Pericardial, But Not Hepatic, Fat by CT Is Associated With CV Outcomes and Structure: The Multi-Ethnic Study of Atherosclerosis.
The study sought to determine the associations between local (pericardial) fat and incident cardiovascular disease (CVD) events and cardiac remodeling independent of markers of overall adiposity.



The impact of pericardial fat-a local fat depot encasing the heart-on myocardial function and long-term CV prognosis independent of systemic consequences of adiposity or hepatic fat is an area of active debate.



We studied 4,234 participants enrolled in the MESA (Multi-Ethnic Study of Atherosclerosis) study with concomitant cardiac magnetic resonance imaging and computed tomography (CT) measurements for pericardial fat volume and hepatic attenuation (a measure of liver fat). Poisson and Cox regression were used to estimate the annualized risk of incident hard atherosclerotic CVD (ASCVD), all-cause death, heart failure, all-cause CVD, hard coronary heart disease, and stroke as a function of pericardial and hepatic fat. Generalized additive models were used to assess the association between cardiac magnetic resonance indices of left ventricular (LV) structure and function and pericardial fat. Models were adjusted for relevant clinical, demographic, and cardiometabolic covariates.



MESA study participants with higher pericardial and hepatic fat were more likely to be older, were more frequently men, and had a higher prevalence of cardiometabolic risk factors (including dysglycemia, dyslipidemia, hypertension), as well as adiposity-associated inflammation. Over a median 12.2-year follow-up (interquartile range: 11.6 to 12.8 years), pericardial fat was associated with a higher rate of incident hard ASCVD (standardized hazard ratio: 1.22; 95% confidence interval: 1.10 to 1.35; p = 0.0001). Hepatic fat by CT was not significantly associated with hard ASCVD (standardized hazard ratio: 0.96; 95% confidence interval: 0.86 to 1.08; p = 0.52). Higher pericardial fat was associated with greater indexed LV mass (37.8 g/m2.7vs. 33.9 g/m2.7, highest quartile vs. lowest quartile; p < 0.01), LV mass-to-volume ratio (1.2 vs. 1.1, highest quartile vs. lowest quartile; p < 0.01). In adjusted models, a higher pericardial fat volume was associated with greater LV mass (p < 0.0001) and concentricity (p < 0.0001).



Pericardial fat is associated with poorer CVD prognosis and LV remodeling, independent of insulin resistance, inflammation, and CT measures of hepatic fat.
Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: rvshah@partners.org.
Ravi V
RV
Shah
Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Amanda
A
Anderson
Department of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
Jingzhong
J
Ding
Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, California.
Matthew
M
Budoff
Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom.
Oliver
O
Rider
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, United Kingdom.
Steffen E
SE
Petersen
Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Majken Karoline
MK
Jensen
Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Manja
M
Koch
Department of Family and Preventative Medicine, University of California-San Diego, San Diego, California.
Matthew
M
Allison
Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
Nadine
N
Kawel-Boehm
Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Jessica
J
Wisocky
Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts.
Michael
M
Jerosch-Herold
Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Kenneth
K
Mukamal
Cardiology Division, Johns Hopkins Medical Institute, Baltimore, Maryland.
João A C
JAC
Lima
Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor, Michigan; Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Ann Arbor, Michigan. Electronic address: vlmurthy@med.umich.edu.
Venkatesh L
VL
Murthy
D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000503:physiopathology; D050154:Adiposity / Q000208:ethnology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
cardiac magnetic resonance imaging; hepatic fat; obesity; pericardial fat; remodeling