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Local and systemic effects of the multifaceted epicardial adipose tissue depot

Nature Reviews Endocrinology volume 11, pages 363–371 (2015)Cite this article

Subjects

Key Points

  • Epicardial adipose tissue is the fat depot between the myocardium and the visceral layer of the pericardium, and is anatomically and functionally contiguous with the myocardium

  • This tissue has the greatest rates of lipogenesis and fatty acid metabolism among visceral fat depots and displays metabolic, thermogenic (similar to brown fat) and mechanical (cardioprotective) properties

  • A transcriptome unique to epicardial adipose is enriched in genes associated with inflammation, endothelial function coagulation and regulation of potassium channels

  • The myocardium is modulated by cytokines, which are secreted by the epicardial fat depot

  • Epicardial fat is a marker of visceral adiposity and can be used to test the efficacy of interventions aimed at modulating adipose tissue characteristics

  • Coronary artery disease, the metabolic syndrome, insulin resistance, fatty liver disease and cardiac abnormalities are associated with increased amounts of epicardial fat

Abstract

Epicardial adipose tissue is a unique and multifaceted fat depot with local and systemic effects. This tissue is distinguished from other visceral fat depots by a number of anatomical and metabolic features, such as increased fatty acid metabolism and a unique transcriptome enriched in genes that are associated with inflammation and endothelial function. Epicardial fat and the heart share an unobstructed microcirculation, which suggests these tissues might interact. Under normal physiological conditions, epicardial fat has metabolic, thermogenic (similar to brown fat) and mechanical (cardioprotective) characteristics. Development of pathological conditions might drive the phenotype of epicardial fat such that it becomes harmful to the myocardium and the coronary arteries. The equilibrium between protective and detrimental effects of this tissue is fragile. Expression of the epicardial-fat-specific transcriptome is downregulated in the presence of severe and advanced coronary artery disease. Improved local vascularization, weight loss and targeted medications can restore the protective physiological functions of epicardial fat. Measurements of epicardial fat have several important applications in the clinical setting: accurate measurement of its thickness or volume is correlated with visceral adiposity, coronary artery disease, the metabolic syndrome, fatty liver disease and cardiac changes. On account of this simple clinical assessment, epicardial fat is a reliable marker of cardiovascular risk and an appealing surrogate for assessing the efficacy of drugs that modulate adipose tissues.

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Figure 1: Localization of epicardial fat.
Figure 2: Transthoracic 2D echocardiographic longitudinal long-axis view of heart.

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  1. Division of Diabetes, Department of Medicine, Endocrinology and Metabolism, Miller School of Medicine, University of Miami, 1400 NW 10th Avenue, Dominion Tower suite 805–807, Miami, 33136, FL, USA

    Gianluca Iacobellis

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Iacobellis, G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol 11, 363–371 (2015). https://doi.org/10.1038/nrendo.2015.58

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