Epicardial Fat: Pathophysiology and Clinical Significance

Over the last decade and a half there has been much interest in understanding the role of epicardial adipose tissue (EAT) in cardiac pathology. EAT is a visceral adipose deposit with putative paracrine function. In the nondiseased state, EAT releases cardioprotective cytokines and chemokines to the coronary vasculature. In pathological states, EAT releases an inflammatory cytokine profile that is believed to contribute to the development and progression of coronary artery disease (CAD). EAT imaging with echocardiography, computed tomography, and magnetic resonance imaging has demonstrated a correlation between EAT size and CAD. Small interventional studies have found evidence that the pathological state of EAT is at least somewhat reversible. The relationship between EAT size and the development and/or progression of CAD may present future clinicians with a new tool for risk assessment and intervention response monitoring. In this article we review current basic science and clinical research, comment on the role of EAT imaging in the management of patients at risk for CAD, and suggest areas for future investigation.