Prognostic value of epicardial fat volume measurements by computed tomography: a systematic review of the literature.
OBJECTIVE
To perform a systematic review of the growing body of literature evaluating the prognostic value of epicardial fat volume (EFV) quantified by cross-sectional imaging.


METHODS
Two independent reviewers performed systematic searches on both PubMed and Scopus using search terms developed with a medical librarian. Peer-reviewed articles were selected based on the inclusion of outcome data, utilization of epicardial fat volume and sufficient reporting for analysis.


RESULTS
A total of 411 studies were evaluated with nine studies meeting the inclusion criteria. In all, the studies evaluated 10,252 patients. All nine studies were based on CT measurements. Seven studies evaluated the prognostic value of EFV unadjusted for calcium score, and six of these studies found a significant association between EFV and clinical outcomes. Seven studies evaluated the incremental value of EFV beyond calcium scoring, and six of these studies found a significant association.


CONCLUSIONS
The majority of studies suggest that EFV quantification is significantly associated with clinical outcomes and provides incremental prognostic value over coronary artery calcium scoring. Future research should use a binary cutoff of 125 mL for evaluation of EFV to provide consistency with other research.


CONCLUSIONS
• Epicardial fat volume (EFV) has prognostic value for adverse cardiac events • Establishment of standardized quantitative categories for EFV is needed • Quantification of EFV could improve risk assessment with calcium scoring.
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA.
James V
JV
Spearman
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA.|Department of Internal Medicine I, Cardiology/Angiology, Giessen University, Giessen, Germany.
Matthias
M
Renker
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA. schoepf@musc.edu.|Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. schoepf@musc.edu.
U Joseph
UJ
Schoepf
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA.
Aleksander W
AW
Krazinski
Department of Library Science and Informatics, Medical University of South Carolina, Charleston, SC, USA.
Teri L
TL
Herbert
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA.|Department of Radiological Sciences, Oncology and Pathology, University of Rome 'Sapienza' - Polo Pontino, Latina, Italy.
Carlo N
CN
De Cecco
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Paul J
PJ
Nietert
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC, 29425, USA.|Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
Felix G
FG
Meinel
D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging*; D011379:Prognosis; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging*; D055815:Young Adult
Cardiac computed tomography; Coronary artery calcium; Epicardial fat; Major adverse cardiac events; Prognostic value