Reply
Victor Y. Cheng, MD*,
Damini Dey, PhD,
Daniel S. Berman, MD
We appreciate the letter from Thomas et al. for emphasizing the emerging value of measuring fat around the heart. However, we respectfully disagree with the primary assertion in the letter, since we in fact did study epicardial fat as defined by the letter authors. On computed tomography (CT), our designation of pericardial fat was "all adipose tissue detected within the pericardium," which matches the definition of epicardial fat specified by Iacobellis et al. (1). A closer look at our work will additionally reveal that we separately studied the volume of adipose tissue inside and outside of the pericardium. In doing so, we showed that only fat inside the pericardium held predictive power for the risk of future cardiovascular events.
Although some investigators performing CT-based research have defined pericardial fat as we did (2–4), others have used pericardial fat to encompass adipose tissue both inside and outside of the pericardium (5,6). Undoubtedly this nonuniform labeling creates confusion. Given the increasing attention paid to fat surrounding the heart and coronary arteries, standardization of terminology may be in order. This notwithstanding, readers of the literature should cautiously examine the methodology to ensure understanding of the exact fatty depot being measured.
The ability to derive additional prognostic information from standard noncontrast calcium scoring CT by quantifying fat volume inside the pericardium is important. We look forward to understanding further the impact of this measure through future investigations.
* Cedars-Sinai Medical Center, Cardiology, 8700 Beverly Blvd, Taper Building Room 1258, Los Angeles, California 90048 (Email: victor.cheng{at}cshs.org).
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REFERENCES
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- Iacobellis G, Willens HJ, Barbaro G, et al. Threshold values of high-risk echocardiographic epicardial fat thickness Obesity 2008;16:887-892.[CrossRef][Web of Science][Medline]
- Rosito GA, 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.[Abstract/Free Full Text]
- Mahabadi AA, Massaro JM, Rosito GA, 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.[Abstract/Free Full Text]
- Dey D, Wong ND, Tamarappoo BK, et al. Computer-aided non-contrast CT-based quantification of pericardial and thoracic fat and their associations with coronary calcium and metabolic syndrome Atherosclerosis 2010;209:136-141.[CrossRef][Web of Science][Medline]
- Ding J, Kritchevsky SB, Harris TB, et al. The association of pericardial fat with calcified coronary plaque Obesity (Silver Spring) 2008;16:1914-1919.[CrossRef][Medline]
- 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.[Abstract/Free Full Text]
Related Article
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Fat Around the Heart
- Sarah Yoder Thomas, Romain Harmancey, and Heinrich Taegtmeyer
J. Am. Coll. Cardiol. Img. 2010 3: 786-787.
[Full Text]
[PDF]
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REFERENCES