Epicardial Fat: Physiological, Pathological, and Therapeutic Implications

Table 2

Studies of epicardial fat as a factor associated with coronary events and metabolic syndrome.

	Author (reference)	Methodology	Conclusions
Coronary events	Ito et al. [135]	Study in 117 patients with simple coronary lesions underwent MCT	EFV was associated with plaque vulnerability, being an independent predictor of ACS (OR: 2.89; 95% CI: 1.14–7.29);
	Alexopoulos et al. [137]	Study in 214 patients that underwent contrast-enhanced CT angiography images without a history of PCI, coronary artery by-pass surgery, or cardiomyopathy	There is an increase in EAT volume in patients with CAD, being an independent predictor of noncalcified plaques (OR: 3.85; 95% CI: 1.42–10.45);
	Mahabadi et al. [138]	4093 randomly selected participants under the Heinz Nixdorf Recall Study were prospectively evaluated; epicardial fat was assessed by cardiac CT	Epicardial fat is associated with the occurrence of fatal and nonfatal coronary events, regardless of the presence of other risk factors and coronary artery calcification score (HR: 1.50; 95% CI: 1.07–2.11);
	Okada et al. [139]	Study in 140 patients with chest pain with known or suspected arterial disease who were not obese and underwent sixty-four MCT	EFV is associated with severity of CAD and with the presence of noncalcified or mixed plaques (without plaques: 85.0 ± 4.2 mL; with nonobstructive plaque: 91.0 ± 8.8 mL; with obstructive plaque in a single vessel: 94.8 ± 6.8 mL; with obstructive plaque in left main or multiple vessels: 105.7 ± 7.3 mL; )
Metabolic syndrome	Iacobellis et al. [145]	Study in 72 consecutive patients with BMI between 22 and 47 kg/m^2; each patient underwent two-dimensional (2D) guided M-mode TTE	MRI VAT is best related to EAT compared to abdominal circumference and thus should be considered an indicator of VAT and cardiovascular risk. Also abdominal circumference was the component more related to MS (; )
	Yorgun et al. [146]	Study in 83 patients with suspected CAD who underwent dual source MDTM	Both EAT and the thickness of the pericoronary fat were associated with the presence of MS; they could be considered useful indicators for this disorder (; ; )
	Okyay et al. [147]	Case-control study in 246 patients (123 with MS and 123 without MS) who underwent M-mode TTE.	There is a close association between subepicardial adipose tissue and the presence of MS, its measurement being a feasible method for evaluating the MS and cardiovascular risk (; ;  )
	Kaya et al. [148]	Case-control study in 60 patients (30 with MS and 30 without MS) over 65 years old who were subjected to two-dimensional echocardiographic method by TTE	EAT was higher in geriatric patients with MS; a value of 7.3 mm or more showed high sensitivity and specificity in predicting MS and it could be considered a diagnostic criterion (; Wald = 12.36; )
	Fernández Muñoz et al. [149]	Cross-sectional study in 34 postmenopausal women with and without MS who underwent TTE	Univariate analysis revealed a significant relationship between EAT and VAT that was higher in postmenopausal women with MS, 544.2 ± 122.9, versus those without MS, 363.6 ± 162.3 mm^2;

ACS: acute coronary syndrome, BMI: body mass index, CAD: coronary artery disease, CT: computed tomography, EAT: epicardial adipose tissue, EFV: epicardial fat volume, MCT: multislice computed tomography, MDTM: multidetector computed tomography, MRI: magnetic resonance imaging, MS: metabolic syndrome, PCI: percutaneous intervention, TTE: transthoracic echocardiogram, and VAT: visceral adipose tissue.