ISSN: 1899-0967
Polish Journal of Radiology
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vol. 83
Original paper

Chest adipose tissue distribution in patients with morbid obesity

Adam Lemanowicz, Waldemar Leszczyński, Grażyna Rusak, Marcin Białecki, Przemysław Ratajczak

© Pol J Radiol 2018; 83: e68-e75
Online publish date: 2018/02/12
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Purpose: Obesity is a well-known of risk factor for atherosclerosis and the amount of visceral adipose tissue is considered as an independent predictor of coronary artery disease (CAD). An aim of the study was to investigate the distribution of intrathoracic adipose tissue in morbidly obese patients.

Material and methods: Fifty-one patients with morbid obesity (BMI ≥ 40 kg/m2) and thirty controls were scanned in a coronary calcium scoring protocol. Control group consisted of patients scanned due to a clinical suspicion of CAD, who did not fulfill obesity criteria. The amount of adipose tissue was measured as epicardial adipose tissue (EAT) thickness, pericoronary fat (PCF) thickness, total intra-pericardial fat (IPF) volume, and total intrathoracic fat (ITF) volume.

Results: Mean BMI of obese patients and controls was 47.3 and 26.5, respectively (p < 0.0001). Patients with obesity and controls did not differ with respect to mean EAT, mean PCF, and IPF. However, ITF was lower in obesity group than in control group (268 vs. 332 cm3, respectively; p < 0.03). Moreover, ROC analysis presented relation between obesity and the superior EAT thickness, PCF at LCX, mean PCF, ITF, and chest soft tissue (CST) thickness (p < 0.03). CST thickness of > 60 mm was the parameter that presented the strongest association with morbid obesity (AUC 0.95; p < 0.0001).

Conlcusions: Increased chest soft tissue thickness but not the increased intrathoracic adipose tissue volume was associated with morbid obesity. Since the quantity of the pericardiac fat is not directly related to the obesity, its accumulation may be related to a mechanism different than that of subcutaneous adipose tissue growth.

adipose tissue, multidetector computed tomography, obesity, morbid

Obesity and overweight. WHO Fact sheet N°311 [Internet]. [cited 2016 Aug 6]. Available from:
World Health Organization: Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894: I–XII, 1–253.
Lee CD, Jacobs DR, Schreiner PJ et al. Abdominal obesity and coronary artery calcification in young adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2007; 86: 48-54.
Lakka TA, Lakka HM, Salonen R et al. Abdominal obesity is associated with accelerated progression of carotid atherosclerosis in men. Atherosclerosis 2001; 154: 497-504.
McClain J, Hsu F, Brown E et al. Pericardial adipose tissue and coronary artery calcification in the Multi-ethnic Study of Atherosclerosis (MESA). Obes (Silver Spring) 2013; 21: 1056-1063.
Liu J, Fox CS, Hickson D, Sarpong D et al. Pericardial adipose tissue, atherosclerosis, and cardiovascular disease risk factors: the Jackson heart study. Diabetes Care 2010; 33: 1635-1639.
Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: Anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005; 2: 536-543.
Liu J, Fox CS, Hickson DA, May WD et al. Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: The Jackson Heart Study. J Clin Endocrinol Metab 2010; 95: 5419-5426.
Neeland IJ, Ayers CR, Rohatgi AK et al. Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults. Obes (Silver Spring) 2013; 21: E439-447.
Mohammed BS, Cohen S, Reeds D et al. Long-term effects of large-volume liposuction on metabolic risk factors for coronary heart disease. Obesity (Silver Spring) 2008; 16: 2648-2651.
Patel P, Abate N. Role of subcutaneous adipose tissue in the pathogenesis of insulin resistance. J Obes 2013; 2013: 489187.
Niedziela J, Hudzik B, Niedziela N et al. The obesity paradox in acute coronary syndrome: A meta-analysis. Eur J Epidemiol 2014; 29: 801-812.
Narumi H, Yoshida K, Hashimoto N et al. Increased subcutaneous fat accumulation has a protective role against subclinical atherosclerosis in asymptomatic subjects undergoing general health screening. Int J Cardiol 2009; 135: 150-155.
Serafin Z, Rusak G, Strześniewski P et al. Comparison of calcium scoring with 4-Multidetector Computed Tomography (4-MDCT) and 64-MDCT: A phantom study. J Comput Assist Tomogr 2012; 36: 88-93.
Serafin Z, Lasek W, Laskowska K. Phantom-calibrated versus automatic coronary artery mass quantification with multidetector-row computed tomography: In vitro and in vivo study. Acta Radiol 2008; 49: 1007-1015.
Fox CS, Massaro JM, Hoffmann U et al. Abdominal visceral and subcutaneous adipose tissue compartments: Association with metabolic risk factors in the Framingham Heart Study. Circulation 2007; 116: 39-48.
Miranda Prado C. Evaluation of visceral and subcutaneous fat by ultrasound and its relationship with clinical and metabolic parameters of insulin resistance and subclinical atherosclerosis. Open J Endocr Metab Dis 2012; 2: 63-69.
Iacobellis G, Ribaudo MC, Assael F et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: A new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003; 88: 5163-5168.
Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab 2005; 90: 6300-6302.
Jeong J-W, Jeong MH, Yun KH et al Echocardiographic epicardial fat thickness and coronary artery disease. Circ J 2007; 71: 536-539.
Gorter PM, van Lindert AS, de Vos AM et al. Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis 2008; 197: 896-903.
Pang C, Gao Z, Yin J et al. Macrophage infiltration into adipose tissue may promote angiogenesis for adipose tissue remodeling in obesity. Am J Physiol Endocrinol Metab 2008; 295: E313-322.
Mahabadi A, Massaro JM, Rosito G et al. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: The Framingham Heart Study. Eur Heart J 2009; 30: 850-856.
Greif M, Becker A, Von Ziegler F et al. Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis. Arterioscler Thromb Vasc Biol 2009; 29: 781-786.
Thanassoulis G, Massaro JM, Hoffmann U et al. Prevalence, distribution, and risk factor correlates of high pericardial and intrathoracic fat depots in the Framingham heart study. Circ Cardiovasc Imaging 2010; 3: 559-566.
Yong HS, Kim EJ, Seo HS et al. Pericardial fat is more abundant in patients with coronary atherosclerosis and even in the non-obese patients: Evaluation with cardiac CT angiography. Int J Cardiovasc Imaging 2010; 26 (Suppl 1): 53-62.
Rosenquist KJ, Pedley A, Massaro JM et al. Visceral and subcutaneous fat quality and cardiometabolic risk. JACC Cardiovasc Imaging 2013; 6: 762-771.
Sardanelli F, Bashir H, Berzaczy D et al. The role of imaging specialists as authors of systematic reviews on diagnostic and interventional imaging and its impact on scientific quality: Report from the EuroAIM Evidence-based Radiology Working Group. Radiology 2014; 272: 533-540.
Talman AH, Psaltis PJ, Cameron JD et al. Epicardial adipose tissue: Far more than a fat depot. Cardiovasc Diagn Ther 2014; 4: 416-429.
Rosito G, Massaro JM, Hoffmann U et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample the framingham heart study. Circulation 2008; 117: 605-613.
Nafakhi H, Al-Mosawi A, Al-Nafakh H, Tawfeeq N. Association of pericardial fat volume with coronary atherosclerotic disease assessed by CT angiography. Br J Radiol 2014; 87: 20130713.
Ding J, Kritchevsky SB, Harris TB et al. The association of pericardial fat with calcified coronary plaque. Obesity (Silver Spring) 2008; 16: 1914-1919.
Iacobellis G, Malavazos A. Pericardial adipose tissue, atherosclerosis, and cardiovascular disease risk factors: The Jackson Heart Study: Comment on Liu et al. Diabetes Care 2010; 33: e127.
Dey D, Nakazato R, Li D et al. Epicardial and thoracic fat – Noninvasive measurement and clinical implications. Cardiovasc Diagn Ther 2012; 2: 85-93.
Wheeler GL, Shi R, Beck SR et al. Pericardial and visceral adipose tissues measured volumetrically with computed tomography are highly associated in type 2 diabetic families. Invest Radiol 2005; 40: 97-101.
Liu J, Taylor H, Fox CS et al. Pericardial Adipose Tissue, Atherosclerosis, and Cardiovascular Disease Risk Factors: The Jackson Heart Study: Response to Iacobellis and Malavazos. Diabetes Care 2010; 33: e128.
Tamarappoo B, Dey D, Shmilovich H et al. Increased pericardial fat volume measured from noncontrast CT predicts myocardial ischemia by SPECT. JACC Cardiovasc Imaging 2010; 3: 1104-1112.
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