Epicardial adipose tissue as a predictor of adverse prognosis
https://doi.org/10.21886/2219-8075-2025-16-2-75-82
Abstract
Cardiovascular diseases (CVD) rank as the leading cause of mortality worldwide. Obesity, which is related to metabolic risk factors for CVD, is a common problem globally and in Russia. However, the generally accepted criteria for obesity cannot fully reflect the risk of developing CVD. According to modern concepts, visceral obesity is a more sensitive marker of CVD. The use of epicardial adipose tissue thickness (EAT thickness) is proposed for the determination of visceral obesity. In this regard, the presented review examines studies aimed at determining the threshold values of EAT thickness for more accurate risk prediction of CVD development. Growing interest in the potential influence of epicardial adipose tissue (EAT) on cardiovascular risk has led to an in-depth study of its functions. Genetic, epigenetic, and environmental factors may contribute to a shift toward dysfunctional EAT, characterized by a proinflammatory and profibrotic phenotype. Due to its close anatomical proximity to the coronary arteries, thicker and dysfunctional EAT actively contributes to the development and progression of coronary atherosclerosis. In addition to classical paracrine transmission, EAT can directly release mediators into the vasa vasorum of the coronary artery wall, a mechanism termed “vasocrine.” Similarly, the proinflammatory and profibrotic secretome that characterizes dysfunctional EAT can impair cardiac structure and function, thus contributing to the pathogenesis of a large number of cardiovascular diseases.
About the Authors
A. S. Meshcheryakova
Rostov State Medical University
Russian Federation
Competing Interests:
Russian Federation
Anastasia S. Meshcheryakova — 3rd year student of the Faculty of Medicine
Rostov-on-Don
Competing Interests:
Authors declare no conflict of interest
N. S. Alekseeva
Rostov State Medical University
Russian Federation
Competing Interests:
Russian Federation
Natalya S. Alekseeva — Cand. Sci. (Med.), Lecturer at the Department of Normal Physiology
Rostov-on-Don
Competing Interests:
Authors declare no conflict of interest
L. A. Khaisheva
Rostov State Medical University
Russian Federation
Competing Interests:
Russian Federation
Larisa A. Khaisheva — Dr. Sci. (Med.), Head of the Department of Therapy
Rostov-on-Don
Competing Interests:
Authors declare no conflict of interest
References
1. Lindstrom M, DeCleene N, Dorsey H, Fuster V, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risks Collaboration, 1990-2021. Journal of the American College of Cardiology. 2022;80(25):2372–2425. https://doi.org/10.1016/j.jacc.2022.11.001
2. World Health Organization. HEARTS technical package for cardiovascular disease management in primary health care: risk-based CVD management. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
3. World Heart Report 2023: Confronting the World’s Number One Killer. Geneva, Switzerland. World Heart Federation. 2023
4. Cercato C, Fonseca FA. Cardiovascular risk and obesity. Diabetology & Metabolic Syndrome. 2019;11(1). https://doi.org/10.1186/s13098-019-0468-0
5. Xue B, Zhang X, Li T, Gu Y, Wang R, et al. Knowledge, attitude, and practice of obesity among university students. Ann Palliat Med. 2021;10(4):4539-4546. https://doi.org/10.21037/apm-21-573
6. Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022;133:155217. https://doi.org/10.1016/j.metabol.2022.155217
7. Dedov I.I., Mokrysheva N.G., Mel’nichenko G.A., Troshina E.A., Mazurina N.V., et al. Obesity. Clinical guidelines. Consilium Medicum. 2021;23(4):311–325. (In Russ.) https://doi.org/10.26442/20751753.2021.4.200832
8. Miklisanskaya S.V., Zolozova E.A., Safiullina A.A., Mazur N.A. Visceral obesity in patients with various body mass index. Lechaschi Vrach. 2020;(8):66-70. (In Russ.) https://doi. org/10.26295/OS.2020.19.39.011 https://doi.org/10.26295/OS.2020.19.39.011
9. Khanna D, Welch BS, Rehman A. Pathophysiology of Obesity. StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 34283442.
10. Statsenko M.E., Derevyanchenko M.V. Effect of visceral obesity on main artery elasticity and vascular age in patients with hypertension, obesity, and type 2 diabetes. Russian Journal of Cardiology. 2021;26(4):4466. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4466
11. Zhang X, Sun Y, Li Y, Wang C, Wang Y, et al. Association between visceral adiposity index and heart failure: A cross‐sectional study. Clinical Cardiology. 2023;46(3):310–319. https://doi.org/10.1002/clc.23976
12. Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. The Lancet Diabetes & Endocrinology. 2019;7(9):715–725. https://doi.org/10.1016/s2213-8587(19)30084-1
13. Chumakova G.A., Kuznetsova T.Yu., Druzhilov M.A., Veselovskaya N.G. Visceral adiposity as a global factor of cardiovascular risk. Russian Journal of Cardiology. 2018;(5):7-14. (In Russ.) https://doi.org/10.15829/1560-4071-2018-5-7-14
14. Blinova N.V., Azimova M.O., Zhernakova Y.V., Zheleznova E.A., Yarovaya E.B., et al. Epicardial adipose tissue as a marker of visceral obesity and its association with metabolic parameters and remodeling of the left chambers of the heart in young people with abdominal obesity. Terapevticheskii arkhiv. 2019;91(9):68-76. https://doi.org/10.26442/00403660.2019.09.000334
15. Packer M. Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium. Journal of the American College of Cardiology. 2018;71(20):2360–2372. https://doi.org/10.1016/j.jacc.2018.03.509
16. Leo S, Tremoli E, Ferroni L, Zavan B. Role of Epicardial Adipose Tissue Secretome on Cardiovascular Diseases. Biomedicines. 2023;11(6):1653. https://doi.org/10.3390/biomedicines11061653
17. Wu Y, Zhang A, Hamilton DJ, Deng T. Epicardial Fat in the Maintenance of Cardiovascular Health. Methodist DeBakey Cardiovascular Journal. 2017;13(1):20. https://doi.org/10.14797/mdcj-13-1-20
18. Walpot J, Van Herck P, Van de Heyning CM, Bosmans J, Massalha S, et al. Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events (MACE) and mortality in patients with heart disease and critically ill patients. Part I: Epicardial adipose tissue. Anaesthesiology Intensive Therapy. 2023;55(3):141–157. https://doi.org/10.5114/ait.2023.130922
19. Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, et al. Epicardial Fat from Echocardiography: A New Method for Visceral Adipose Tissue Prediction. Obesity Research. 2003;11(2):304–310. https://doi.org/10.1038/oby.2003.45
20. Eroglu S. How do we measure epicardial adipose tissue thickness by transthoracic echocardiography? The Anatolian Journal of Cardiology. 2015;15(5):416–419. https://doi.org/10.5152/akd.2015.5991
21. Ibanez B, Fernández-Ortiz A, Fernández-Friera L, GarcíaLunar I, Andrés V, Fuster V. Progression of Early Subclinical Atherosclerosis (PESA) Study. Journal of the American College of Cardiology. 2021;78(2):156–179. https://doi.org/10.1016/j.jacc.2021.05.011
22. Safaryan A.S., Vygodin V.A., Nebieridze D.V., Nikonova K.V. Comparability of cardiovascular risk assessment according to the SCORE and the coronary artery calcium score (Agatston score). Cardiovascular Therapy and Prevention. 2023;22(9):3650. (In Russ.) https://doi.org/10.15829/1728-8800-2023-3650
23. Iacobellis G. Epicardial adipose tissue in contemporary cardiology. Nature reviews. Cardiology. 2022;19(9):593-606. https://doi.org/10.1038/s41569-022-00679-9
24. Mustafina I.A., Ionin V.A., Dolganov A.A., Ishmetov V.Sh., Pushkareva A.E., et al. Role of epicardial adipose tissue in the development of cardiovascular diseases. Russian Journal of Cardiology. 2022;27(1S):4872. (In Russ.) https://doi.org/10.15829/1560-4071-2022-4872
25. Polyakova E.A., Berkovich O.A., Baranova E.I. Prognostic value of epicardial fat thickness in coronary heart disease patients after myocardial revascularization. Kardiologiia. 2020;60(3):4-13. https://doi.org/10.18087/cardio.2020.3.n874
26. Doukbi E, Soghomonian A, Sengenès C, Ahmed S, Ancel P, et al. Browning epicardial adipose tissue: friend or foe? Cells. 2022;11(6):991. https://doi.org/10.3390/cells11060991
27. Gustafsson B, Rovio SP, Ruohonen S, Hutri-Kähönen N, Kähönen M, et al. Determinants of echocardiographic epicardial adipose tissue in a general middle-aged population – The Cardiovascular Risk in Young Finns Study. Scientific Reports. 2024;14(1). https://doi.org/10.1038/s41598-024-61727-7
28. Kuznetsova T.Yu., Chumakova G.A., Druzhilov M.A., Veselovskaya N.G. Clinical application of quantitative echocardiographic assessment of epicardial fat tissue in obesity. Russian Journal of Cardiology. 2017;(4):81-87. (In Russ.) https://doi.org/10.15829/1560-4071-2017-4-81-87
29. Davydova A.V., Nikiforov V.S., Khalimov Y.S. Thickness of epicardial adipose tissue as a predictor of cardiovascular risk. Consilium Medicum. 2018;20(10):91-94. (In Russ.) https://doi.org/10.26442/2075-1753_2018.10.91-94
30. Dzhioeva O.N., Maksimova O.A., Rogozhkina E.A., Drapkina O.M. Aspects of transthoracic echocardiography protocol in obese patients. Russian Journal of Cardiology. 2022;27(12):5243. (In Russ.) https://doi.org/10.15829/1560-4071-2022-5243
31. Blinova N.V., Azimova M.O., Zhernakova J.V., Saidova M.A., Ternovoy S.K., et al. Assessment of epicardial adipose tissue by echocardiography for risk stratification in young adults with abdominal obesity. Systemic Hypertension. 2020;17(4):74-79. (In Russ.) https://doi.org/10.26442/2075082X.2020.4.200557
32. Chumakova G.A., Gritsenko O.V., Gruzdeva O.V., Zateev A.V. Predicting the risk of left ventricular diastolic dysfunction in obesity. Russian Journal of Cardiology. 2022;27(4):4811. (In Russ.) https://doi.org/10.15829/1560-4071-2022-4811
33. Chin JF, Aga YS, Abou Kamar S, Kroon D, Snelder SM, et al. Association between epicardial adipose tissue and cardiac dysfunction in subjects with severe obesity. European Journal of Heart Failure. 2023;25(11):1936–1943. https://doi.org/10.1002/ejhf.3011
34. Druzhilov M.A., Kuznetsova T.Yu. Epicardial adipose tissue thickness as a possible predictor of carotid atherosclerosis in patients with abdominal obesity. Russian Journal of Cardiology. 2021;26(3):4297. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4297
35. Fernandes-Cardoso A, Santos-Furtado M, Grindler J, Ferreira LA, Andrade JL, Santo MA. Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity. Nutrition, Metabolism and Cardiovascular Diseases. 2017;27(8):731-738. https://doi.org/10.1016/j.numecd.2017.05.009
36. Ng ACT, Strudwick M, van der Geest RJ, Ng ACC, Gillinder L, et al. Impact of Epicardial Adipose Tissue, Left Ventricular Myocardial Fat Content, and Interstitial Fibrosis on Myocardial Contractile Function. Circ Cardiovasc Imaging. 2018;11(8):e007372. https://doi.org/10.1161/CIRCIMAGING.117.007372
37. Choy M, Huang Y, Peng Y, Liang W, He X, et al. Association between epicardial adipose tissue and incident heart failure mediating by alteration of natriuretic peptide and myocardial strain. BMC Med. 2023;21(1):117. https://doi.org/10.1186/s12916-023-02836-4
38. Goeller M, Achenbach S, Marwan M, Doris MK, Cadet S, et al. Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. Journal of Cardiovascular Computed Tomography. 2018;12(1):67–73. https://doi.org/10.1016/j.jcct.2017.11.007
39. Eisenberg E, McElhinney PA, Commandeur F, Chen X, Cadet S, et al. Deep Learning-Based Quantification of Epicardial Adipose Tissue Volume and Attenuation Predicts Major Adverse Cardiovascular Events in Asymptomatic Subjects. Circ Cardiovasc Imaging. 2020;13(2):e009829. https://doi.org/10.1161/CIRCIMAGING.119.009829
40. Islas F, Gutiérrez E, Cachofeiro V, Martínez-Martínez E, Marín G, et al. Importance of cardiac imaging assessment of epicardial adipose tissue after a first episode of myocardial infarction. Front Cardiovasc Med. 2022;9:995367. https://doi.org/10.3389/fcvm.2022.995367
41. Morales-Portano JD, Peraza-Zaldivar JÁ, Suárez-Cuenca JA, Aceves-Millán R, Amezcua-Gómez L, et al. Echocardiographic measurements of epicardial adipose tissue and comparative ability to predict adverse cardiovascular outcomes in patients with coronary artery disease. The International Journal of Cardiovascular Imaging. 2018;34(9):1429–1437. https://doi.org/10.1007/s10554-018-1360-y
42. Gruzdeva O.V., Borodkina D.A., Akbasheva О.Е., Dyleva Yu.A., Uchasova E.G., et al. The Relationship Between Epicardial and Perivascular Adipose Tissue Thickness and Adipokine-Cytokine Profile in Ischemic Heart Disease Patients with and without Visceral Obesity. DoctorRu. 2018;152(8):12–91. (In Russ.). https://doi.org/10.31550/1727-2378-2018-152-8-12-19
43. Massalha S, Walpot J, Dey D, Guler EC, Clarkin O, et al. Epicardial adipose tissue: an independent predictor of post-operative adverse cardiovascular events (CTA VISION substudy). JACC Cardiovasc Imaging. 2020;13(3):882-884. https://doi.org/10.1016/j.jcmg.2019.09.017
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For citations:
Meshcheryakova A.S., Alekseeva N.S., Khaisheva L.A. Epicardial adipose tissue as a predictor of adverse prognosis. Medical Herald of the South of Russia. 2025;16(2):75-82. (In Russ.) https://doi.org/10.21886/2219-8075-2025-16-2-75-82
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