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(Circulation. 2009;119:1586-1591.)
© 2009 American Heart Association, Inc.

Epidemiology

Pericardial Fat, Intrathoracic Fat, and Measures of Left Ventricular Structure and Function

The Framingham Heart Study

Caroline S. Fox, MD, MPH; Philimon Gona, PhD; Udo Hoffmann, MD, MPH; Stacy A. Porter, MA; Carol J. Salton, BA; Joseph M. Massaro, PhD; Daniel Levy, MD; Martin G. Larson, ScD; Ralph B. D'Agostino, Sr, PhD; Christopher J. O'Donnell, MD, MPH; Warren J. Manning, MD

From the National Heart, Lung and Blood Institute’s Framingham Heart Study, Framingham, Mass (C.S.F., C.O.D., M.G.L., P.G., J.M.M., R.B.D.); Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston Mass (C.S.F.); Harvard Medical School, Boston, Mass (SP); Boston University Department of Mathematics, Boston, Mass (J.M.M., M.G.L., P.G., R.B.D.); Radiology Department (U.H.) and the Department of Medicine (C.O.D.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; and Division of Cardiology (C.J.S., W.J.M.) and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston Mass.

Correspondence to Caroline S. Fox, MD, MPH, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702. E-mail foxca{at}nhlbi.nih.gov

Received October 15, 2008; accepted January 26, 2009.

Background— Pericardial fat has been implicated in the pathogenesis of obesity-related cardiovascular disease. Whether the associations of pericardial fat and measures of cardiac structure and function are independent of the systemic effects of obesity and visceral adiposity has not been fully explored.

Methods and Results— Participants from the Framingham Heart Study (n=997; 54.4% women) underwent chest and abdominal computed tomography and cardiovascular magnetic resonance imaging between 2002 and 2005. Pericardial fat, intrathoracic fat, and visceral adipose tissue quantified from multidetector computed tomography, along with body mass index and waist circumference, were examined in relation to cardiovascular magnetic resonance measures of left ventricular (LV) mass, LV end-diastolic volume, and left atrial dimension. In women, pericardial fat (r=0.20 to 0.35, P<0.001), intrathoracic fat (r=0.25 to 0.37, P<0.001), visceral adipose tissue (r=0.24 to 0.45, P<0.001), body mass index (r=0.36 to 0.53, P<0.001), and waist circumference (r=0.30 to 0.48, P<0.001) were directly correlated with LV mass, LV end-diastolic volume, and left atrial dimension. In men, pericardial fat (r=0.19 to 0.37, P<0.001), intrathoracic fat (r=0.17 to 0.31, P<0.001), visceral adipose tissue (r=0.19 to 0.36, P<0.001), body mass index (r=0.32 to 0.44, P<0.001), and waist circumference (r=0.34 to 0.44, P<0.001) were directly correlated with LV mass and left atrial dimension, but LV end-diastolic volume was not consistently associated with adiposity measures. Associations persisted after multivariable adjustment but not after additional adjustment for body weight and visceral adipose tissue, except for pericardial fat and left atrial dimension in men.

Conclusions— Pericardial fat is correlated with cardiovascular magnetic resonance measures, but the association is not independent of or stronger than other ectopic fat stores or proxy measures of visceral adiposity. An important exception is left atrial dimension in men. These results suggest that the systemic effects of obesity on cardiac structure and function may outweigh the local pathogenic effects of pericardial fat.

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