Title : The role of epicardial adipose tissue in clinical cardiology
Abstract:
Epicardial adipose tissue is an area of multidisciplinary interest and tremendous potential for upcoming research. It is composed of adipocytes as well as inflammatory cells, nervous cells, vascular cells and immune cells. It has multiple protective functions and has functional interactions with the cardiac tissue due to shared circulation and lack of anatomical barrier. EAT contributes to disease progression by a variety of mechanisms from immune response, inflammation, oxidative response, endothelial damage, lipid accumulation. In cardiovascular diseases like CAD, Atrial fibrillation, Heart failure and Diabetes mellitus EAT promotes atherogenesis, arrhythmias, cellular fibrosis and apoptosis. EAT can be assessed by 2D Echocardiography, Cardiac MRI and contrast or non-contrast enhanced CT. Localisation of regionally distributed EAT in left atrial and pericoronary has immense scope in predicting the associated cardiovascular risk. A higher EAT volume is associated with a Coronary artery calcium score greater than 10 which can predict atherosclerosis risk. EAT volume and thickness is also higher in chronic Atrial fibrillation patients compared to patients with paroxysmal Atrial fibrillation. In addition, EAT is a novel target for cardiometabolic drugs with effects on GLP1R and SGLT2 receptors. EAT expresses Angiotensin Converting Enzyme 2 (ACE2) that serves as an entry receptor for SARS-CoV-2 and functions as a reservoir for the virus. To conclude, EAT presents tremendous promise in risk prediction and clinical application. The possibility of cardiometabolic modulation provides an avenue for modification of cardiovascular risk. The research on this topic is still in its beginning stages and its potential is yet to be demonstrated in clinical decision making.
Audience Take Away Notes
• This presentation discusses the role of Epicardial Adipose tissue with the physiologic and pathological properties of EAT and its implication in cardiovascular disease and application in risk stratification
• We discuss imaging techniques to measure it clinically and assess cardiovascular risk while also understanding the significance of regional distribution of EAT and how Coronary and Left atrial EAT affect cardiovascular diseases
• We discuss how it can be a potential therapeutic target for cardiometabolic medications modulating adipose tissue
• We also shine light on the correlation between type 2 Diabetes mellitus and high levels of epicardial adipose tissue and its role in COVID-19 related cardiac syndrome
