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Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart

Nature Clinical Practice Cardiovascular Medicine volume 2, pages 536–543 (2005)Cite this article

Abstract

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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Figure 1: Macroscopic appearance of epicardial fat.
Figure 2: Microscopic appearance of epicardial fat.
Figure 3: Echocardiographic imaging of epicardial adipose tissue.
Figure 4: MRI of epicardial adipose tissue.

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References

  1. Grundy SM et al. (2004) Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on scientific issues related to definition. Circulation 109: 433–438

    Article  Google Scholar 

  2. Carr DB et al. (2004) Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes 53: 2087–2094

    Article  CAS  Google Scholar 

  3. Kershaw EE et al. (2004) Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 89: 2548–2556

    Article  CAS  Google Scholar 

  4. Sharma AM (2002) Adipose tissue: a mediator of cardiovascular risk. Int J Obes Relat Metab Disord 26 (Suppl 4): S5–S7

    Article  CAS  Google Scholar 

  5. Dusserre E et al. (2000). Differences in mRNA expression of the proteins secreted by the adipocytes in human subcutaneous and visceral adipose tissues. Biochim Biophys Acta 1500: 88–96

    Article  CAS  Google Scholar 

  6. Wajchenberg BL (2000). Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2: 697–738

    Article  Google Scholar 

  7. Sharma AM (2004) Mediastinal fat, insulin resistance, and hypertension. Hypertension 44: 117–118

    Article  CAS  Google Scholar 

  8. Silver M and Silver M (2001) Examination of the heart and of cardiovascular specimens in surgical pathology. In Cardiovascular Pathology, edn 3, 1–29 (Ed Schoen F). Philadelphia: Churchill Livingstone

    Google Scholar 

  9. Marchington JM et al. (1989) Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B 94: 225–232

    Article  CAS  Google Scholar 

  10. Corradi D et al. (2004). The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts. Cardiovasc Pathol 13: 313–316

    Article  Google Scholar 

  11. Olivetti G et al. (1995) Gender differences and aging: effects on the human heart. J Am Coll Cardiol 26: 1068–1079

    Article  CAS  Google Scholar 

  12. Iacobellis G et al. (2003) Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 11: 304–310

    Article  Google Scholar 

  13. Iacobellis G et al. (2003) Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 88: 5163–5168

    Article  CAS  Google Scholar 

  14. Iacobellis G et al. (2003) Images in cardiology: massive epicardial adipose tissue indicating severe visceral obesity. Clin Cardiol 26: 237

    Article  Google Scholar 

  15. Sironi AM et al. (2004) Visceral fat in hypertension: influence on insulin resistance and β-cell function. Hypertension 44: 127–133

    Article  CAS  Google Scholar 

  16. Schejbal V (1989) Epicardial fatty tissue of the right ventricle morphology, morphometry and functional significance. Pneumologie 43: 490–499

    CAS  PubMed  Google Scholar 

  17. Reiner L et al. (1955). Statistical analysis of the epicardial fat weight in human hearts. AMA Arch Pathol 60: 369–373

    CAS  PubMed  Google Scholar 

  18. Reiner L et al. (1959). The weight of the human heart, I. Normal cases. AMA Arch Pathol 68: 58–73

    CAS  PubMed  Google Scholar 

  19. Reiner LMA et al. (1961). The weight of the human heart, II. Hypertensive cases. Arch Pathol 71: 180–201

    CAS  PubMed  Google Scholar 

  20. Reiner LMA et al. (1964). The weight of the human heart. III. Ischemic heart disease. Arch Pathol 77: 205–217

    PubMed  Google Scholar 

  21. Shirani J et al. (1995). Quantitative measurement of normal and excessive (cor adiposum) subepicardial adipose tissue, its clinical significance, and its effect on electrocardiographic QRS voltage. Am J Cardiol 76: 414–418

    Article  CAS  Google Scholar 

  22. Tansey DK et al. (2005) Fat in the right ventricle of the normal heart. Histopathology 46: 98–104

    Article  CAS  Google Scholar 

  23. Iacobellis G et al. (2004). Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol 94: 1084–1087

    Article  Google Scholar 

  24. Pond CM (1998) The Fats of Life. Cambridge: Cambridge University Press

    Book  Google Scholar 

  25. Mattacks CA and Pond CM (1987) Site-specific and sex differences in the rates of fatty acid/triacylglycerol substrate cycling in adipose tissue and muscle of sedentary and exercised dwarf hamsters. Int J Obes 12: 585–597

    Google Scholar 

  26. Caffier G and Krunes RM (1984) Action of free fatty acids on contractility and action potential of the heart. In Cellular and Molecular Aspects of the Regulation of the Heart: Proceedings of the Symposium held in Berlin, 1982, 279–280 (Eds Will-Shahab L et al.) Berlin: Akademie-Verlag

    Google Scholar 

  27. Manzella D et al. (2002) Elevated post-prandial free fatty acids are associated with cardiac sympathetic overactivity in type II diabetic patients. Diabetologia 45: 1737–1738

    Article  CAS  Google Scholar 

  28. Manzella D et al. (2001) Role of free fatty acids on cardiac autonomic nervous system in noninsulin-dependent diabetic patients: effects of metabolic control. J Clin Endocrinol Metab 86: 2769–2774

    Article  CAS  Google Scholar 

  29. Paolisso G et al. (1997) Association of fasting plasma free fatty acid concentration and frequency of ventricular premature complexes in nonischemic non-insulin-dependent diabetic patients. Am J Cardiol 80: 932–937

    Article  CAS  Google Scholar 

  30. Mazurek T et al. (2003) Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 108: 2460–2466

    Article  Google Scholar 

  31. Iacobellis G et al. (2005) Adiponectin expression in human epicardial adipose tissue in vivo is lower in patients with coronary artery disease. Cytokine 29: 251–255

    CAS  PubMed  Google Scholar 

  32. Lauer MN et al. (2000) AGT, PAI and resistin gene expression in human epicardial fat [abstract #100]. 38th Annual Meeting of the European Association for the Study of Diabetes, Budapest, Hungary, OP017

  33. Heymes C et al. (2003) Increased myocardial NADPH oxidase activity in human heart failure. J Am Coll Cardiol 41: 2164–2671

    Article  CAS  Google Scholar 

  34. Kalra DK et al. (2002) Increased myocardial gene expression of tumor necrosis factor-α and nitric oxide synthase-2: a potential mechanism for depressed myocardial function in hibernating myocardium in human. Circulation 105: 1537–1540

    Article  CAS  Google Scholar 

  35. Laine P et al. (1999) Association between myocardial infarction and the mast cells in the adventitia of the infarct-related coronary artery. Circulation 99: 361–369

    Article  CAS  Google Scholar 

  36. Moreno PR et al. (2002) Intimomedial interface damage and adventitial inflammation is increased beneath disrupted atherosclerosis in the aorta: implications for plaque vulnerability. Circulation 105: 2504–2511

    Article  Google Scholar 

  37. LiFeng Z et al. (2003) Diabetes-induced oxidative stress and low-grade inflammation in porcine coronary arteries. Circulation 108: 472–478

    Article  Google Scholar 

  38. Miyata K et al. (2000) Rho-kinase is involved in macrophage-mediated formation of coronary vascular lesions in pigs in vivo. Arterioscler Thromb Vasc Biol 20: 2351–2358

    Article  CAS  Google Scholar 

  39. Shimokawa H et al. (1996) Chronic treatment with interleukin-1β induces coronary intimal lesions and vasospastic responses in pigs in vivo. J Clin Invest 97: 769–776

    Article  CAS  Google Scholar 

  40. Lohn M et al. (2002) Periadventitial fat releases a vascular relaxing factor. FASEB J 16: 1057–1063

    Article  Google Scholar 

  41. Wei M et al. (1997) Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans—a 7-year prospective study. Obes Res 5: 16–23

    Article  CAS  Google Scholar 

  42. Ross R et al. (1994) Sex differences in lean and adipose tissue distribution by magnetic resonance imaging: anthropometric relationships. Am J Clin Nutr 59: 1277–1285

    Article  CAS  Google Scholar 

  43. Ross R et al. (1992) Quantification of adipose tissue by MRI: relationship with anthropometric variables. J Appl Physiol 72: 787–795

    Article  CAS  Google Scholar 

  44. Kamel EG et al. (2000) Usefulness of anthropometry and DXA in predicting intra-abdominal fat in obese men and women. Obes Res 8: 36–42

    Article  CAS  Google Scholar 

  45. Bonora E et al. (1995) Is it possible to derive a reliable estimate of human visceral and subcutaneous abdominal adipose tissue from simple anthropometric measurements? Metabolism 44: 1617–1625

    Article  CAS  Google Scholar 

  46. Iwao S et al. (2001) Does waist circumference add to the predictive power of the body mass index for coronary risk? Obes Res 9: 685–695

    Article  CAS  Google Scholar 

  47. Ribeiro-Filho RR et al. (2003) Methods of estimation of visceral fat: advantages of ultrasonography. Obes Res 11: 1488–1494

    Article  Google Scholar 

  48. Pontiroli AE et al. (2002) Ultrasound measurement of visceral and subcutaneous fat in morbidly obese patients before and after laparoscopic adjustable gastric banding: comparison with computerized tomography and with anthropometric measurements. Obes Surg 12: 648–651

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. a Clinical Research Fellow, Department of Medicine, Cardiovascular Obesity Research and Management at the Michael G deGroote School of Medicine, Hamilton, Ontario, Canada

    Gianluca Iacobellis

  2. a Canada Research Chair in the Department of Medicine, Cardiovascular Obesity Research and Management at the Michael G deGroote School of Medicine, Hamilton, Ontario, Canada

    Arya M Sharma

  3. Assistant Professor in the Pathology Section at the University of Parma, Italy

    Domenico Corradi

Authors
  1. Gianluca Iacobellis
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  2. Domenico Corradi
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  3. Arya M Sharma
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Corresponding author

Correspondence to Gianluca Iacobellis.

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The authors declare no competing financial interests.

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Iacobellis, G., Corradi, D. & Sharma, A. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Rev Cardiol 2, 536–543 (2005). https://doi.org/10.1038/ncpcardio0319

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