Clinical Investigation
Pericardial Fat & Cardiometabolic Risk
Pericardial Rather Than Epicardial Fat is a Cardiometabolic Risk Marker: An MRI vs Echo Study

https://doi.org/10.1016/j.echo.2011.06.013Get rights and content

Background

Several studies using echocardiography identified epicardial adipose tissue (EPI) as an important cardiometabolic risk marker. However, validation compared with magnetic resonance imaging (MRI) or computed tomography has not been performed. Moreover, pericardial adipose tissue (PERI) has recently been shown to have some correlation with cardiovascular disease risk factors. The aims of this study were to validate echocardiographic analyses compared with MRI and to evaluate which cardiac fat depot (EPI or PERI) is the most appropriate cardiovascular risk marker.

Methods

Forty-nine healthy subjects were studied (age range, 25–68 years; body mass index, 21–40 kg/m2), and PERI and EPI fat depots were measured using echocardiography and MRI. Findings were correlated with MRI visceral fat and subcutaneous fat, blood pressure, insulin sensitivity, triglycerides, cholesterol, insulin, glucose, and 10-year coronary heart disease risk.

Results

Most cardiac fat was constituted by PERI (about 77%). PERI thickness by echocardiography was well correlated with MRI area (r = 0.36, P = .009), and independently of the technique used for quantification, PERI was correlated with body mass index, waist circumference, visceral fat, subcutaneous fat, blood pressure, insulin sensitivity, triglycerides, cholesterol, glucose, and coronary heart disease risk. On the contrary, EPI thicknesses correlated only with age did not correlate significantly with MRI EPI areas, which were found to correlate with age, body mass index, subcutaneous fat, and hip and waist circumferences.

Conclusions

Increased cardiac fat in the pericardial area is strongly associated with features of the metabolic syndrome, whereas no correlation was found with EPI, indicating that in clinical practice, PERI is a better cardiometabolic risk marker than EPI.

Section snippets

Subjects

The patient population under investigation was a subset of subjects who participated in previously published studies,7, 20 selected according to the following criteria: (1) absence of diabetes at enrollment, (2) BMI < 40 kg/m2, (3) absence of metabolic or nonmetabolic diseases (except essential hypertension), and (4) no treatment with drugs known to affect glucose tolerance. A subset of subjects enrolled for the metabolic study also agreed to undergo complete rest echocardiography. Thus, the

Results

Clinical, echocardiographic, and MRI characteristics of the study population are reported in Table 1. As shown in the table, in this group of subjects with a wide range of BMIs, most cardiac fat was constituted by PERI (77%). In Figure 1, we report two sample cases acquired with MRI and echocardiography.

Discussion

In obese patients, PERI was strongly correlated with the metabolic syndrome, whereas no correlation was found with EPI. In particular, PERI was associated with cardiovascular risk factors, increased visceral fat accumulation, blood pressure, glucose tolerance, lipid concentrations, insulin resistance, and 10-year CHD risk calculated using the Framingham score. Moreover, when comparing ultrasound and cardiac magnetic resonance (CMR) for the detection of total fat and the relative contribution of

Conclusions

Imaging of cardiac fat has relevant implications for the assessment of risk in several subsets of patients.2, 6, 10, 12 Our results demonstrate that MRI and ultrasound are comparable for the assessment of adipose tissue, with differences strictly related to technology characteristics: MRI was more accurate and operator independent than echocardiography and not limited by the acoustic window, but with threefold higher cost, lower availability, and longer imaging and analysis times. PERI is

Acknowledgments

We acknowledge the expert technical assistance of Emma Buzzigoli, Filomena Fabrizio, Sandra Patti, and Demetrio Ciociaro.

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    Drs. Sicari and Sironi contributed equally to this work. This study was financially supported by funds from the Italian National Research Council. Dr. Gastaldelli is a recipient of a grant from the European Foundation for the Study of Diabetes.

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