* Currently it is better to use only two terms .Epicardial fat and thoracic fat .Other terminology should be avoided.
- Echo
- Multi-slice CT Scan
- MRI
Which part of cardiac cycle it is measured ?
Since epicardial fat is a compressible structure , in diastole the myocardial mass encroaches the epicardium any imaging modality the distinction between epicardial and para-cardiac fat tends to attenuated.
Even MRI images obtained with diastolic gating , may not be reliable .End systolic frames are now considered ideal.
(J Am Coll Cardiol. 2011 Oct 4;58(15):1640;Distinction of “fat around the heart”.Kaushik M, Reddy YM.)
What is the normal epi-cardial fat volume ?
There is no standard normal.In one large study from Boston in people with a BMI between 25-30 the mean epi-cardial fat volume was 125 cubic cms
(*Intrathoraic fat same as para-cardiac fat located outside parietal pericardium )
How to differentiate fat from pericardial fluid ?
It can be a very difficult issue especially when you expect both as in hypothyroidism .It needs proper gain settings and interpretation.
Here is case report of how epicardial fat was mistken for PE even in TEE
Can we measure the net mass of cardiac fat , does it compress the heart ?
When we say average heart weighs 300 grams it includes fat embedded in it. I don’t think it is possible to measure the fat mass ,but clinically it may be important.Read this .Can-epicardial-fat-constrict-the-heart-an-authentic-yes-from-ulsan-korea ?
Final message
Estimation of epicardial fat volume is largely a research tool.In grossly obese patients it may have some clinical utility.Increased anterior fat pad in routine 2D echo is an useful screening test. However, it requires MRI/CT imaging for accurate quantification.
References