Coronary artery disease is accompanied by increased epicardial fat volume

Abstract

A recently published article titled “Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: Results from the ALTER-BIO registry” aroused our great interest [ [1] Milanese G. Silva M. Ledda R.E. Goldoni M. Nayak S. Bruno L. et al. Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: results from the ALTER-BIO registry. Int. J. Cardiol. 2020; 314: 20-24 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ]. As we known, epicardial fat is biologically active ectopic fat depot that surrounds the heart, and increasing evidence shows that the thickness and volume of epicardial fat is closely related to various cardiovascular diseases (e.g., coronary artery disease (CAD), heart failure, atrial fibrillation) [ [2] Jiang D.S. Zeng H.L. Li R. Huo B. Su Y.S. Fang J. et al. Aberrant epicardial adipose tissue extracellular matrix remodeling in patients with severe ischemic cardiomyopathy: insight from comparative quantitative proteomics. Sci. Rep. 2017; 7: 43787 Crossref PubMed Scopus (16) Google Scholar ]. In this study, Gianluca et al. collected Coronary Computed Tomographic Angiography (CCTA), demographic and clinical variables of 1344 individuals, and the epicardial fat volume was semi-automated measured. Their results demonstrated that the volume of epicardial fat was positively associated with coronary artery calcifications, and larger amount of epicardial fat was observed in individuals with obstructive CAD, but epicardial fat volume has little predictive value to confidently determine CAD presence and severity [ [1] Milanese G. Silva M. Ledda R.E. Goldoni M. Nayak S. Bruno L. et al. Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: results from the ALTER-BIO registry. Int. J. Cardiol. 2020; 314: 20-24 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ]. In CAD patients, not only does the volume of epicardial fat change, it also undergoes remodeling, and its function also changes, leading to increased secretion of extracellular matrix [ [2] Jiang D.S. Zeng H.L. Li R. Huo B. Su Y.S. Fang J. et al. Aberrant epicardial adipose tissue extracellular matrix remodeling in patients with severe ischemic cardiomyopathy: insight from comparative quantitative proteomics. Sci. Rep. 2017; 7: 43787 Crossref PubMed Scopus (16) Google Scholar ]. Given that epicardial fat shares an unobstructed microcirculation with the underlying myocardium, it secrets cytokines to induce myocardial inflammation and cardiac remodeling, then to affect cardiac function [ [3] Packer M. Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardium. J. Am. Coll. Cardiol. 2018; 71: 2360-2372 Crossref PubMed Scopus (205) Google Scholar ]. Comparative quantitative proteomics results demonstrated that the biological processes including extracellular matrix, metabolism, immune response, cytoskeleton organization, and transcription/translation were affected both in epicardial fat and myocardium [ [2] Jiang D.S. Zeng H.L. Li R. Huo B. Su Y.S. Fang J. et al. Aberrant epicardial adipose tissue extracellular matrix remodeling in patients with severe ischemic cardiomyopathy: insight from comparative quantitative proteomics. Sci. Rep. 2017; 7: 43787 Crossref PubMed Scopus (16) Google Scholar , [4] Yi X. Jiang D.S. Feng G. Jiang X.J. Zeng H.L. An altered left ventricle protein profile in human ischemic cardiomyopathy revealed in comparative quantitative proteomics. Kardiol. Pol. 2019; 77: 951-959 PubMed Google Scholar ]. Numerous studies indicated that epicardial fat is an independent predictor of cardiovascular risk. Although epicardial fat volume has limited effectiveness in predicting CAD presence and severity [ [1] Milanese G. Silva M. Ledda R.E. Goldoni M. Nayak S. Bruno L. et al. Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: results from the ALTER-BIO registry. Int. J. Cardiol. 2020; 314: 20-24 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ], it has been found to predict clinical fatal and nonfatal coronary events independently of cardiovascular risk factors and coronary calcium score [ [5] Gaborit B. Sengenes C. Ancel P. Jacquier A. Dutour A. Role of epicardial adipose tissue in health and disease: a matter of fat?. Compr Physiol. 2017; 7: 1051-1082 Crossref PubMed Scopus (69) Google Scholar ].