Curriculum in CardiologyHuman epicardial adipose tissue: A review
Section snippets
Anatomy and physiology of EAT
The epicardium or visceral layer of the pericardium is a population of mesothelial cells that migrate onto the surface of the heart from the area of the septum transversum (the embryological source of the diaphragm). Epicardial, mesenteric, and omental fat all share the same origin from the splanchnopleuric mesoderm associated with the gut.11 In the normal adult, epicardial fat is concentrated in the atrioventricular (AV) and interventricular (IV) grooves and along the major branches of the
Autopsy
Corradi et al27 dissected epicardial fat from the underlying myocardium in a series of 117 patients and found that it accounted for approximately 15% (mean, 54 ± 23 g [±SD]) of a normal heart weight (365 ± 49 g). They also found a direct correlation between LV and RV mass and corresponding epicardial fat mass. In a later study, the same authors confirmed the direct correlation (r = 0.755, P = .01) between EAT mass and myocardial ventricular mass measured by echocardiography in 60 subjects with
Pathophysiology of adipose tissue and adipokines in obesity
The pathophysiology of adipokine expression and secretion in VAT and SCAT needs to be reviewed to provide a conceptual basis for understanding adipokine pathophysiology. In contrast to the lack of studies comparing EAT in healthy nonobese and obese humans, the expression and secretion of adipokines in VAT and SCAT have been well documented in biopsies taken from lean healthy patients at elective intra-abdominal surgery as compared with biopsies from obese healthy patients undergoing bariatric
Epicardial fat in obesity
In their 1933 report on adiposity of the heart, Smith and Willius58 performed autopsies on 136 obese patients (mean 43% above ideal body weight; range, 13%-103%). They noted that “in most instances, a definite relationship between the excess of epicardial fat and the degree of general obesity occurred.” This observation was based on increased heart weight and not on dissected epicardial fat mass. As epicardial fat increases, it extends over the anterior surface of the heart, more over the RV
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Disclosure: Harold S. Sacks is a member of the Speakers Bureau and has received honoraria from Takeda Pharmaceuticals and Merck Pharmaceuticals.