Diabetes Metab J.  2024 May;48(3):373-384. 10.4093/dmj.2023.0190.

Epicardial Adipose Tissue and Heart Failure, Friend or Foe?

• Cho DH
• Park SM

• KMID: 2555768
• DOI: http://doi.org/10.4093/dmj.2023.0190

Abstract

Heart failure (HF) management guidelines recommend individualized assessments based on HF phenotypes. Adiposity is a known risk factor for HF. Recently, there has been an increased interest in organ-specific adiposity, specifically the role of the epicardial adipose tissue (EAT), in HF risk. EAT is easily assessable through various imaging modalities and is anatomically and functionally connected to the myocardium. In pathological conditions, EAT secretes inflammatory cytokines, releases excessive fatty acids, and increases mechanical load on the myocardium, resulting in myocardial remodeling. EAT plays a pathophysiological role in characterizing both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). In HFrEF, EAT volume is reduced, reflecting an impaired metabolic reservoir, whereas in HFpEF, the amount of EAT is associated with worse biomarker and hemodynamic profiles, indicating increased EAT activity. Studies have examined the possibility of therapeutically targeting EAT, and recent studies using sodium glucose cotransporter 2 inhibitors have shown potential in reducing EAT volume. However, further research is required to determine the clinical implications of reducing EAT activity in patients with HF.

Keyword

Adiposity; Epicardial adipose tissue; Heart failure; Myocardium

Figure

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  Fig. 1. The gross anatomy of epicardial adipose tissue (EAT) in an 81-year-old woman with three-vessel coronary artery disease who underwent a coronary artery bypass graft.

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  Fig. 2. Representative images of epicardial adipose tissue (EAT). (A) Echocardiographic images of EAT. (B) Cardiac magnetic resonance images of EAT. Asterisk indicates EAT and white arrow indicates pericardium. (C, D) Computed tomography images of EAT. Green colored area indicates EAT. PAT, pericardial adipose tissue; RV, right ventricle; LV, left ventricle; LA, left atrium.

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  Fig. 3. The pathophysiologic mechanism of epicardial adipose tissue (EAT). PAT, pericardial adipose tissue; PAI-1, plasminogen activator inhibitor 1; TNF-α, tumor necrosis factor-alpha; IL, interleukin; LV, left ventricle; e` velocity, early diastolic velocity of the mitral annulus; GLS, global longitudinal strain.

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  Fig. 4. The epicardial adipose tissue (EAT) amount in the heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and control groups. (A) EAT amount in HFrEF vs. control. (B) EAT amount in HFpEF vs. control. (C) EAT amount in HFrEF, HFpEF, and control. CMR, cardiac magnetic resonance. aThis study used cm3 as the measurement unit of EAT.

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  Fig. 5. Mechanism of sodium glucose cotransporter 2 (SGLT2) inhibitor reducing epicardial adipose tissue (EAT). VAT, visceral adipose tissue; OHA, oral hypoglycemic agent.

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