Pericardial adiposity, an independent risk factor of adverse cardiovascular phenotypes: Study

UK: Pericardial adipose tissue (PAT) plays an independent role in adversely impacting cardiovascular health and CMR-measured PAT is a potential novel imaging biomarker of cardiovascular risk, suggest study findings published in The European Heart Journal - Cardiovascular Imaging.

The study showed an association of PAT with unhealthy cardiovascular structure and function, independent of vascular risk factors, baseline comorbidities, inflammatory markers, and multiple non-invasive and imaging measures of obesity. 

Maddalena Ardissino, National Heart and Lung Institute, London, and her research team demonstrated novel associations of CMR-measured PAT with adverse cardiovascular structure and function, independent of a wide range of confounders in a large population-based study of 42 598 UK Biobank participants

Pericardial adipose tissue (PAT) is the visceral adipose compartment surrounding the heart and coronary vasculature. PAT mirrors systemic inflammation, which is a risk factor for cardiovascular disease. Cardiovascular magnetic resonance imaging (CMR), sometimes known as cardiac MRI, is a medical imaging technology for the non-invasive assessment of the function and structure of the cardiovascular system. CMR has become an essential tool for the evaluation of patients affected or at risk of developing cardiovascular diseases.

Researchers extracted PAT and selected CMR metrics using automated pipelines. The estimated associations of PAT with each CMR metric using linear regression adjusting for age, sex, ethnicity, deprivation, smoking, exercise, processed food intake, BMI, diabetes, hypertension, height cholesterol, waist-to-hip ratio, impedance fat measures, and MRI abdominal visceral adiposity measures.

Key findings of the study are,

• Higher PAT was independently associated with unhealthy left ventricular (LV) structure, poorer LV function, lower left atrial ejection fraction, and lower aortic distensibility.

• Higher PAT was associated with cardiometabolic disease (hypertension, diabetes, high cholesterol), adverse serum lipids, poorer glycaemic control, and greater systemic inflammation

• Multiple mediation analysis revealed several potential mechanistic pathways, with hypertension, lipid changes, and inflammatory biomarkers as the most important potential partial mediators, which overall only partially explained the PAT-CMR relationships.

From the study results, researchers conclude that PAT is a valuable indicator of cardiovascular health, independent of other measures of obesity and cardiometabolic disease and has a distinct mechanistic role in causing cardiovascular disease. Furthermore, results demonstrate the potential of CMR-measured PAT as a new imaging biomarker of cardiovascular risk.

Apart from its strength, the study had a few limitations and so further work is required to illustrate the clinical utility of CMR PAT in other independent cohorts and its association with incident health outcomes, the authors wrote.

Reference:

Maddalena Ardissino, Celeste McCracken, Andrew Bard, Charalambos Antoniades, et al.  Pericardial adiposity is independently linked to adverse cardiovascular phenotypes: a CMR study of 42 598 UK Biobank participants, European Heart Journal - Cardiovascular Imaging, 2022;, jeac101, https://doi.org/10.1093/ehjci/jeac101