Epicardial Adipose Tissue Assessed by Computed Tomography and Echocardiography Are Associated With Adverse Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Chong B 1 , Jayabaskaran J 1 , Ruban J 1 , Goh R 1 , Chin YH 1 , Kong G 1 Show all authors , Ng CH 1 , Lin C 1 , Loong S 1 , Muthiah MD 1 , Khoo CM 2 , Shariff E 3 , Chan MY 1 , Lajeunesse-Trempe F 4 , Tchernof A 4 , Chevli P 5 , Mehta A 6 , Mamas MA 7 , Dimitriadis GK 8 , Chew NWS 9

Affiliations 

  • 1 Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.)
  • 2 Division of Endocrinology, Department of Medicine (C.M.K.), National University Hospital, Singapore
  • 3 Universiti Teknologi MARA (UiTM) Sungai Buloh, Selangor, Malaysia (E.S.)
  • 4 Quebec Heart and Lung Institute (F.L.-T., A.T.), Quebec City, Canada
  • 5 Section on Hospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (P.C.)
  • 6 VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond (A.M.)
  • 7 Institute of Population Health, University of Manchester, United Kingdom (M.A.M.)
  • 8 Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom (F.L.-T., G.K.D.)
  • 9 Department of Cardiology, National University Heart Centre (M.Y.C., N.W.S.C.), National University Health System, Singapore
Circ Cardiovasc Imaging, 2023 May;16(5):e015159.
PMID: 37192298 DOI: 10.1161/CIRCIMAGING.122.015159

Abstract

BACKGROUND: Epicardial adipose tissue (EAT) has garnered attention as a prognostic and risk stratification factor for cardiovascular disease. This study, via meta-analyses, evaluates the associations between EAT and cardiovascular outcomes stratified across imaging modalities, ethnic groups, and study protocols.

METHODS: Medline and Embase databases were searched without date restriction on May 2022 for articles that examined EAT and cardiovascular outcomes. The inclusion criteria were (1) studies measuring EAT of adult patients at baseline and (2) reporting follow-up data on study outcomes of interest. The primary study outcome was major adverse cardiovascular events. Secondary study outcomes included cardiac death, myocardial infarction, coronary revascularization, and atrial fibrillation.

RESULTS: Twenty-nine articles published between 2012 and 2022, comprising 19 709 patients, were included in our analysis. Increased EAT thickness and volume were associated with higher risks of cardiac death (odds ratio, 2.53 [95% CI, 1.17-5.44]; P=0.020; n=4), myocardial infarction (odds ratio, 2.63 [95% CI, 1.39-4.96]; P=0.003; n=5), coronary revascularization (odds ratio, 2.99 [95% CI, 1.64-5.44]; P<0.001; n=5), and atrial fibrillation (adjusted odds ratio, 4.04 [95% CI, 3.06-5.32]; P<0.001; n=3). For 1 unit increment in the continuous measure of EAT, computed tomography volumetric quantification (adjusted hazard ratio, 1.74 [95% CI, 1.42-2.13]; P<0.001) and echocardiographic thickness quantification (adjusted hazard ratio, 1.20 [95% CI, 1.09-1.32]; P<0.001) conferred an increased risk of major adverse cardiovascular events.

CONCLUSIONS: The utility of EAT as an imaging biomarker for predicting and prognosticating cardiovascular disease is promising, with increased EAT thickness and volume being identified as independent predictors of major adverse cardiovascular events.

REGISTRATION: URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42022338075.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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