Epicardial Adipose Tissue in Arrhythmogenic Cardiomyopathy

Abstract

Arrhythmogenic cardiomyopathy (ACM) is an inherited heart disease characterized by fibrofatty replacement of the ventricular myocardium, with an estimated prevalence of 1:5000 people in the general population. Sudden cardiac death is the first manifestation of this disease in 16-23% of patients with ACM. Fibrofatty infiltration can be identified with noninvasive cardiac magnetic resonance. Studies of epicardial fat deposits have suggested pathogenic roles of epicardial fats in mediating cardiac diseases and arrhythmias. Although myocardial fat infiltration has been well described in ACM, changes in epicardial fat deposits with this disease have not been well investigated. Our study shows that patients with ACM have a higher amount of EAT compared to controls. Additionally, the EAT amount seems to increase with the evolution of the disease.

Keywords: arrhythmogenic cardiomyopathy; cardiac magnetic resonance; epicardial adipose tissue.

Figure 1

A patient with ACM. Black-blood T1-weighted 4-chamber image shows an example of measuring interventricular groove EAT (red line).

Figure 2

EAT values in the two groups.

Figure 3

First and 2-year follow-up CMR in a patient with ACM. The two upper images are SSFP 4 chamber sequences showing the EAT measure at the baseline CMR (on the left) and at the 2-year follow-up CMR (on the right). The two lower images are LGE sequences at the baseline CMR (on the left) and at the 2-year follow-up CMR (on the right). The increase in EAT at the 2-year follow-up corresponds to a greater severity of the disease, highlighted by a more extensive LGE (ring-like distribution on the LV and RV free wall involvement).