[Contemporary Cardiology] Epicardial Adipose Tissue (From Cell to Clinic) ||

This book is the first authoritative and comprehensive volume dedicated to epicardial adipose tissue (EAT). It provides an up-to-date and highly illustrated synopsis of the anatomical, biomolecular, genetic, imaging features, and clinical applications of EAT and its role in cardiovascular disease. It relays to the reader a contemporary view of the emerging interplay between the heart and adiposity-related diseases. In addition, this volume discusses the clinical implications and therapeutic targets of EAT in atrial fibrillation, heart failure and coronary artery disease. Comprehensive yet focused, Epicardial Adipose Tissue: From Cell to Clinic is an essential resource for physicians, residents, fellows, and medical students in cardiology, endocrinology, primary care, and health promotion and disease prevention. Preface 7 Contents 9 Contributors 11 About the Editor 13 1: Anatomy of the Epicardial Adipose Tissue 15 Introduction 15 Comparative Anatomy 15 Human Anatomy 18 Embryology 18 Microscopic Anatomy 18 Macroscopic Anatomy 19 References 21 2: Physiology and Cardioprotection of the Epicardial Adipose Tissue 23 Introduction 23 Epicardial Fat Nutrifying the Myocardium 24 Epicardial Fat Cardioprotective Adipokines 25 Adiponectin 25 Adrenomedullin 26 Omentin 27 Epicardial as Brown Fat 27 Epicardial Fat Regulatory Transcriptome 29 Epicardial Fat Mechanical Cardioprotection 29 Effect of Aging and Gender on Epicardial Fat Cardioprotection 30 References 30 3: Transcriptomic and Proteomic Analysis of the Epicardial Adipose Tissue 32 Introduction 32 Epicardial Fat Transcriptomics in Animals and Humans 33 Unique Gene Expression in Epicardial Fat 34 Epicardial Fat Paracrine/Endocrine Function 39 Epicardial Fat Immunological/Inflammation Function 41 Factors That Modulate Epicardial Fat Gene Expression 42 Exercise 42 Age and Sex 42 Surgery 43 Diseases 43 Medication 43 Concluding Remarks 44 References 44 4: Pathology and Cardiotoxicity of the Epicardial Adipose Tissue 50 Visceral Adiposity and Cardiovascular Risk 50 Myocardial Lipotoxicity of Epicardial Fat 51 Epicardial Fat and Heart Chambers 52 Microscopic Changes 52 Macroscopic Changes 53 Epicardial Fat and Ventricles 53 Epicardial Fat and Atria 57 Epicardial Fat and Diastole 57 Epicardial Fat and Systole 58 References 58 5: Echocardiographic Imaging of the Epicardial Adipose Tissue 61 Introduction 61 Methodology 62 Epicardial Versus Pericardial Fat Thickness 62 Epicardial Fat Thickness Range 62 Echocardiographic Epicardial Fat Is a Marker of Visceral Fat 63 Advantages of Echocardiographic Epicardial Fat Thickness 63 Limitations of Echocardiographic Epicardial Fat Thickness 64 References 65 6: Computed Tomography Imaging of Epicardial Adipose Tissue 66 Imaging Tools as Part of Primary and Secondary Prevention 66 CT Imaging for Quantification of Fat Depots 67 Requirements for CT Imaging 68 Methods for Assessment of EAT from CT Imaging 68 Reference Values for CT-Derived EAT 70 CT-Derived EAT and Cardiovascular Risk Factors 70 CT-Derived EAT and Markers of Subclinical Atherosclerosis 70 CT-Derived EAT Volume and Atherosclerotic Disease Manifestation 71 CT-Derived EAT and Non-atherosclerotic Cardiac Diseases 72 CT-Derived EAT Attenuation: A Novel and Complemental Risk Marker? 73 CT-Derived Perivascular Fat Assessment and Its Implications 74 Periaortic Fat 77 Future Perspective 77 Conclusion 78 References 78 7: Magnetic Resonance Imaging of the Epicardial Adipose Tissue 82 Introduction 82 Cardiac MRI of the Epicardial Fat 82 Advantages of CMR Imaging of Epicardial Fat 85 Limitations of CMR Imaging of Epicardial Fat 85 Proton Magnetic Resonance Spectroscopy and Epicardial Fat 85 References 86 8: Coronary Artery Disease and Epicardial Adipose Tissue 88 Introduction 88 Epicardial Fat Inflammation 88 Epicardial Fat Lipotoxicity 92 Epicardial Fat Glucotoxicity 93 Epicardial Fat Downregulation in Advanced Coronary Artery Disease 94 Clinical Role of Epicardial Fat in Coronary Artery Disease 94 Impact of Epicardial Adipectomy on CAD 98 Conclusion 98 References 99 9: Perivascular Adipose Tissue and Atherosclerosis 102 Introduction 103 Atherogenesis and Inflammation 103 Defining Perivascular Adipose Tissue 104 PVAT Effects on the Vascular Wall – Outside to Inside Signaling 105 Adipose Tissue Remodeling in Response to Signals Form the Circulation 111 PVAT as a Sensor of Early Vascular Disease Signals – Inside to Outside Signaling 112 Imaging Perivascular Adipose Tissue 113 Quantitate Imaging Features 114 Qualitative Imaging Features 114 Measuring PVAT Attenuation: Introducing the Fat Attenuation Index (FAI) 115 Calculating FAI 115 FAI as an Internal “Thermometer” of the Entire Coronary Tree 117 FAI as a Local Biomarker of Coronary Plaque Inflammation and Vulnerability 117 FAI as a Predictor of Long-Term Outcomes 118 Entering the Big Data Era: PVAT Radiomic Phenotyping 119 Summary 121 References 122 10: Atrial Fibrillation and Epicardial Adipose Tissue 127 Introduction 127 Obesity and Atrial Fibrillation 128 EAT and Atrial Fibrillation: Anatomy, Physiology, and Pathophysiological Mechanisms 130 Anatomy 130 Physiology 131 Pathophysiological Mechanisms 131 Fatty Infiltration 131 Inflammation 132 Atrial Remodelling 133 Electrical Remodelling 133 Structural Remodeling 133 Oxidative Stress 134 Neural Mechanism 134 Genetic Factors 135 Clinical Evidence of Association Between EAT and Atrial Fibrillation 135 Clinical Implications of EAT in Atrial Fibrillation and Possible Therapeutic Options 138 EAT as Risk Predictive Biomarker for Atrial Fibrillation 138 Potential Therapeutic Options Targeting EAT 139 Weight Loss 139 Medications 139 Conclusion 140 References 140 11: Heart Failure and Epicardial Adipose Tissue 149 Introduction 149 Thermogenic Epicardial Fat and Heart Failure 149 Epicardial Fat Adipokines and Heart Failure 150 Epicardial Fat in Diastolic and Systolic Heart Failure 150 References 153 12: Autonomic Nervous System Modulation of the Epicardial Adipose Tissue in Heart Failure and Atrial Fibrillation 155 Introduction 155 Sympathetic Nervous System of the Heart 155 Parasympathetic Nervous System of the Heart 157 Autonomic Dysregulation and EAT: Implications for Human AF and Heart Failure 157 Summary 160 References 160 13: Cardiometabolic Risk and Epicardial Adipose Tissue 164 Introduction 164 Metabolic Syndrome 164 Adipose Tissue Changes in Metabolic Syndrome 165 Epicardial Fat as Marker of Visceral Adiposity 165 Epicardial Fat and Metabolic Syndrome 166 Epicardial Fat, Diabetes, and Insulin Resistance 166 Epicardial Fat and Liver Steatosis 167 Epicardial Fat and HIV-Related Cardiovascular Risk 168 Epicardial Fat and Psoriasis-Related Cardiovascular Risk 169 Epicardial Fat and Menopause-Related Cardiovascular Risk 170 Racial and Ethnic Differences in Epicardial Fat 170 Conclusion 170 References 171 14: Adrenal Secretome and Epicardial Adipose Tissue 175 Introduction 175 Epicardial Adipose Tissue and Primary Aldosteronism 176 Epicardial Adipose Tissue and Adrenal Incidentaloma 177 Epicardial Adipose Tissue and Cushing Syndrome 178 References 178 15: Targeting the Epicardial Adipose Tissue 181 Introduction 181 Weight Loss Interventions Effects on Epicardial Fat 182 Diet 182 Bariatric Surgery 182 Exercise Effects on Epicardial Fat 184 Anti-Diabetes Drugs Effects on Epicardial Fat 185 Glucagon-Like Peptide-1 Receptors Agonists 185 Dipeptidyl-4 Inhibitors 187 Sodium-Glucose Cotransporter 2 Inhibitors 188 Thiazolidinediones 188 Metformin 189 Insulin 189 Statins Effects on Epicardial Fat 189 Other Drugs Targeting Epicardial Fat 190 Growth Hormone 190 Phosphodiesterase Type 5 Inhibitors 190 Testosterone 190 Thyroid 190 TNF Alpha Inhibitors 192 References 192 Index 196