Journal of the American Society of Echocardiography
State of the Art Review ArticleEchocardiographic Epicardial Fat: A Review of Research and Clinical Applications
Section snippets
What Is Epicardial Fat and Where Is It Located?
Epicardial fat is the true visceral fat depot of the heart.1, 2, 3, 4, 5 Epicardial and intra-abdominal fat evolve from brown adipose tissue during embryogenesis. In the adult human heart, epicardial fat is commonly found in the atrioventricular and interventricular grooves. Minor foci of fat are also located subepicardially along the free walls of the atria and around the two appendages. As the amount of epicardial fat increases, it progressively fills the space between the ventricles,
Measurement of Epicardial Fat Using Echocardiography
Visceral fat deposition has been recognized as an important risk factor for cardiovascular disease.42, 43 The quantification of visceral fat is a helpful practical diagnostic tool for clinicians who are committed to managing patients at high risk for cardiovascular disease. In a clinical setting, visceral fat is typically measured by surrogate markers, such as waist circumference alone or the ratio of waist circumference to hip circumference. More direct measurements of visceral fat, including
Potential Uses of Echocardiographic Epicardial Fat Thickness for Diagnosis
The potential role of echocardiographic epicardial fat thickness as a marker and predictor of cardiometabolic risk has been evaluated. Different cutoff points of epicardial fat thickness for the prediction of metabolic syndrome, excess visceral fat accumulation, insulin resistance, subclinical atherosclerosis, and CAD have been proposed and are summarized in Table 1.
Potential Use of Echocardiographic Epicardial Fat for Monitoring Therapy
On the basis of the evidence that epicardial fat reflects visceral adiposity, its echocardiographic measurement has been used as a therapeutic target in subjects who undergo weight-loss interventions,70 bariatric surgery,71 exercise programs,72 and hormone-replacement treatment.73 Echocardiographic epicardial fat thickness significantly decreased in all 3 studies that included body weight modulations and changes. In fact, epicardial fat decreased after very low calorie diet, bariatric
Future Directions
Although several types of evidence have been provided, most published studies might not have large enough sample sizes to draw definitive conclusions to establish a strong association between echocardiographic epicardial fat thickness and cardiometabolic risk. The currently available data might not allow a precise estimate of the relationshipr, might not allow to fully explore the relationship within various subgroups, and might not allow the calculation of the diagnostic properties of
Conclusions
Echocardiographic epicardial fat is an inexpensive, reproducible, and direct measure of visceral fat. It may have an important role in predicting and stratifying cardiovascular risk in both clinical care and the research setting. However, more robust and convincing evidence is necessary to evaluate whether echocardiographic epicardial fat thickness may have these diagnostic and predictive properties and really become a routine way of assessing cardiovascular risk in a clinical setting. Further
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