Skip to main content
Log in

Myocardial fat as a part of cardiac visceral adipose tissue: physiological and pathophysiological view

  • Review
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Thoracic fat includes extra-pericardial (outside the visceral pericardium) and intra-pericardial (inside the visceral pericardium) adipose tissue. It is called ectopic adipose tissue although it is a normal anatomical structure. Intra-pericardial adipose tissue, which is predominantly composed of epicardial and pericoronary adipose tissue, has a significant role in cardiovascular system function. It provides metabolic-mechanical support to the heart and blood vessels in physiological conditions, while it represents metabolic-cardiovascular risk in case of qualitative and quantitative structural changes in the tissue: it correlates with coronary atherosclerotic disease, left ventricular mass, left atrium enlargement and atrial fibrillation presence. In the last decade there has been mounting evidence of fat cells presence in the myocardium of healthy (non-diseased) persons as well as in persons with both cardiovascular and non-cardiovascular diseases. Thus, it is necessary to clarify the incidence, aetiology, physiological role of fat cells in the myocardium, as well as the clinical significance of pathological fatty infiltration of the myocardium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Dey D, Nakazato R, Li D, Berman DS (2012) Epicardial and thoracic fat-noninvasive measurement and clinical implications. Cardiovasc Diagn Ther 2(2):85–93

    PubMed Central  PubMed  Google Scholar 

  2. Yun KH, Rhee SJ, Yoo NJ, Oh SK, Kim NH, Jeong JW et al (2009) Relationship between the echocardiographic epicardial adipose tissue thickness and serum adiponectin in patients with angina. J Cardiovac Ultrasond 17(4):121–126

    Article  Google Scholar 

  3. Britton KA, Wang N, Palmisano J, Corsini E, Schlett CL, Hoffmann U et al (2013) Thoracic periaortic and visceral adipose tissue and their cross-sectional associations with measures of vascular function. Obesity (Silver Spring) 21(7):1496–1503

    Article  Google Scholar 

  4. Bertaso AG, Bertol D, Duncan BB, Foppa M (2013) Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol 101(1):e18–e28

    PubMed Central  PubMed  Google Scholar 

  5. Sacks HS, Fain JN (2007) Human epicardial adipose tissue: a review. Am Heart J 153:907–917

    Article  CAS  PubMed  Google Scholar 

  6. Pananowitz L (2001) Fat infiltration in the heart. Heart 85:253

    Google Scholar 

  7. Kimura F, Matsuo Y, Nakajima T, Nishikawa T, Kawamura S, Sannohe S et al (2010) Myocardial fat at cardiac imaging: how can we differentiate pathologic from physiologic fatty infiltration? Radiographics 30:1587–1602

    Article  PubMed  Google Scholar 

  8. Iozzo P (2011) Myocardial, perivascular and epicardial fat. Diab Care 34:S371–S379

    Article  CAS  Google Scholar 

  9. Iozzo P, Lautamaki R, Borra R, Lehto HR, Bucci M, Viljanen A et al (2009) Contribution of glucose tolerance and sex to cardiac adiposity. J Clin Endocrinol Metab 94:4472–4482

    Article  CAS  PubMed  Google Scholar 

  10. Fitzgibbons TP, Cezch MP (2014) Epicardial and perivascular adipose tissues and their influence on cardiovascular disease: basic mechanisms and clinical associations. J Am Heart Assoc 3:e000582

    Article  PubMed Central  PubMed  Google Scholar 

  11. Iacobellis G, Pistilli D, Gucciardo M, Leonetti F, Miraldi F, Brancaccio G et al (2005) Adiponectin expression in human epicardial adipose tissue in vivo is lower in patients with coronary artery disease. Cytokine 29:251–255

    CAS  PubMed  Google Scholar 

  12. Mahabadi AA, Massaro JM, Rosito GA, Levy D, Murabito JM, Wolf PA et al (2009) Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J 30:850–856

    Article  PubMed Central  PubMed  Google Scholar 

  13. Greenstein AS, Khavandi K, Wihers SB, Sonoyama K, Clancy O, Jeziorska M et al (2009) Local inflammation and hypoxia abolish the protective anticontractile properties of perivascular fat in obese patients. Circulation 119:1661–1670

    Article  CAS  PubMed  Google Scholar 

  14. Zhang H, Zhang C (2009) Regulation of microvascular function by adipose tissue in obesity and type 2 diabetes: evidence of adipose-vascular loop. Am J Biomed Sci 1:133–142

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Iacobellis G, Willens HJ (2009) Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 22:1311–1319

    Article  PubMed  Google Scholar 

  16. Fox CS, Gona P, Hoffmann U, Porter SA, Salton CJ, Massaro JM et al (2009) Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham Heart Study. Circulaton 119:1586–1591

    Article  Google Scholar 

  17. Natale F, Tedesco MA, Mocerino R, de Simone V, Di Marco GM, Aronne L et al (2009) Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiogr 10:549–555

    Article  PubMed  Google Scholar 

  18. Britton KA, Pedley A, Massaro JM, Corsini EM, Murabito JM, Hoffmann U et al (2012) Prevalence, distribution, and ris factor correlates of high thoracic periaortic fat in the Framingham heart study. J Am Heart Assoc 1(6):e004200

    Article  PubMed Central  PubMed  Google Scholar 

  19. Marchington JM, Mattacks CA, Pond CM (1989) Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B 94:225–232

    Article  CAS  PubMed  Google Scholar 

  20. Alexopoulos N, McLean DS, Janik M, Arepalli CD, Stillman AE, Raggi P (2010) Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis 210:150–154

    Article  CAS  PubMed  Google Scholar 

  21. Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A et al (2003) Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 88:5163–5168

    Article  CAS  PubMed  Google Scholar 

  22. Echavarría-Pinto M, Hernando L, Alfonso F (2013) From the epicardial adipose tissue to vulnerable coronary plaques. World J Cardiol 5(4):68–74

    Article  PubMed Central  PubMed  Google Scholar 

  23. Montani JP, Carroll JF, Dwyer TM, Antic V, Yang Z, Dulloo AF (2004) Ectopic fat storage, blood vessels and kidneys in the pathogenesis of cardiovascular diseases. Int J Obes Relat Metab Disord 28:S58–S65

    Article  CAS  PubMed  Google Scholar 

  24. Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS et al (2008) Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcifications in a community-based sample: the Framingham Heart Study. Circulation 117:605–613

    Article  PubMed  Google Scholar 

  25. Savks HS, Fain JN, Bahouth SW, Ojha S, Frontini A, Budge H et al (2013) Adult epicardial fat exhibits beige features. J Clin Endocrinol Metab 98:E1448–E1455

    Article  Google Scholar 

  26. Corradi D, Maestri R, Callegari S, Pastori P, Goldoni M, Luong TV et al (2004) The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts. Cardiovasc Pathol 13:313–316

    Article  PubMed  Google Scholar 

  27. Venteclef N, Guglielmi V, Balse E, Gaborit B, Cotillard A, Atassi F et al (2013) Human epicardial adipose tissue induces fibrosis of the atrial myocardium through the secretion of adipo-fibrokines. Eur Heart J. doi:10.1093/eurheartj/eht099

    PubMed  Google Scholar 

  28. Wong CX, Abed HS, Molaee P, Nelson AJ, Brooks AG, Sharma G et al (2011) Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol 57:1745–1751

    Article  PubMed  Google Scholar 

  29. Kim E, Choe YH, Han BK, Kim SM, Kim JS, Park SW et al (2007) Right ventricular fat infiltration in asymptomatic subjects: observation from ECG gated 16 slice multidetector CT. J Comput Assist Tomogr 31:22–28

    Article  PubMed  Google Scholar 

  30. Iacobellis G, Ribaudo MC, Zapaterrano A, Iannucci CV, Leonetti F (2004) Relation between epicardial adipose tissue and left ventricular mass. Am J Cardiol 94:1084–1087

    Article  PubMed  Google Scholar 

  31. Khawaja T, Greer C, Chokshi A, Chavarria N, Thadani S, Jones M et al (2011) Epicardial fat volume in patients with left ventricular systolic dysfunction. Am J Cardiol 108:397–401

    Article  PubMed  Google Scholar 

  32. Enriga EC, Bakker W, Smulders YM, Serné EH, Yudkin JS, Stehouwer CDA (2007) Regulation of vascular function and insulin sensitivity by adipose tissue: focus on perivascular adipose tissue. Microcirculation 14:389–402

    Article  Google Scholar 

  33. Vela D, Buja LM, Madjid M, Burke A, Naghavi M, Willerson JT, Casscells SW et al (2007) The role of periadventitial fat in atherosclerosis. Arch Pathol Lab Med 131:481–487

    PubMed  Google Scholar 

  34. Lohn M, Dubrovska G, Lauterbach B, Luft FC, Gollasch M, Sharma AM (2002) Periadventitial fat releases a vascular relaxing factor. FASEB J 16:1057–1063

    Article  PubMed  Google Scholar 

  35. Baker AR, Silva NF, Quinn DW, Harte AL, Pagano D, Bonser RS et al (2006) Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol 5:1

    Article  PubMed Central  PubMed  Google Scholar 

  36. Yudkin JS, Eringa E, Stehouwer CD (2005) “Vasocrine” signalling from perivascular fat: a mechanism linking insulin resistance to vascular disease. Lancet 365:1817–1820

    Article  PubMed  Google Scholar 

  37. Gaborit B, Kober F, Jacquier A, Moro PJ, Flavian A, Quilici J et al (2012) Epicardial fat volume is associated with coronary microvascular response in healthy subjects: a pilot study. Obesity (Silver Spring) 20:1200–1205

    Article  CAS  Google Scholar 

  38. Britton KA, Fox CS (2011) Perivascular adipose tissue and vascular disease. Clin Lipidol 6:79–91

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Demircelik MB, Yilmaz OC, Gurem OM, Selcoki Y, Atlar IA, Bozkurt A et al (2014) Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease. Clinics 69(6):388–392

    Article  PubMed Central  PubMed  Google Scholar 

  40. Basso C, Thiene G (2005) Adipositas cordis, fatty infiltration of the right ventricle, and arrhythmogenic right ventricular cardiomyopathy: just a matter of fat? Cardiovasc Pathol 14:37–41

    Article  PubMed  Google Scholar 

  41. Tansey DK, Aly Z, Sheppard MN (2005) Fat in the right ventricle of the normal heart. Histopathology 46:98–104

    Article  CAS  PubMed  Google Scholar 

  42. Kellman P, Hernando D, Arai AE (2010) Myocardial fat imaging. Curr Cardiovasc Imaging Rep 3:83–91

    Article  PubMed Central  PubMed  Google Scholar 

  43. Litwin SE (2012) Normal weight obesity: is bigger really badder? Circ Cardiovasc Imaging 5:286–288

    Article  PubMed  Google Scholar 

  44. de la Grandmaison LG, Le Bihan C, Duringon M (2001) Assessment of right ventricular lipomatosis by histomorphometry in control adult autopsy cases. Int J Legal Med 115:105–108

    Article  Google Scholar 

  45. Fontaine G, Fontaliran F, Zenati O, Guzman CE, Rigoulet J, Berthier JL et al (1999) Fat in the heart: a feature unique to the human species? Observational reflections on an unsolved problem. Acta Cardiol 54:189–194

    CAS  PubMed  Google Scholar 

  46. Goldfarb JW, Arnold S, Roth M, Han J (2007) T1-weighted magnetic resonance imaging shows fatty depositions after myocardial infarction. Magn Reson Med 57:828–834

    Article  PubMed  Google Scholar 

  47. Ahn SS, Kim YJ, Hur J, Lee HJ, Kim TH, Choe KO et al (2009) CT detection, of subendocardial fat in myocardial infarction. Am J Roentgenol 192:532–537

    Article  Google Scholar 

  48. Minjie L, An J, Gang J, Shiliang J, Qiong L, Ning M et al (2012) Myocardial fat deposition in dilatated cardiomyopathy-assessment by using MR water-fat separation imaging. Heart 98:E249–E250

    Google Scholar 

  49. Ichikawa Y, Kitagawa W, Chino S, Ishida M, Matsuoka K, Tanigawa T et al (2009) Adipose tissue detected by multislice computed tomography in patients after myocardial infarction. JACC Cardiovasc Imaging 2:548–555

    Article  PubMed  Google Scholar 

  50. Basso C, Ronco F, Marcus F, Abudureheman A, Rizzo S, Frigo AC et al (2008) Quantitative assessment of endomyocardial biopsy in arrhythmogenic right ventricular cardiomyopathy/dysplasia: an in vitro validation of diagnostic criteria. Eur Heart J 29:2760–2771

    Article  PubMed  Google Scholar 

  51. Marcus F, McKenna WJ, Sherill D, Basso C, Bauce B, Bluemke DA et al (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task force criteria. Circulation 121:1533–1541

    Article  PubMed Central  PubMed  Google Scholar 

  52. Kimura F, Sakai F, Sakomura Y, Fujimura M, Ueno E, Matsuda N et al (2002) Helical CT features of arrhythmogenic right ventricular cardiomyopathy. Radiographics 22:1111–1124

    Article  PubMed  Google Scholar 

  53. Heyer CM, Kagel T, Lemburg SP, Bauer TT, Nicolas V (2003) Lipomatous hypertrophy of the interatrial septum: a prospective study of incidence, imaging findings, and clinical symptoms. Chest 124:2068–2073

    Article  PubMed  Google Scholar 

  54. Araoz PA, Mulvagh SL, Tazelaar HD, Julsrud PR, Breen JF (2000) CT and MR imaging of benign primary cardiac neoplasms with echocardiographic correlation. Radiographics 20:1303–1319

    Article  CAS  PubMed  Google Scholar 

  55. Shaaya EA, Hirshberg JS, Rabe OT, Thibert RL, Inglessis I, Sharma A et al (2013) Cardiac-fat containing lesions are common in tuberous sclerosis complex. AM J Med Genet A 161:1662–1665

    Article  Google Scholar 

  56. Nishimura T, Yanagisawa A, Sakata H, Sakata K, Shimoyama K, Ishihara T et al (2001) Thallium-201 single photon emission computed tomography (SPECT) in patients with Duchenne’s progressive muscular dystrophy: a histopathologic correlation study. Jpn Circ J 65:99–105

    Article  CAS  PubMed  Google Scholar 

  57. Puchalski MD, Williams RV, Askovich B, Sower CT, Hor KH, Su JT et al (2009) Late gadolinium enhancement: precursor to cardiomyopathy in Duchenne muscular dystrophy? Int J Cardiovasc Imaging 25:57–63

    Article  PubMed Central  PubMed  Google Scholar 

  58. Iacobellis G, Corradi D, Sharma AM (2005) Epicardial adipose tissue: anatomic, biomolecular and clinical relation to the heart. Nat Clin Pract Cardiovasc Med 2:536–543

    Article  PubMed  Google Scholar 

  59. Hartung H, Feldman B, Lovec H, Coulier F, Birnbaum D, Goldfarb M (1997) Murine FGF-12 and FGF-13: expression in embryonic nervous system, connective tissue and heart. Mech Dev 64(1–2):31–39

    Article  CAS  PubMed  Google Scholar 

  60. Van der Meer RW, Smit JW, Hammer S, Schär M, Bax JJ, Smit JW et al (2008) The ageing male heart: myocardial triglyceride contents as independent predictor of diastolic dysfunction. Eur Heart J 29:1516–1522

    Article  PubMed  Google Scholar 

  61. Lou BT, Jiang HG, Zhao YH, Chen XY (2010) Pathology of myocardial fatty infiltration: an autopsy report from 117 cases. Zhonghua Xin Guan Bing Za Zhi 38:350–353

    Google Scholar 

  62. Malavazos AE, Di Leo G, Secchi F, Lupo EN, Dogliotti G, Coman C et al (2010) Relation of echocardiographic epicardial fat thickness and myocardial fat. Am J Cardiol 105(12):1831–1835

    Article  PubMed  Google Scholar 

  63. Palojoki E, Saraste A, Eriksson A, Pulkki K, Kallajoki M, Voipio-Pulkki LM et al (2001) Cardiomyocyte apoptosis and ventricular remodeling after myocardial infarction in rats. Am J Physiol Heart Circ Physiol 280:H2726–H2731

    CAS  PubMed  Google Scholar 

  64. Su L, Siegel JE, Fishbein MC (2004) Adipose tissue in myocardial infarction. Cardiovasc Pathol 13:98–102

    Article  PubMed  Google Scholar 

  65. Sieber-Blum M (2004) Cardiac neural crest stem cells. Anat Rec A Discov Mol Cell Evol Biol 276:34–42

    Article  PubMed  Google Scholar 

  66. D’Amati G, di Gioia CRT, Giordano C, Gallo P (2000) Myocyte transdifferentiation. A possible pathogenic mechanism for arrhythmogenic right ventricular cardiomyopathy. Arch Pathol Lab Med 124:287–290

    PubMed  Google Scholar 

  67. Chellamuthu S, Smith AM, Thomas SM, Hill C, Brown PW, Al-Mohammad A (2014) Is cardiac MRI an effective test for arrhythmogenic right ventricular cardiomyopathy diagnosis? World J Cardiol 26(6):675–681

    Article  Google Scholar 

  68. Feng Y, Wang Y, Cao N, Yang H, Wang Y (2012) Progenitor/stem cell transplantation for repair of myocardial infarction: Hype or hope? Ann Palliat Med 1:65–77

    PubMed Central  PubMed  Google Scholar 

  69. Selthofer-Relatić K (2014) Cardiac visceral adiposity and right ventricle apex remodelling—locus minoris resistentiae. Med Hypo 82:404

    Google Scholar 

  70. Selthofer-Relatić K, Rajc J, Belovari T, Bošnjak I, Dumenčić B (2014) Fatty infiltration of the right heart—histopathological human analysis. Cardiologia Croatica 9(9–10):444

    Article  Google Scholar 

  71. Lazzarini V, Mentz RJ, Fiuzat M, Metra M, O’Connor CM (2013) Heart failure in elderly patients: distinctive features and unresolved issues. Eur J Heart Fail 15:717–723

    Article  PubMed Central  PubMed  Google Scholar 

  72. Wong LS, van der Harst P, de Boer RA, Huzen J, van Gilst WH, van Veldhuisen DJ (2010) Aging, telomeres and heart failure. Heart Fail Rev 15:479–486

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  73. Crendal E, Dutheil F, Naughton G, McDonald T, Obert P (2014) Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males. BMC Cardiovasc Disord 14:95

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to K. Selthofer-Relatić.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Selthofer-Relatić, K., Bošnjak, I. Myocardial fat as a part of cardiac visceral adipose tissue: physiological and pathophysiological view. J Endocrinol Invest 38, 933–939 (2015). https://doi.org/10.1007/s40618-015-0258-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-015-0258-y

Keywords

Navigation