Overview
Fatty degeneration of the heart, characterized by epicardial adipose tissue (EAT) or pericardial fat, is significantly associated with various cardiovascular diseases 125. Pericardial fat is linked to coronary artery disease (CAD), ventricular dysfunction, heart failure (HF), atrial fibrillation (AF), and major adverse cardiac events (MACE) 2.Diagnosis
Imaging: Computed tomography (CT) can quantify epicardial adipose tissue (EAT) volume and density 15.
EAT Density: The overall pooled EAT density is -85.86 Hounsfield Units (HU), with -86.40 HU in healthy subjects and -80.71 HU in patients with coronary artery disease 5.
Prognostic Value: Higher left atrial EAT volume measured by CT is associated with atrial fibrillation (AF) recurrence after catheter ablation 1.
Predictive Value: Pericardial fat is significantly associated with cardiovascular diseases and is a good predictor of obesity 2.Management
Dyslipidemia/Hypertriglyceridemia: Omega-3 fatty acids (Ω3FAs) near-linearly lower triglyceride and non-high-density lipoprotein cholesterol, especially at doses >2 g/day in populations with hyperlipidemia and overweight/obesity 3.
Cardiovascular Risk Reduction: Ω3FAs reduce very high triglyceride levels, hospitalizations, and cardiovascular disease mortality (e.g., fatal and total myocardial infarctions) 4.Special Populations
Comorbidities: Omega-3 fatty acids are particularly effective in populations with hyperlipidemia and overweight/obesity for triglyceride and non-high-density lipoprotein cholesterol reduction 3.Key Recommendations
Quantification of epicardial adipose tissue (EAT) volume by computed tomography (CT) can serve as a prognostic criterion for atrial fibrillation recurrence after catheter ablation, particularly for left atrial EAT volume 1. (Evidence: Strong)
Pericardial fat is significantly associated with various cardiovascular diseases, including coronary artery disease and ventricular dysfunction, and its volume may be considered for incorporation into cardiovascular risk scores 2. (Evidence: Strong)
Omega-3 fatty acids are recommended for patients with persistently elevated severe hypertriglyceridemia as a "risk-enhancing factor" for atherosclerotic cardiovascular disease, based on their ability to lower triglyceride levels and reduce cardiovascular events 34. (Evidence: Strong)References
1 Golukhova EZ, Bulaeva NI, Alexandrova SA, Saparbaev AS, Abgaryan AA, Berdibekov BS. Quantification of epicardial adipose tissue by computed tomographic scanning as a prognostic criterion of atrial fibrillation recurrence after catheter ablation. Kardiologiia 2023. link
2 Al-Makhamreh HK, Toubasi AA, Al-Harasis LM, Albustanji FH, Al-Sayegh TN, Al-Harasis SM. Pericardial fat and cardiovascular diseases: A systematic review and meta-analysis. Journal of evidence-based medicine 2023. link
3 Wang T, Zhang X, Zhou N, Shen Y, Li B, Chen BE et al.. Association Between Omega-3 Fatty Acid Intake and Dyslipidemia: A Continuous Dose-Response Meta-Analysis of Randomized Controlled Trials. Journal of the American Heart Association 2023. link
4 Rodriguez D, Lavie CJ, Elagizi A, Milani RV. Update on Omega-3 Polyunsaturated Fatty Acids on Cardiovascular Health. Nutrients 2022. link
5 Monti CB, Capra D, Zanardo M, Guarnieri G, Schiaffino S, Secchi F et al.. CT-derived epicardial adipose tissue density: Systematic review and meta-analysis. European journal of radiology 2021. link