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Review
. 2014 Dec;4(6):416-29.
doi: 10.3978/j.issn.2223-3652.2014.11.05.

Epicardial adipose tissue: far more than a fat depot

Andrew H Talman  1 , Peter J Psaltis  1 , James D Cameron  1 , Ian T Meredith  1 , Sujith K Seneviratne  1 , Dennis T L Wong  1
Affiliations
Review

Epicardial adipose tissue: far more than a fat depot

Andrew H Talman et al. Cardiovasc Diagn Ther. 2014 Dec.

Abstract

Epicardial adipose tissue (EAT) refers to the fat depot that exists on the surface of the myocardium and is contained entirely beneath the pericardium, thus surrounding and in direct contact with the major coronary arteries and their branches. EAT is a biologically active organ that may play a role in the association between obesity and coronary artery disease (CAD). Given recent advances in non-invasive imaging modalities such a multidetector computed tomography (MDCT), EAT can be accurately measured and quantified. In this review, we focus on the evidence suggesting a role for EAT as a quantifiable risk marker in CAD, as well as describe the role EAT may play in the development and vulnerability of coronary artery plaque.

Keywords: Epicardial adipose tissue (EAT); coronary artery disease (CAD); epicardial fat; multidetector computed tomography (MDCT).

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Figures

Figure 1
Figure 1
Epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT) separated by a clearly visible parietal pericardium (open arrow) on axial computed tomography images of the heart. Pericardial fat is made up of the combination of EAT plus PAT.
Figure 2
Figure 2
Figure illustrating epicardial and pericardial fat quantification. (A) On an axial view the pericardial sac is easily identified as a thin band enveloping the heart. Epicardial fat is the fat contained between the pericardium and the heart. (B) Total thoracic fat (epicardial fat plus paracardial fat). (C) The pericardial sac is traced by an expert observer in 10-20 axial slices between the upper and lower borders of the heart. (D) Semi-automated software calculates all epicardial fat (pink overlay), separated from paracardial fat (red overlay).
Figure 3
Figure 3
Proposed mechanisms in which epicardial adipokines may access underlying atheroma to play a role in coronary atherogenesis. (I) Paracrine signalling: adipokines directly diffuse through layers of the arterial wall; (II) vasocrine signalling: adipokines transverse through the vessel into adventitial vasa vasorum lumen and are transported downstream to react with cells in the intima and media around atherosclerotic plaques (20). Reproduced with permission from Elsevier Limited.
See this image and copyright information in PMC

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