Epicardial adipose tissue in contemporary cardiology

Iacobellis, Gianluca

doi:10.1038/s41569-022-00679-9

Cited by 812Cardiovascular Disease and AdiposityCardiac Fibrosis and RemodelingCardiac Imaging and Diagnostics

Epicardial adipose tissue in contemporary cardiology

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Iacobellis, Gianluca·2022·Nature Reviews Cardiology

DOI 10.1038/s41569-022-00679-9PMC PMC8926097

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Abstract

Interest in epicardial adipose tissue (EAT) is growing rapidly, and research in this area appeals to a broad, multidisciplinary audience. EAT is unique in its anatomy and unobstructed proximity to the heart and has a transcriptome and secretome very different from that of other fat depots. EAT has physiological and pathological properties that vary depending on its location. It can be highly protective for the adjacent myocardium through dynamic brown fat-like thermogenic function and harmful via paracrine or vasocrine secretion of pro-inflammatory and profibrotic cytokines. EAT is a modifiable risk factor that can be assessed with traditional and novel imaging techniques. Coronary and left atrial EAT are involved in the pathogenesis of coronary artery disease and atrial fibrillation, respectively, and it also contributes to the development and progression of heart failure. In addition, EAT might have a role in coronavirus disease 2019 (COVID-19)-related cardiac syndrome. EAT is a reliable potential therapeutic target for drugs with cardiovascular benefits such as glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter 2 inhibitors. This Review provides a comprehensive and up-to-date overview of the role of EAT in cardiovascular disease and highlights the translational nature of EAT research and its applications in contemporary cardiology.

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Perivascular and epicardial adipose tissue impose direct adverse effects on the vascular endothelium and myocardium.
“Perivascular and epicardial adipose tissue impose direct adverse effects on the vascular endothelium and myocardium. 30”
From Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (2023) · cites this paper as [30]
The Introduction says epicardial adipose tissue (EAT) can harm adjacent myocardium through inflammatory and profibrotic secretions, and the Coronary artery disease section says EAT secretes factors associated with increased endothelial permeability. The paper identifies pericoronary EAT around coronary arteries, but does not establish the claim for perivascular adipose tissue generally. It also describes EAT as protective under normal conditions, so the unqualified assertion of adverse effects overstates the source. These sections have no page numbers in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Visceral adiposity is causally implicated in adverse cardiovascular outcomes via the release of proinflammatory cytokines.
“Visceral adiposity in particular has been causally implicated in adverse cardiovascular outcomes via the release of proinflammatory cytokines.6”
From Semaglutide and cardiovascular outcomes by baseline and changes in adiposity measurements: a prespecified analysis of the SELECT trial (2025) · cites this paper as [6]
The 'Role of EAT in cardiovascular disease > Coronary artery disease' section says epicardial adipose tissue can influence coronary artery disease through the release of pro-inflammatory cytokines. That supports the proposed mechanism for this specific visceral fat depot, but does not establish the broader claim that visceral adiposity is causally implicated in adverse cardiovascular outcomes generally. The supplied passages have no page numbers. (LLM, conf=0.86)
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Local Production of Fatty Acid–Binding Protein 4 in Epicardial/Perivascular Fat and Macrophages Is Linked to Coronary Atherosclerosis
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Obesity as a Potential Predictor of Disease Severity in Young COVID‐19 Patients: A Retrospective Study
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Human epicardial fat expresses glucagon-like peptide 1 and 2 receptors genes
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Influence of Epicardial and Visceral Fat on Left Ventricular Diastolic and Systolic Functions in Patients After Myocardial Infarction
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Secretory Type II Phospholipase A2 Is Produced and Secreted by Epicardial Adipose Tissue and Overexpressed in Patients with Coronary Artery Disease
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Novel atherogenic pathways from the differential transcriptome analysis of diabetic epicardial adipose, tissue
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Proteomics of epicardial adipose tissue in patients with heart failure
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Does epicardial fat contribute to COVID-19 myocardial inflammation?
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Abundant epicardial adipose tissue surrounding the left atrium predicts early rather than late recurrence of atrial fibrillation after catheter ablation
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Coronary artery disease is associated with higher epicardial Retinol‐binding protein 4 (RBP4) and lower glucose transporter (GLUT) 4 levels in epicardial and subcutaneous adipose tissue
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Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19
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Epicardial fat gene expression after aerobic exercise training in pigs with coronary atherosclerosis: relationship to visceral and subcutaneous fat
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Epicardial Fat in Atrial Fibrillation and Heart Failure
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Human Epicardial Adipose Tissue cTGF Expression is an Independent Risk Factor for Atrial Fibrillation and Highly Associated with Atrial Fibrosis
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Linking Arrhythmias and Adipocytes: Insights, Mechanisms, and Future Directions
Pabón, M. A., Manocha, K. K., Cheung, J. W., & Lo, J. C. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.01752 · Cited by 48 · see citing works
Epicardial adipose tissue thickness as a predictor of impaired microvascular function in patients with non-obstructive coronary artery disease
Alam, M. S., Green, R., de Kemp, R., Beanlands, R. S., & Chow, B. J. W. (2013) · Journal of Nuclear Cardiology · doi:10.1007/s12350-013-9739-6 · Cited by 47 · see citing works
Gender differences in the association of epicardial adipose tissue and coronary artery calcification: EPICHEART study
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Artificial intelligence, radiomics and other horizons in body composition assessment
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Epicardial Fat Inflammation in Severe COVID‐19
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Epicardial and Subcutaneous Adipose Tissue Fatty Acids Profiles in Diabetic and Non-Diabetic Patients Candidate for Coronary Artery Bypass Graft
Pezeshkian, M., & Mahtabipour, M.-R. (2013) · Europe PMC (PubMed Central) · doi:10.5681/bi.2013.004 · Cited by 42 · see citing works
Transcriptional analysis of adipose tissue during development reveals depot-specific responsiveness to maternal dietary supplementation
Fainberg, H. P., Birtwistle, M., Alagal, R. I., Alhaddad, A., Pope, M., Davies, G., Woods, R. M., Castellanos, M., May, S. T., Ortori, C. A., et al. (2018) · Scientific Reports · doi:10.1038/s41598-018-27376-3 · Cited by 41 · see citing works
Expression of the Receptor for Advanced Glycation End Products in Epicardial Fat: Link with Tissue Thickness and Local Insulin Resistance in Coronary Artery Disease
Dozio, E., Vianello, E., Briganti, S., Lamont, J. V., Tacchini, L., Schmitz, G., & Romanelli, M. M. C. (2015) · Journal of Diabetes Research · doi:10.1155/2016/2327341 · Cited by 39 · see citing works
Serglycin is a novel adipocytokine highly expressed in epicardial adipose tissue
Imoto-Tsubakimoto, H., Takahashi, T., Ueyama, T., Ogata, T., Adachi, A., Nakanishi, N., Mizushima, K., Naito, Y., & Matsubara, H. (2013) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2013.01.078 · Cited by 38 · see citing works
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Agra, R. M., Teijeira‐Fernández, E., Pascual-Figal, D. A., Sánchez‐Más, J., Fernández‐Trasancos, Á., González‐Juanatey, J. R., & Eiras-Penas, S. (2013) · European Journal of Clinical Investigation · doi:10.1111/eci.12186 · Cited by 37 · see citing works
Direction-dependent conduction in lone atrial fibrillation
Wong, C. X. J., Stiles, M. K., John, B., Brooks, A. G., Lau, D. H., Dimitri, H. R., Kuklik, P., SHIPP, N. J., Sullivan, T., & Sanders, P. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.05.037 · Cited by 37 · see citing works
Is epicardial fat attenuation a novel marker of coronary inflammation?
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Higher ACE2 expression levels in epicardial cells than subcutaneous stromal cells from patients with cardiovascular disease: Diabetes and obesity as possible enhancer
Couselo‐Seijas, M., Almengló, C., Agra-Bermejo, R. M., Fernández, Á. L., Álvarez, E., González‐Juanatey, J. R., & Eiras-Penas, S. (2020) · European Journal of Clinical Investigation · doi:10.1111/eci.13463 · Cited by 34 · see citing works
Altered Levels of Fatty Acids and Inflammatory and Metabolic Mediators in Epicardial Adipose Tissue in Patients With Systolic Heart Failure
Fosshaug, L. E., Dahl, C. P., Risnes, I., Bohov, P., Berge, R. K., Nymo, S. H., Geiran, O. R., Yndestad, A., Gullestad, L. L., Aukrust, P., et al. (2015) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2015.07.014 · Cited by 32 · see citing works
The association of the amounts of epicardial fat, P wave duration, and PR interval in electrocardiogram
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Cardiac Sympathetic Denervation in the Failing Heart
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Effect of liraglutide on epicardial adipose tissue thickness with echocardiography in patients with obese type 2 diabetes mellitus
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CD5L, Macrophage Apoptosis Inhibitor, Was Identified in Epicardial Fat-Secretome and Regulated by Isoproterenol From Patients With Heart Failure
Agra-Bermejo, R., Cacho-Antonio, C., Rozados-Luís, A., Couselo-Seijas, M., Fernandez, A. L., Martínez-Cereijo, J., Bravo, S., González-Juanatey, J., & Eiras, S. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.00620 · Cited by 18 · see citing works
Epicardial fat inflammation response to COVID‐19 therapies
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Effect of Dapagliflozin on Myocardial Insulin Sensitivity and Perfusion: Rationale and Design of The DAPAHEART Trial
Sorice, G. P., Cinti, F., Leccisotti, L., D’Amario, D., Lorusso, M., Guzzardi, M. A., Mezza, T., Cocchi, C., Capece, U., Ferraro, P. M., et al. (2021) · Diabetes Therapy · doi:10.1007/s13300-021-01083-1 · Cited by 15 · see citing works
Pitcher perfect: arrhythmia monitoring at the Munich Oktoberfest
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Vasodilator-Stimulated Phosphoprotein: Regulators of Adipokines Resistin and Phenotype Conversion of Epicardial Adipocytes
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Cardioprotective Heme Oxygenase 1‐PGC1α Signaling in Epicardial Fat Attenuates Cardiovascular Risk in Humans as in Obese Mice
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Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes
Lincoff, A. M., Brown-Frandsen, K., Colhoun, H. M., Deanfield, J., Emerson, S. S., Esbjerg, S., Hardt-Lindberg, S., Hovingh, G. K., Kahn, S. E., Kushner, R. F., et al. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2307563 · Cited by 3,236 · see citing works
Atrial cardiomyopathy revisited—evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS)
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Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers
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Obesity, dyslipidemia, and cardiovascular disease: A joint expert review from the Obesity Medicine Association and the National Lipid Association 2024
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Impact of Obesity on Atrial Fibrillation Pathogenesis and Treatment Options
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Semaglutide and cardiovascular outcomes by baseline and changes in adiposity measurements: a prespecified analysis of the SELECT trial
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Omentin1 ameliorates myocardial ischemia-induced heart failure via SIRT3/FOXO3a-dependent mitochondrial dynamical homeostasis and mitophagy
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Obesity and cardiovascular disease: an ESC clinical consensus statement
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Human epicardial adipose tissue expresses glucose-dependent insulinotropic polypeptide, glucagon, and glucagon-like peptide-1 receptors as potential targets of pleiotropic therapies
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Epicardial fat links obesity to cardiovascular diseases
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BOA
Haubold, J., Baldini, G., Parmar, V., Schaarschmidt, B. M., Koitka, S., Kroll, L., van Landeghem, N., Umutlu, L., Forsting, M., Nensa, F., et al. (2023) · Investigative Radiology · doi:10.1097/rli.0000000000001040 · Cited by 53 · see citing works
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Targeting the Substrate for Atrial Fibrillation
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Effects of SGLT-2 inhibitors on adipose tissue distribution in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials
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AI-derived epicardial fat measurements improve cardiovascular risk prediction from myocardial perfusion imaging
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Cardio-Lipotoxicity of Epicardial Adipose Tissue
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Heart Failure and Obesity: Translational Approaches and Therapeutic Perspectives. A Scientific Statement of the Heart Failure Association of the ESC
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Association between epicardial adipose tissue and incident heart failure mediating by alteration of natriuretic peptide and myocardial strain
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Semaglutide therapy decreases epicardial fat inflammation and improves psoriasis severity in patients affected by abdominal obesity and type-2 diabetes
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Haemodynamic and Metabolic Phenotyping of Patients with Aortic Stenosis and Preserved Ejection Fraction: A Specific Phenotype of Heart Failure with Preserved Ejection Fraction?
Biase, N. D., Mazzola, M., Punta, L. D., Fiore, V. D., Carlo, M. D., Giannini, C., Costa, G., Paneni, F., Mengozzi, A., Nesti, L., et al. (2023) · European Journal of Heart Failure · doi:10.1002/ejhf.3018 · Cited by 40 · see citing works
Association of the triglyceride-glucose index combined with a body shape index with all-cause and cardiovascular mortality in individuals with cardiovascular-kidney-metabolic syndrome stage 0–3: findings from two prospective cohorts
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Heart-on-a-chip systems: disease modeling and drug screening applications
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Radiomics features of pericoronary adipose tissue improve CT-FFR performance in predicting hemodynamically significant coronary artery stenosis
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Tissue-resident memory T cells in epicardial adipose tissue comprise transcriptionally distinct subsets that are modulated in atrial fibrillation
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Impact of Dysfunctional Adipose Tissue Depots on the Cardiovascular System
D'Oria, R., Genchi, V. A., Caccioppoli, C., Calderoni, I., Marrano, N., Biondi, G., Borrelli, A., Gioia, L. D., Giorgino, F., & Laviola, L. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232214296 · Cited by 38 · see citing works
Deep learning-quantified body composition from positron emission tomography/computed tomography and cardiovascular outcomes: a multicentre study
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Authors: Iacobellis, G.
Affiliations: University of Miami (US)
Corresponding author: Iacobellis, Gianluca
ORCID: Iacobellis, Gianluca
Venue: Nature Reviews Cardiology
Publisher: Springer Science and Business Media LLC
Published: 2022-03-16
Volume: 19
Issue: 9
Pages: 593-606
ISSN: 1759-5002 (ISSN-L)
1759-5010
DOI: 10.1038/s41569-022-00679-9
PMC: PMC8926097
OpenAlex: W4220961850
Cited by: 797
References: 161
Citations by year: 2026: 195 · 2025: 236 · 2024: 214 · 2023: 118 · 2022: 32
FWCI: 31.35
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Nature Reviews Cardiology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords: epicardial adipose tissue, coronary artery disease, atrial fibrillation, heart failure, brown fat thermogenesis, inflammatory cytokines, profibrotic cytokines, GLP-1 receptor agonists, SGLT2 inhibitors, cardiovascular risk factors
MeSH terms: COVID-19, Adipose Tissue, Atrial Fibrillation, Cardiology, Humans, Pericardium

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Epicardial adipose tissue in contemporary cardiology

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