Epicardial fat, rather than pericardial fat, is independently associated with diastolic filling in subjects without apparent heart disease

Saleem, Dabbah; Komarov, H.; Marmor, Alon; Assy, Nimer

doi:10.1016/j.numecd.2014.01.019

Cited by 22 publications

(27 citation statements)

References 22 publications

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“…Epicardial fat serves a number of important physiologic functions including acting as a buffer for coronary arteries against torsion, regulation of fatty acid metabolism for coronary arteries, thermogenesis, and protection of the cardiac autonomic ganglia and nerves . The association of increased epicardial fat with diastolic dysfunction has been consistently demonstrated in various studies . A recent meta‐analysis of studies using relatively simple indicators of diastolic dysfunction, mitral valve E/A ratio or E/e′, showed a significant correlation between the amount of epicardial fat and diastolic dysfunction (Figure ).…”

Section: Epicardial Fatmentioning

confidence: 96%

Hypoxia‐inducible factor 1‐alpha (HIF‐1α) as a factor mediating the relationship between obesity and heart failure with preserved ejection fraction

Warbrick

Rabkin

2019

Obesity Reviews

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Summary Heart failure with preserved ejection fraction (HFpEF), a common condition with an increased mortality, is strongly associated with obesity and the metabolic syndrome. The latter two conditions are associated with increased epicardial fat that can extend into the heart. This review advances the proposition that hypoxia‐inhibitory factor‐1α (HIF‐1α) maybe a key factor producing HFpEF. HIF‐1α, a highly conserved transcription factor that plays a key role in tissue response to hypoxia, is increased in adipose tissue in obesity. Increased HIF‐1α expression leads to expression of a potent profibrotic transcriptional programme involving collagen I, III, IV, TIMP, and lysyl oxidase. The net effect is the formation of collagen fibres leading to fibrosis. HIF‐1α is also responsible for recruiting M1 macrophages that mediate obesity‐associated inflammation, releasing IL‐6, MCP‐1, TNF‐α, and IL‐1β with increased expression of thrombospondin, pro α2 (I) collagen, transforming growth factor β, NADPH oxidase, and connective tissue growth factor. These factors can accelerate cardiac fibrosis and impair cardiac diastolic function. Inhibition of HIF‐1α expression in adipose tissue of mice fed a high‐fat diet suppressed fibrosis and reduces inflammation in adipose tissue. Delineation of the role played by HIF‐1α in obesity‐associated HFpEF may lead to new potential therapies.

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Section: Epicardial Fatmentioning

confidence: 96%

Hypoxia‐inducible factor 1‐alpha (HIF‐1α) as a factor mediating the relationship between obesity and heart failure with preserved ejection fraction

Warbrick

Rabkin

2019

Obesity Reviews

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“…Studies associating PF or EAT with diastolic function are scarce and often contradictive. A partial explanation may be that most studies so far were performed in a non-healthy population, which may confound the reported associations of PF or EAT with diastolic function (15)(16)(17)(18)(19)(20). Here, we studied the association between PF and diastolic function in a lean to obese middle-aged population, with normal systolic and diastolic cardiac function.…”

Section: Discussionmentioning

confidence: 96%

“…Some of these mediators are known to have pro brotic properties, linking the in ammation of enlarged EAT with brosis (14). From studies performed in (morbidly) obese subjects with a high prevalence of T2DM, we know that PF, EAT, and CAT are linked to several diastolic function parameters (15)(16)(17). However, studies associating PF directly with diastolic function in healthy subjects are scarce, and the underlying mechanisms remain unknown (18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Pericardial fat and its influence on cardiac diastolic function

Wit‐Verheggen

Altintas

Spee

et al. 2020

Preprint

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Abstract Background Pericardial fat (PF) has been suggested to directly act on cardiomyocytes, leading to diastolic dysfunction. The aim of this study was to investigate whether a higher PF volume is associated with a lower diastolic function in healthy subjects.Methods 254 adults (40-70 years, BMI 18-35 kg/m2, normal left ventricular ejection fraction), with (a)typical chest pain (otherwise healthy) from the cardiology outpatient clinic were retrospectively included in this study. All patients underwent a coronary computed tomographic angiography for the measurement of pericardial fat volume, as well as a transthoracic echocardiography for the assessment of diastolic function parameters. To assess the independent association of PF and diastolic function parameters, multivariable linear regression analysis was performed. To maximize differences in PF volume, the group was divided in low (lowest quartile of both sexes) and high (highest quartile of both sexes) PF volume. Multivariable binary logistic analysis was used to study the associations within the groups between PF and diastolic function, adjusted for age, BMI, and sex.Results Significant associations for all four diastolic parameters with the PF volume were found after adjusting for BMI, age, and sex. In addition, subjects with high pericardial fat had a reduced left atrial volume index (p=0.02), lower E/e (p<0.01) and E/A (p=0.01), reduced e’ lateral (p<0.01), reduced e’ septal p=0.03), compared to subjects with low pericardial fat.Conclusion These findings confirm that pericardial fat volume, even in healthy subjects with normal cardiac function, is associated with diastolic function. Our results suggest that the mechanical effects of PF may limit the distensibility of the heart and thereby directly contribute to diastolic dysfunction.Trial registration NCT01671930

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“…Our observation of increased EFV contributing to the association with SSc-PAH may relate to the close proximity of EAT to pulmonary artery that potentially enables direct diffusion (14,40) of inflammatory mediators into the wall of the pulmonary artery and triggers the development of PAH. Besides the paracrine and vasocrine effects, enlarged EFV may exhibit mass effect and mechanical restriction of pulmonary arteries and left ventricle (40), leading to their impaired relaxation and diastolic dysfunction (41,42). Increased EFV has an incremental value for prediction of diastolic dysfunction (43).…”

Section: Discussionmentioning

confidence: 99%

Increased Epicardial Fat Volume Is Independently Associated with the Presence and Severity of Systemic Sclerosis

Long

Stojanovska²,

Brown

et al. 2017

Academic Radiology

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Rationale and Objectives The study aimed to determine if intrathoracic fat volumes are associated with the presence and severity of systemic sclerosis (SSc), defined by the presence of pulmonary arterial hypertension (PAH). Materials and Methods A total of 265 patients were included in the study, 202 of whom had SSc (134 had SSc with no PAH and 68 had SSc-associated PAH) and who underwent high-resolution computed tomography, and 63 controls who underwent coronary computed tomography angiography with calcium scoring. Intrathoracic and epicardial (EFV) fat volumes were quantified by manual tracing of the mediastinum and the pericardium, the difference of which represents the extrapericardial fat volume. Associations between these three fat volumes and the presence and severity of SSc, adjusted for cardiovascular risk factors and interstitial lung disease, were evaluated by logistic regression analysis. Results Of the 202 patients with SSc, the mean age was 54 years (ranged from 20 to 86), and 79% (192 of 202) were women. Adjusted EFV (odds ratio [OR]: 1.065; 95% confidence interval [CI]: 1.046–1.084, P = < 0.0001), ≤extrapericardial fat volume (OR: 1.028, 95% CI: 1.017–1.038, P = < 0.0001), and intrathoracic fat volume (OR: 1.033, 95% CI: 1.023–1.043, P = 0.001) were associated with the presence of SSc. Only EFV was associated with SSc severity (adjusted OR: 1.010, 95% CI: 1.003–1.018, P = 0.007). Conclusion Increased epicardial fat volume is associated with the presence and severity of SSc, independent of cardiovascular risk factors and interstitial lung disease.

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Epicardial fat, rather than pericardial fat, is independently associated with diastolic filling in subjects without apparent heart disease

Cited by 22 publications

References 22 publications

Hypoxia‐inducible factor 1‐alpha (HIF‐1α) as a factor mediating the relationship between obesity and heart failure with preserved ejection fraction

Hypoxia‐inducible factor 1‐alpha (HIF‐1α) as a factor mediating the relationship between obesity and heart failure with preserved ejection fraction

Pericardial fat and its influence on cardiac diastolic function

Increased Epicardial Fat Volume Is Independently Associated with the Presence and Severity of Systemic Sclerosis

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