Association of Pericardial Fat with Cardiac Structure, Function, and Mechanics: The Multi-Ethnic Study of Atherosclerosis

• Published in: Journal of the American Society of Echocardiography Vol. 35; no. 6; pp. 579 - 587.e5
• Main Authors: Min, Jeff, Putt, Mary E., Yang, Wei, Bertoni, Alain G., Ding, Jingzhong, Lima, Joao A.C., Allison, Matthew A., Barr, R. Graham, Al-Naamani, Nadine, Patel, Ravi B., Beussink-Nelson, Lauren, Kawut, Steven M., Shah, Sanjiv J., Freed, Benjamin H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2022
• Subjects: Adipose Tissue - diagnostic imaging; Adiposity; Adult; Atherosclerosis - diagnosis; Cardiomyopathies; Early heart failure; Echocardiography; Humans; Myocardial strain analysis; Pericardial fat; Pericardium - diagnostic imaging; Pericardial fat; CHF; MESA; RV; LV; HFpEF; 2D; ASE; NT-proBNP; KCCQ-12; BMI; Echocardiography; AF; Myocardial strain analysis; ICC; FAC; PASP; TAPSE; RA; CT; Early heart failure; FVC; LA; FEV1; 6MWD; CHD
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2022.01.005

Pericardial fat has been associated with adverse cardiovascular outcomes through adiposity-associated inflammation and insulin resistance, which in turn are linked to cardiac dysfunction. We sought to evaluate the association between pericardial fat volume and cardiac structure and function in adults without baseline cardiovascular disease.
We analyzed data from the Multi-Ethnic Study of Atherosclerosis. Linear regression was used to examine the association between pericardial fat volume (by cardiac computed tomography during exam 1, 2000-2002) and cardiac function by echocardiography, six-minute walk distance (6MWD), and symptom severity as assessed using the Kansas City Cardiomyopathy Questionnaire-12 (exam 6, 2016-18).
Among 3,032 participants, each 1 SD (39.3 cm3) increase in pericardial fat volume was associated with lower (worse) absolute left atrial reservoir strain (β = –0.98%; 95% CI, –1.29, –0.68; P < .001), right ventricular free wall strain (β = –0.75%; 95% CI, –1.00, –0.51; P < .001), and right atrial reservoir strain (β = –0.59%; 95% CI, –1.00, –0.19; P < .01) after adjustment for potential confounders. Greater pericardial fat volume was associated with lower 6MWDs (β = –5.70 m; 95% CI, –10.34, –1.06; P = .02) but not with Kansas City Cardiomyopathy Questionnaire-12 scores or N-terminal pro b-type natriuretic peptide after multivariable adjustment.
In a population-based cohort of adults, pericardial fat volume was independently associated with subclinical atrial and right ventricular dysfunction and reduced 6MWD. These distinct changes in cardiac structure and function suggest a potential mechanistic role for pericardial fat in early heart failure.
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•Speckle-tracking strain analysis was applied to 3,032 elderly participants in the MESA cohort.•Pericardial fat volume was associated with worse biatrial and RV strain.•Pericardial fat volume was associated with lower 6MWDs.•Pericardial fat worsens cardiac mechanics and may result in early heart failure.