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. 2021 Feb 20;11(2):362. doi: 10.3390/diagnostics11020362

Table 1.

Cardiac adiposity screening by imaging modalities. Advantages, limitations and clinical implications apart from arrhythmias.

CT [15,16,17,18,19,20,21,22,23,24] CMR [25,26,27,28,29,30,31,32,33] Echocardiograhy
[14,34,35,36,37]
Advantages • EAT/PAT assessment:
  • -

    volumetric technique

  • -

    3-dimensional EAT measurement

  • -

    high reproducibility

  • -

    better spatial resolution than CMR

  • -

    EAT assessment on contrast and non-contrast scans

• Additional information:
  • -

    relation of EAT radiodensity with metabolic processes

  • -

    calcification of the coronary arteries

  • -

    coronary artery stenosis

  • -

    anatomical and metabolic data with PET/CT

 • EAT/PAT assessment:
  • -

    volumetric technique

  • -

    3-dimensional EAT measurement

  • -

    high reproducibility

  • -

    no radiation exposure

  • -

    no use of contrast agents

• Myocardial fatty infiltration assessment by:
  • -

    1H-MRS

  • -

    multiecho Dixon methods

• Additional information:
  • -

    biventricular function assessment

  • -

    LV mass

  • -

    LA volume

  • -

    fibrosis by LGE

 • EAT/PAT thickness assessment:
  • -

    relatively inexpensive

  • -

    widely available

  • -

    no radiation exposure

• Additional information:
  • -

    biventricular function assessment

  • -

    LV mass

  • -

    LA volume
Limitations
  • -

    radiation exposure

  • -

    nephrotoxicity

 • CMR:
  • -

    lack of availability/expertise

  • -

    high cost

  • -

    marked obesity

  • -

    claustrophobia

  • -

    often the pericardium not clearly seen on inferior slices of CMR scans

  • -

    impossible to scan CMR-unsafe devices (metallic clips, pacemakers, defibrillators)

• 1H-MRS
  • -

    lack of availability/expertise

  • -

    high cost

  • -

    contamination from EAT/PΑΤ
  • -

    no volumetric EAT estimation

  • -

    difficulties in distinguishing the EAT from PAT or pericardial effusion

  • -

    dependent on operator’s

  • -

    experience
Clinical implications • EAT/PAT is associated with
  • -

    adverse CV outcome

  • -

    CAD

  • -

    coronary artery calcification

 • EAT/PAT is associated with
  • -

    presence/severity of CAD

  • -

    impaired LV systolic function

  • -

    myocardial fibrosis

• Myocardial fatty infiltration associations
  • -

    diastolic dysfunction

  • -

    dilated cardiomyopathy

  • -

    ARVC

  • -

    myocardial fibrosis

 • EAT thickness is associated with:
  • -

    presence/severity of CAD

  • -

    LV hypertrophy

  • -

    diastolic dysfunction

  • -

    HFpEF/HFmrEF

  • -

    metabolic syndrome

  • -

    carotid atherosclerosis

  • -

    Framingham risk score

Abbreviations: ARVC: arrhythmogenic right ventricle cardiomyopathy; CAD: coronary artery disease; CMR: cardiovascular magnetic resonance; CT: computed tomography; CV: cardiovascular; EAT: epicardial adipose tissue; 1H-MRS: hydrogen proton magnetic resonance spectroscopy; HFmrEF: heart failure with mid-range ejection fraction; HFpEF: heart failure with preserved ejection fraction; LA: left atrium; LGE: late gadolinium enhancement; LV: left ventricle; PAT: pericardial adipose tissue; PET: positron emission tomography.