Prognostic value of epicardial fat volume measurements by computed tomography: a systematic review of the literature

Abstract

Objectives To perform a systematic review of the growing body of literature evaluating the prognostic value of epicardial fat volume (EFV) quantified by cross-sectional imaging for adverse clinical outcomes. Methods Two independent reviewers performed systematic searches on both PubMed and Scopus using search terms developed with a medical librarian. Peer-reviewed articles were selected based on the inclusion of outcome data, utilization of epicardial fat volume and sufficient reporting for analysis. Results A total of 411 studies were evaluated with 9 studies meeting the inclusion criteria. In all, the studies evaluated 10,252 patients. All 9 studies were based on CT measurements. Seven studies evaluated the prognostic value of EFV unadjusted for calcium score, and 6 of these studies found a significant association between EFV and clinical outcomes. Seven studies evaluated the incremental value of EFV beyond calcium scoring, and 6 of these studies found a significant association. Conclusions The majority of studies suggest that EFV quantification is significantly associated with clinical outcomes and provides incremental prognostic value over coronary artery calcium scoring. Future research should use a binary cut-off of 125mL for evaluation of EFV to provide consistency with other research.

Effect of the Epicardial Adipose Tissue Volume on the Prevalence of Paroxysmal and Persistent Atrial Fibrillation

“…32 To our knowledge, no report has evaluated the cutoff value of the EATV for predicting the development of AF. 33 Shmilovich et al evaluated the threshold for the upper normal limit of the EATVI measured on non-contrast cardiac CT; the 95th-percentile definition of the upper normal limit of the EATVI was 68 mL/m 2 (equivalent to EATV of 125 mL), and this value can be an independent predictor (OR, 2.8; 95% confidence interval, 1.3-6.4, P=0.012) of major adverse cardiovascular events (MACEs) consisting of cardiovascular death, myocardial infarction, stroke, and percutaneous or surgical coronary artery revascularization. 34 Interestingly, the cutoff values of the EATVI in the study by Shmilovich et al 34 for MACEs and in the current study for PAF and PeAF are comparable.…”

Increased severity of liver fat content and liver fibrosis in non-alcoholic fatty liver disease correlate with epicardial fat volume in type 2 diabetes: A prospective study

“…Epicardial adipose tissue (EAT) is a fat depot that is emerging as a novel marker of subclinical cardiovascular disease, and, like CAC score, it can be derived from non-contrast cardiac computed tomography (CT). Several studies have demonstrated that EAT provides incremental prognostic information over and above CAC and traditional risk factors for the prediction of major adverse cardiac events [17, 18]. EAT is unique to other fat depots in the body in that it may exert proatherogenic effects on the coronary arteries through local inflammatory mediators and infiltration of inflammatory cells [19–24].…”

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

“…It is postulated that close proximity of the increased EAT to the heart and vessels (14) and the lack of a physical barrier between these structures allow for diffusion of proinflammatory cytokines that could play role in the development of cardiometabolic diseases (14–16). Computed tomography (CT) is a reliable and reproducible method for quantification of epicardial fat volume (EFV) (17) independent of cardiac cycle phase (18). Unlike CT, echocardiography can only measure EAT thickness as a one-dimensional measure (16).…”