Pericardial adiposity is independently linked to adverse cardiovascular phenotypes: a CMR study of 42 598 UK Biobank participants

Abstract

Aims We evaluated independent associations of cardiovascular magnetic resonance (CMR)-measured pericardial adipose tissue (PAT) with cardiovascular structure and function and considered underlying mechanism in 42 598 UK Biobank participants. Methods and results We extracted PAT and selected CMR metrics using automated pipelines. We estimated associations of PAT with each CMR metric using linear regression adjusting for age, sex, ethnicity, deprivation, smoking, exercise, processed food intake, body mass index, diabetes, hypertension, height cholesterol, waist-to-hip ratio, impedance fat measures, and magnetic resonance imaging abdominal visceral adiposity measures. Higher PAT was independently associated with unhealthy left ventricular (LV) structure (greater wall thickness, higher LV mass, more concentric pattern of LV hypertrophy), poorer LV function (lower LV global function index, lower LV stroke volume), lower left atrial ejection fraction, and lower aortic distensibility. We used multiple mediation analysis to examine the potential mediating effect of cardiometabolic diseases and blood biomarkers (lipid profile, glycaemic control, inflammation) in the PAT-CMR relationships. Higher PAT was associated with cardiometabolic disease (hypertension, diabetes, high cholesterol), adverse serum lipids, poorer glycaemic control, and greater systemic inflammation. We identified potential mediation pathways via hypertension, adverse lipids, and inflammation markers, which overall only partially explained the PAT-CMR relationships. Conclusion We demonstrate association of PAT with unhealthy cardiovascular structure and function, independent of baseline comorbidities, vascular risk factors, inflammatory markers, and multiple non-invasive and imaging measures of obesity. Our findings support an independent role of PAT in adversely impacting cardiovascular health and highlight CMR-measured PAT as a potential novel imaging biomarker of cardiovascular risk.

Cardiovascular Significance and Genetics of Epicardial and Pericardial Adiposity

“…We then fine-tuned a deep-learning model based on ResNet50 to annotate EPAT in the remaining participants. In a heldout test set of 50 individuals, the model achieved a Dice score of 0.80 compared with a human annotator, similar to a recently reported model based on UKB CMR data . We further excluded 788 participants whose 4-chamber images were not predicted to show at least 5 cm 2 of each cardiac chamber as a quality control step to remove misaligned or poor-quality images (eMethods and eFigure 1 in Supplement 1).…”

“…Paracrine or vasocrine release of cytokines and immune response factors from EAT to coronary arteries has been suggested to drive the development of atherosclerosis . However, EPAT and VAT have comparable associations with cardiovascular risk factors and the metabolic syndrome, which raises the question of whether many of the observed disease associations may reflect global consequences of unhealthy visceral adiposity rather than more localized cardiac effects.…”

“…20 All statistical analyses not otherwise specified were carried out in R, version 4.3.0 for UKB and R, version 4.3.2 for FinnGen (R Project for Statistical Computing). 21 Statistical significance was set at a 2-sided P value < 5 × 10 −8 for the GWAS and at a 2-sided P value < .05 for all other analyses. Data were analyzed from March 2022 to December 2023.…”

Pericardial fat and cardiovascular diseases: A systematic review and meta‐analysis

“…41 However, studies linked pericardial adiposity to adverse cardiovascular outcomes were independent from lipid profile. 42 Moreover, in a randomized clinical trial, weight loss interventions were associated with reduction in pericardial adipose tissue and improvement in lipid profile. 43 The study added to the literature by supporting the already existing clinical evidence that pericardial fat had a role in cardiovascular diseases independent of BMI 44 has traditionally been the most commonly used and simplest reproducible tool for measuring obesity and overall body adiposity.…”

“…Studies had demonstrated a significant correlation between pericardial fat and increased total cholesterol, triglyceride and low‐density lipoprotein 41 . However, studies linked pericardial adiposity to adverse cardiovascular outcomes were independent from lipid profile 42 . Moreover, in a randomized clinical trial, weight loss interventions were associated with reduction in pericardial adipose tissue and improvement in lipid profile 43 …”