Echocardiographic epicardial fat: a review of research and clinical applications
Abstract
Epicardial fat plays a role in cardiovascular diseases. Because of its anatomic and functional proximity to the myocardium and its intense metabolic activity, some interactions between the heart and its visceral fat depot have been suggested. Epicardial fat can be visualized and measured using standard two-dimensional echocardiography. Standard parasternal long-axis and short-axis views permit the most accurate measurement of epicardial fat thickness overlying the right ventricle. Epicardial fat thickness is generally identified as the echo-free space between the outer wall of the myocardium and the visceral layer of pericardium and is measured perpendicularly on the free wall of the right ventricle at end-systole. Echocardiographic epicardial fat thickness ranges from a minimum of 1 mm to a maximum of almost 23 mm. Echocardiographic epicardial fat thickness clearly reflects visceral adiposity rather than general obesity. It correlates with metabolic syndrome, insulin resistance, coronary artery disease, and subclinical atherosclerosis, and therefore it might serve as a simple tool for cardiometabolic risk prediction. Substantial changes in echocardiographic epicardial fat thickness during weight-loss strategies may also suggest its use as a marker of therapeutic effect. Echocardiographic epicardial fat measurement in both clinical and research scenarios has several advantages, including its low cost, easy accessibility, rapid applicability, and good reproducibility. However, more evidence is necessary to evaluate whether echocardiographic epicardial fat thickness may become a routine way of assessing cardiovascular risk in a clinical setting.
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EAT is higher in subjects with T2DM and metabolic syndrome, independently of traditional body fat indicators.
“Epicardial adipose tissue is higher in subjects with T2DM and metabolic syndrome, independently of traditional body fat indicators [5–7].”
From Effects of Semaglutide Versus Dulaglutide on Epicardial Fat Thickness in Subjects with Type 2 Diabetes and Obesity (2020) · cites this paper as [5]
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Clinical importance of epicardial adipose tissue
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Gaborit, B., Kober, F., Jacquier, A., Moro, P. J., Cuisset, T., Boullu, S., Dadoun, F., Alessi, M.-C., Morange, P., Clément, K., et al. (2012) · International Journal of Obesity · doi:10.1038/ijo.2011.117 · Cited by 116 · see citing works
Statin therapy modulates thickness and inflammatory profile of human epicardial adipose tissue
Parisi, V., Petraglia, L., D'Esposito, V., Cabaro, S., Rengo, G., Caruso, A., Grimaldi, M. G., Baldascino, F., De Bellis, A., Vitale, D., et al. (2019) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.06.106 · Cited by 114 · see citing works
Epicardial fat: a new cardiovascular therapeutic target
Iacobellis, G. (2016) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2016.01.004 · Cited by 104 · see citing works
Lima-Martínez, M. M., Paoli, M., Rodney, M., Balladares, N., Contreras, M., D’Marco, L., & Iacobellis, G. (2016) · Endocrine · doi:10.1007/s12020-015-0710-y · Cited by 92 · see citing works
Self-citationEpicardial adipose tissue feeding and overfeeding the heart
Iacobellis, G., & Barbaro, G. (2019) · Nutrition · doi:10.1016/j.nut.2018.07.002 · Cited by 82 · see citing works
Self-citationIncreased Epicardial Adipose Tissue Thickness in Type 2 Diabetes Mellitus and Obesity
Song, D. K., Hong, Y. S., Lee, H., Oh, J.-Y., Sung, Y.-A., & Kim, Y. (2015) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2015.39.5.405 · Cited by 80 · see citing works
Nakanishi, K., Fukuda, S., Tanaka, A., Otsuka, K., Taguchi, H., & Shimada, K. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.08.001 · Cited by 62 · see citing works
Increased epicardial fat and plasma leptin in type 1 diabetes independently of obesity
Iacobellis, G., Diaz, S., Mendez, A., & Goldberg, R. (2014) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2013.11.001 · Cited by 54 · see citing works
Effect of exercise on epicardial adipose tissue in adults: A systematic review and meta-analyses
Colonetti, T., Grande, A. J., Amaral, M. C., Colonetti, L., Uggioni, M. L., da Rosa, M. I., Hernandez, A. V., Tse, G., Liu, T., Nerlekar, N., et al. (2021) · Heart Failure Reviews · doi:10.1007/s10741-020-09965-5 · Cited by 40 · see citing works
Salem, N. A., Batouty, N. M., Tawfik, A. M., Sobh, D. M., Gadelhak, B., Hendawy, S. R., & Laimon, W. (2021) · Journal of Clinical Research in Pediatric Endocrinology · doi:10.4274/jcrpe.galenos.2021.2021.0030 · Cited by 7 · see citing works
- Authors
- Iacobellis, G., & Willens, H. J.
- Affiliations
- McMaster University (CA)
- University of Miami (US)
- Corresponding author
- Iacobellis, Gianluca
- ORCID
- Iacobellis, Gianluca
- Venue
- Journal of the American Society of Echocardiography
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 22
- Issue
- 12
- Pages
- 1311-1319
- ISSN
- 0894-7317 (ISSN-L)
- OpenAlex
- W2129744024
- Cited by
- 700
- References
- 78
- Citations by year
- 2026: 38 · 2025: 32 · 2024: 40 · 2023: 31 · 2022: 49 · 2021: 46 · 2020: 56 · 2019: 58 · 2018: 48 · 2017: 39 · 2016: 53 · 2015: 45 · 2014: 51 · 2013: 45 · 2012: 29
- FWCI
- 3.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Society of Echocardiography (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- epicardial adipose tissue, visceral fat, right ventricle, cardiovascular risk prediction, cardiometabolic risk, metabolic syndrome, insulin resistance, coronary artery disease, subclinical atherosclerosis, weight loss
- MeSH terms
- Adipose Tissue, Echocardiography, Humans, Image Enhancement, Pericardium, Biomedical Research
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