title: Pericardial rather than epicardial fat is a cardiometabolic risk marker: an MRI vs echo study.
abstract: BACKGROUND
  Several studies using echocardiography identified epicardial adipose tissue (EPI) as an important cardiometabolic risk marker. However, validation compared with magnetic resonance imaging (MRI) or computed tomography has not been performed. Moreover, pericardial adipose tissue (PERI) has recently been shown to have some correlation with cardiovascular disease risk factors. The aims of this study were to validate echocardiographic analyses compared with MRI and to evaluate which cardiac fat depot (EPI or PERI) is the most appropriate cardiovascular risk marker.
  
  
  METHODS
  Forty-nine healthy subjects were studied (age range, 25-68 years; body mass index, 21-40 kg/m(2)), and PERI and EPI fat depots were measured using echocardiography and MRI. Findings were correlated with MRI visceral fat and subcutaneous fat, blood pressure, insulin sensitivity, triglycerides, cholesterol, insulin, glucose, and 10-year coronary heart disease risk.
  
  
  RESULTS
  Most cardiac fat was constituted by PERI (about 77%). PERI thickness by echocardiography was well correlated with MRI area (r = 0.36, P = .009), and independently of the technique used for quantification, PERI was correlated with body mass index, waist circumference, visceral fat, subcutaneous fat, blood pressure, insulin sensitivity, triglycerides, cholesterol, glucose, and coronary heart disease risk. On the contrary, EPI thicknesses correlated only with age did not correlate significantly with MRI EPI areas, which were found to correlate with age, body mass index, subcutaneous fat, and hip and waist circumferences.
  
  
  CONCLUSIONS
  Increased cardiac fat in the pericardial area is strongly associated with features of the metabolic syndrome, whereas no correlation was found with EPI, indicating that in clinical practice, PERI is a better cardiometabolic risk marker than EPI.
authors.affiliation: National Research Council Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Sironi
authors.forename: Roberta
authors.initials: R
authors.lastname: Petz
authors.forename: Francesca
authors.initials: F
authors.lastname: Frassi
authors.forename: Vladislav
authors.initials: V
authors.lastname: Chubuchny
authors.forename: Daniele
authors.initials: D
authors.lastname: De Marchi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Positano
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.forename: Amalia
authors.initials: A
authors.lastname: Gastaldelli
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000378:metabolism; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D012680:Sensitivity and Specificity