Author + information
- Received January 5, 2018
- Revision received February 20, 2018
- Accepted March 18, 2018
- Published online May 14, 2018.
- Milton Packer, MD∗ ()
- ↵∗Address for correspondence:
Dr. Milton Packer, Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, Dallas, Texas 75226.
Epicardial adipose tissue has unique properties that distinguish it from other depots of visceral fat. Rather than having distinct boundaries, the epicardium shares an unobstructed microcirculation with the underlying myocardium, and in healthy conditions, produces cytokines that nourish the heart. However, in chronic inflammatory disorders (especially those leading to heart failure with preserved ejection fraction), the epicardium becomes a site of deranged adipogenesis, leading to the secretion of proinflammatory adipokines that can cause atrial and ventricular fibrosis. Accordingly, in patients at risk of heart failure with preserved ejection fraction, drugs that promote the accumulation or inflammation of epicardial adipocytes may lead to heart failure, whereas treatments that ameliorate the proinflammatory characteristics of epicardial fat may reduce the risk of heart failure. These observations suggest that epicardial adipose tissue is a transducer of the adverse effects of systemic inflammation and metabolic disorders on the heart, and thus, represents an important target for therapeutic interventions.
Dr. Packer has served as a consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardiorentis, Celyad, Daiichi-Sankyo, Gilead, Novo Nordisk, Novartis, Relypsa, Sanofi, Takeda, Teva, and ZS Pharma.
- Received January 5, 2018.
- Revision received February 20, 2018.
- Accepted March 18, 2018.
- Central Illustration
- Obesity as a Systemic Inflammatory State and Epicardial Adipose Tissue as a Local Transducer of Systemic Inflammation
- Inflammation Modulates the Biology of Epicardial Adipose Tissue
- Epicardial Adipose Tissue Transduces Inflammation to the Myocardium
- Epicardial Adipose Tissue as a Therapeutic Target in HFpEF
- Effect of Statins on Epicardial Adipose Tissue and Heart Failure
- Effect of Antidiabetic Drugs on Epicardial Adipose Tissue and Heart Failure
- Effect of Mineralocorticoid Receptor Antagonists on Epicardial Adipose Tissue and Heart Failure
- Effect of Natriuretic Peptides and Neprilysin Inhibition on Epicardial Adipose Tissue and Heart Failure
- Summary and Conclusions