Pericardial fat and its influence on cardiac diastolic function

Vera H W de Wit-Verheggen, Sibel Altintas, Romy J M Spee, Casper Mihl, Sander M J van Kuijk, Joachim E Wildberger, Vera B Schrauwen-Hinderling, Bas L J H Kietselaer, Tineke van de Weijer, Vera H W de Wit-Verheggen, Sibel Altintas, Romy J M Spee, Casper Mihl, Sander M J van Kuijk, Joachim E Wildberger, Vera B Schrauwen-Hinderling, Bas L J H Kietselaer, Tineke van de Weijer

Abstract

Background: Pericardial fat (PF) has been suggested to directly act on cardiomyocytes, leading to diastolic dysfunction. The aim of this study was to investigate whether a higher PF volume is associated with a lower diastolic function in healthy subjects.

Methods: 254 adults (40-70 years, BMI 18-35 kg/m2, normal left ventricular ejection fraction), with (a)typical chest pain (otherwise healthy) from the cardiology outpatient clinic were retrospectively included in this study. All patients underwent a coronary computed tomographic angiography for the measurement of pericardial fat volume, as well as a transthoracic echocardiography for the assessment of diastolic function parameters. To assess the independent association of PF and diastolic function parameters, multivariable linear regression analysis was performed. To maximize differences in PF volume, the group was divided in low (lowest quartile of both sexes) and high (highest quartile of both sexes) PF volume. Multivariable binary logistic analysis was used to study the associations within the groups between PF and diastolic function, adjusted for age, BMI, and sex.

Results: Significant associations for all four diastolic parameters with the PF volume were found after adjusting for BMI, age, and sex. In addition, subjects with high pericardial fat had a reduced left atrial volume index (p = 0.02), lower E/e (p < 0.01) and E/A (p = 0.01), reduced e' lateral (p < 0.01), reduced e' septal p = 0.03), compared to subjects with low pericardial fat.

Conclusion: These findings confirm that pericardial fat volume, even in healthy subjects with normal cardiac function, is associated with diastolic function. Our results suggest that the mechanical effects of PF may limit the distensibility of the heart and thereby directly contribute to diastolic dysfunction. Trial registration NCT01671930.

Keywords: Cardiac diastolic function; Epicardial fat; Pericardial fat.

Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
Flowchart of inclusion (n = 254). 254 patients from the Maastricht biomarker CT study were eligible for the analysis of the association of PF and diastolic function in healthy subjects
Fig. 2
Fig. 2
Definition of pericardial fat (PF) and the related adipose tissues. The adipose tissue surrounding the heart is defined as the pericardial fat (PF) and is a combination of epicardial and cardiac fat components. Within the PF, the pericardium demarcates the epicardial adipose tissue (EAT) from the cardiac adipose tissue (CAT). EAT (depicted in blue) is located between the myocardium and visceral pericardium, CAT (depicted in green) is located adherent and external to the parietal pericardium
Fig. 3
Fig. 3
The variation of PF volume to sex, age and BMI in a healthy population. PF volume is higher in males as in females (a), PF volume is not related to age (b) and PF volume is associated with BMI (c)
Fig. 4
Fig. 4
PF is not associated with diastolic function parameters in a healthy population. Data of the entire cohort (n = 254) are displayed. No correlations are found
Fig. 5
Fig. 5
No relation of PF to its CAT and EAT component. The amount of CAT (a) and EAT (b) are not related to PF. Although EAT and CAT volume show a wide variation, they are linearly associated to each other (c), indicating that both increase with an increase of PF

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