergency Hospital, Cluj-Napoca, 400349, Romania
  • 2nd Department of Internal Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
  • Department of Endocrinology, County Clinic Emergency Hospital, Cluj-Napoca, 400349, Romania
  • 2nd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
  • 2nd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
  • [1] Vague J., La différenciation sexuelle, facteur déterminant des formes de l’obésité, Presse Med., 1947, 55, 339–340
  • [2] Bjorntrop P., Metabolic implications of body fat distribution, Diabetes Care, 1991, 14, 1132–1143[Crossref]
  • [3] Ravussin E., Smith S.R., Increased fat intake, impaired fat oxidation, and failure of fat cell proliferation result in ectopic fat storage, insulin resistance, and type 2 diabetes mellitus, Ann N Y Acad Sci, 2002 Jun, 967, 363–378[Crossref]
  • [4] Rabkin S.W., Epicardial fat: properties, function and relationship to obesity, Obes Rev, 2007 May, 8, 253–261 [Crossref]
  • [5] Marchington J.M., Mattacks C.A., Pond C.M., Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties, Comp Biochem Physiol, 1989, 94, 225–232
  • [6] Stern N., Marcus Y., Perivascular fat: innocent bystander or active player in vascular disease?, J Cardiometab Syndr, 2006, Spring, 1, 115–120[Crossref]
  • [7] Willens H.J., Gómez-Marín O., Comparison of epicardial and pericardial fat thickness assessed by echocardiography in African American and non-Hispanic White men: a pilot study, Ethn Dis, 2008, Summer, 18, 311–316
  • [8] Reiner L., Mazzoleni A., Rodriguez F.l., Statistical analysis of the epicardial fat weight in human hearts, AMA Arch Pathol, 1955 Oct, 60, 369–373
  • [9] Corradi D., Maestri R., Callegari S., Pastori P., Goldoni M., Luong T.V., et al., The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts, Cardiovasc Pathol, 2004, 13, 313–316[Crossref]
  • [10] Iacobellis G., Assael F., Ribaudo M.C., 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[Crossref]
  • [11] Silaghi A., Piercecchi-Marti M.D., Grino M., Leonetti G., Alessi M.C., Clement K., et al., Epicardial adipose tissue extent: relationship with age, body fat distribution, and coronaropathy, Obesity, 2008, 16, 2424–2430[Crossref]
  • [12] Shimokawa H., Ito A., Fukumoto Y., Kadokami T., Nakaike R., Sakata M., et al., Chronic treatment with interleukin-1 beta induces coronary intimal lesions and vasospastic responses in pigs in vivo. The role of platelet-derived growth factor, J Clin Invest, 1996, 97, 769–776
  • [13] Miyata K., Shimokawa H., Kandabashi T., Higo T., Morishige K., Eto Y., et al., Rho-kinase is involved in macrophagemediated formation of coronary vascular lesions in pigs in vivo, Arterioscler Thromb Vasc Biol, 2000, Nov, 20, 2351–2358 [Crossref]
  • [14] Ishii T., Asuwa N., Masuda S., Ishikawa Y., The effects of a myocardial bridge on coronary atherosclerosis and ischaemia, J Pathol, 1998, May 185, 4–9<4::AID-PATH50>3.0.CO;2-3[Crossref]
  • [15] Ishikawa Y., Ishii T., Asuwa N., Masuda S., Absence of atherosclerosis evolution in the coronary arterial segment covered by myocardial tissue in cholesterol-fed rabbits, Virchows Arch, 1997, Feb 430, 163–171[Crossref]
  • [16] Henrichot E., Juge-Aubry C.E., Pernin A., Production of chemokines by perivascular adipose tissue: a role in the pathogenesis of atherosclerosis?, Arterioscler Thromb Vasc Biol, 2005, Dec, 25, 2594–2599[Crossref]
  • [17] Mazurek T., Zhang L., Zalewski A., Mannion J.D., Diehl J.T., Arafat H.,et al., Human epicardial adipose tissue is a source of inflammatory mediators, Circulation, 2003,18;108(20), 2460–2466[Crossref]
  • [18] Karastergiou K., Evans I., Ogston N., Miheisi N., Nair D., Kaski JC., et al., Epicardial adipokines in obesity and coronary artery disease induce atherogenic changes in monocytes and endothelial cells, Arterioscler Thromb Vasc Biol, 2010, 30, 1340–1346[Crossref]
  • [19] 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, 21,29, 251–255
  • [20] Iglesias M.J., Eiras S., Piñeiro R., López-Otero D., Gallego R., Fernández A.L., et al., Gender differences in adiponectin and leptin expression in epicardial and subcutaneous adipose tissue, Findings in patients undergoing cardiac surgery, Rev Esp Cardiol, 2006, 59, 1252–1260[Crossref]
  • [21] Kourliouros A., Karastergiou K., Nowell J., Gukop P., Tavakkoli Hosseini M., et al., Protective effect of epicardial adiponectin on atrial fibrillation following cardiac surgery. Eur J Cardiothorac Surg, 2010, Jul 5, in press, DOI:10.1016/j.ejcts.2010.05.006 [Crossref]
  • [22] Baker A.R., Silva N.F., Quinn D.W., Harte A.L., Pagano D., Bonser R.S., et al., Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease, Cardiovasc, Diabetol, 2006, 5, 1–7[Crossref]
  • [23] Fain J.N., Sacks H.S., Buehrer B., Bahouth S.W., Garrett E., Wolf R.Y., 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[Crossref]
  • [24] Malavazos A.E., Ermetici F., Cereda E., Ambrosi B., Epicardial fat thickness: relationshipwith plasma visfatin and plasminogen activator inhibitor-1 levels in visceral obesity, Nutr Metab Cardiovasc Dis, 2008, 18, 523–530[Crossref]
  • [25] Roubícek T., Dolinková M., Bláha J., Haluzíková D., Bosanská L., Mráz M., et al., Increased angiotensinogen production in epicardial adipose tissue during cardiac surgery: possible role in a postoperative insulin resistance, Physiol Res, 2008, 57, 911–917
  • [26] Ferder L., Inserra F., Martínez-Maldonado M., Inflammation and the metabolic syndrome: role of angiotensin II and oxidative stress, Curr Hypertens Rep, 2006, 8, 191–198[Crossref]
  • [27] Kurata A., Nishizawa H., Kihara S., Maeda N., Sonoda M., Okada T., et al. Blockade of Angiotensin II type-1 receptor reduces oxidative stress in adipose tissue and ameliorates adipocytokine dysregulation, Kidney Int, 2006, 70, 1717–1724[Crossref]
  • [28] Hamid S.A., Baxter G.F., Adrenomedullin: regulator of systemic and cardiac homeostasis in acute myocardial infarction, Pharmacol Therapeut, 2005, 105, 95–112[Crossref]
  • [29] Ishimitsu T., Ono H., Minami J., Matsuoka H., Pathophysiologic and therapeutic implications of adrenomedullin in cardiovascular disorders, Pharmacol Therapeut, 2006, 111, 909–927[Crossref]
  • [30] Hamid S.A., Baxter G.F., A critical cytoprotective role of endogenous adrenomedullin in acute myocardial infarction, J Mol Cell Cardiol, 2006, 41, 360–363[Crossref]
  • [31] 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[Crossref]
  • [32] Marchington J.M., Pond C.M., 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 vitro, Int J Obes, 1990, 14, 1013–1022
  • [33] Vural B., Atalar F., Ciftci C., Demirkan A., Susleyici-Duman B., Gunay D., et al., Presence of fatty-acidbinding protein 4 expression in human epicardial adipose tissue in metabolic syndrome, Cardiovasc Pathol, 2008, 17, 392–398[Crossref]
  • [34] Pond C.M., The contribution of wild animal biology to human physiology and medicine: adipose tissue associated with lymphoid and cardiac tissues, Ecoscience, 2003, 10, 1–9
  • [35] Salgado-Somoza A., Teijeira-Fernández E., Fernández A.L., González-Juanatey J.R., Eiras S., Proteomic analysis of epicardial and subcutaneous adipose tissue reveals differences in proteins involved in oxidative stress, Am J Physiol Heart Circ Physiol, 2010, 299, H202–H209[Crossref]
  • [36] Iacobellis G., Leonetti F., Epicardial adipose tissue and insulin resistance in obese Subjects, J Clin Endocrinol Metab, 2005, 90, 6300–6302[Crossref]
  • [37] Sacks H.S., Fain J.N., Human epicardial adipose tissue: a review, Am Heart J, 2007 Jun, 153, 907–917[Crossref]
  • [38] Iacobellis G., Ribaudo M.C., 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[Crossref]
  • [39] Singh N., Singh H., Khanijoun HK., Iacobellis G., Echocardiographic assessment of epicardial adipose tissue - a marker of visceral adiposity, Mcgill J Med, 2007, 10, 26–30
  • [40] 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[Crossref]
  • [41] Ahn S.G., Lim H.S., Joe D.Y., Kang S.J., Choi B.J., Choi S.Y., et al., Relationship of Epicardial Adipose Tissue by Echocardiography to Coronary Artery Disease, Relationship of epicardial adipose tissue by echocardiography to coronary artery disease, Heart, 2008, 94, e7[Crossref]
  • [42] Iacobellis G., Singh N., Wharton S., Sharma A.M., Substantial changes in epicardial fat thickness after weight loss in severely obese subjects, Obesity (Silver Spring), 2008, 16, 1693–1697[Crossref]
  • [43] Willens H.J., Byers P., Chirinos J.A., Labrador E., Hare J.M., de Marchena E., et al., Effects of weight loss after bariatric surgery on epicardial fat measured using echocardiography, Am J Cardiol, 2007, 1, 99, 1242–1245[Crossref]
  • [44] 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[Crossref]
  • [45] Iacobellis G., Imaging of visceral adipose tissue: an emerging diagnostic tool and therapeutic target, Curr Drug Targets Cardiovasc Haematol Disord, 2005, 5, 345–353[Crossref]
  • [46] Gorter P.M., van Lindert A.S., de Vos A.M., Meijs M.F., van der Graaf Y., Doevendans P.A., et al., Quantification of epicardial and pericoronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease, Atherosclerosis, 2008, 197, 896–903[Crossref]
  • [47] Flüchter., Haghi D., Dinter D., Heberlein W., Kühl H.P., Neff W., et al., Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging, Obesity (Silver Spring), 2007, 15, 870–878[Crossref]
  • [48] Kessels K., Cramer M.J., Velthuis B., Epicardial adipose tissue imaged by magnetic resonance imaging: an important risk marker of cardiovascular disease, Heart, 2006, 92, 962[Crossref]
  • [49] Sarin S., Wenger C., Marwaha A., Qureshi A., Go B.D., Woomert C.A., et al., Clinical significance of epicardial fat measured using cardiac multislice computed tomography, Am J Cardiol, 2008, Sep 15, 102, 767–771[Crossref]
  • [50] Bastarrika G., Broncano J., Schoepf UJ., Schwarz F., Lee YS., Abro JA., et al., Relationship between coronary artery disease and epicardial adipose tissue quantification at cardiac CT: comparison between automatic volumetric measurement and manual bidimensional estimation, Acad Radiol, 2010, 17, 727–734[Crossref]
  • [51] Kankaanpää M., Lehto H.R., Pärkkä J.P., Komu M., Viljanen A., Ferrannini E., et al. Myocardial triglyceride content and epicardial fat mass in human obesity: relationship to left ventricular function and serum free fatty acid levels, J Clin Endocrinol Metab, 2006, 91, 4689–4695[Crossref]
  • [52] Vasan R.S., Cardiac function and obesity, Heart, 2003, 89, 1127–1129[Crossref]
  • [53] Pascual M., Pascual D.A., Soria F., Effects of isolated obesity on systolic and diastolic left ventricular function, Heart, 2003, 89, 1152–1156[Crossref]
  • [54] Peterson L.R., Waggoner A.D., Schechtman K.B., Meyer T., Gropler R.J., Barzilai B., et al., Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging, J Am Coll Cardiol, 2004, 43, 1399–1404[Crossref]
  • [55] Otto M.E., Belohlavek M., Romero-Corral A., Gami A.S., Gilman G., Svatikova A., et al. Comparison of right and left ventricular function in obese and nonobese men, Am J Cardiol, 2004, 93, 1569–1572[Crossref]
  • [56] Krishnan R., Becker R.J., Beighley L.M., Lopez-Candales A., Impact of body mass index on markers of left ventricular thickness and mass calculation: results of a pilot analysis, Echocardiography, 2005, 22, 203–210[Crossref]
  • [57] Iacobellis G., Ribaudo MC., Zappaterreno A., Iannucci C.V., Leonetti F., et al., Prevalence of uncomplicated obesity in an Italian obese population, Obes Res, 2005, 13, 1116–122[Crossref]
  • [58] Iacobellis G., Ribaudo M.C., 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[Crossref]
  • [59] Iacobellis G., True uncomplicated obesity is not related to increased left ventricular mass and systolic dysfunction, J Am Coll Cardiol, 2004, 44, 2257[Crossref]
  • [60] Iacobellis G., Ribaudo MC., Zappaterreno A., Iannucci C.V., Di Mario U., Leonetti F., et al., Adapted changes in left ventricular structure and function in severe uncomplicated obesity, Obes Res, 2004, 12, 1616–1621[Crossref]
  • [61] Iacobellis G., Ribaudo MC., Zappaterreno A., Iannucci C.V., Leonetti F., et al., Relation between epicardial adipose tissue and left ventricular mass, Am J Cardiol, 2004, 94, 1084–1087[Crossref]
  • [62] Gates P.E., Gentile C.L., Seals D.R., Christou D.D., Adiposity contributes to differences in left ventricular structure and diastolic function with age in healthy men, J Clin Endocrinol Metab, 2003, 88, 4884–4890[Crossref]
  • [63] Mureddu G.F., Greco R., Rosato G.F., Cella A., Vaccaro O., Contaldo F., et al. Relation of insulin resistance to left ventricular hypertrophy and diastolic dysfunction in obesity, Int J Obes Relat Metab Disord, 1998, 22, 363–368[Crossref]
  • [64] Iacobellis G., Leonetti F., Singh N., M Sharma A., Relationship of epicardial adipose tissue with atrial dimensions and diastolic function in morbidly obese subjects. Int J Cardiol, 2007, 115, 272–273[Crossref]
  • [65] Kazlauskaite R., Doukky R., Evans A., Margeta B., Ruchi A., Fogelfeld L., et al., Predictors of diastolic dysfunction among minority patients with newly diagnosed type 2 diabetes, Diabetes Res Clin Pract, 2010, 88, 189–195
  • [66] Iacobellis G., Pellicelli A.M., Grisorio B., Barbarini G., Leonetti F., Sharma A.M., et al., Relation of epicardial fat and alanine aminotransferase in subjects with increased visceral fat, Obesity (Silver Spring), 2008, 16, 179–183[Crossref]
  • [67] Cikim A.S., Topal E., Harputluoglu M., Keskin L., Zengin Z., Cikim K., et al. Epicardial adipose tissue, hepatic steatosis and obesity, J Endocrinol Invest, 2007, 30, 459–464 [Crossref]
  • [68] Stramaglia G., Greco A., Guglielmi G., De Matthaeis A., Vendemiale GL., Echocardiography and dual-energy x-ray absorptiometry in the elderly patients with metabolic syndrome: a comparison of two different tecniques to evaluate visceral fat distribution, J Nutr Health Aging, 2010, 14, 6–10[Crossref]
  • [69] Perseghin G., Lattuada G., De Cobelli F., Esposito A., Belloni E., Ntali 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[Crossref]
  • [70] Prati F., Arbustini E., Labellarte A., Sommariva L., Pawlowski T., Manzoli A., et al., Eccentric atherosclerotic plaques with positive remodelling have a pericardial distribution: a permissive role of epicardial fat? A threedimensional intravascular ultrasound study of left anterior descending artery lesions, Eur Heart J, 2003, 24, 329–336[Crossref]
  • [71] Iacobellis G., Gao YJ., Sharma AM., Do cardiac and perivascular adipose tissue play a role in atherosclerosis?, Curr Diab Rep, 2008, 8, 20–24[Crossref]
  • [72] Jeong J.W., Jeong M.H., Yun K.H., Oh S.K., Park E.M., Kim Y.K., et al., Echocardiographic epicardial fat thickness and coronary artery disease, Circ J, 2007, 71, 536–539[Crossref]
  • [73] Chaowalit N., Somers V.K., Pellikka P.A, Rihal C.S., Lopez-Jimenez F., et al., Subepicardial adipose tissue and the presence and severity of coronary artery disease, Atherosclerosis, 2006, 186, 354–359[Crossref]
  • [74] Chaowalit N., Lopez-Jimenez F., Epicardial adipose tissue: friendly companion or hazardous neighbour for adjacent coronary arteries?, Eur Heart J., 2008, 29, 695–697[Crossref]
  • [75] Gorter P.M., de Vos A.M., van der Graaf Y., Stella P.R., Doevendans P.A., Meijs M.F., 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[Crossref]
  • [76] Iacobellis G., Willens H.J., Barbaro G., Sharma A.M., Threshold Values of High-risk Echocardiographic Epicardial Fat Thickness, Obesity (Silver Spring), 2008, 16, 887–892[Crossref]
  • [77] 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[Crossref]
  • [78] Iacobellis G., Sharma A.M., Pellicelli A.M, Grisorio B., Barbarini G., Barbaro G., et al., 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[Crossref]
  • [79] Lanes R., Soros A., Flores K., Gunczler P., Carrillo E., Bandel J., et al., 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[Crossref]
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