{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:19:36Z","timestamp":1747196376330,"version":"3.40.5"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T00:00:00Z","timestamp":1681430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Epicardial fat represents visceral adiposity. Many observational studies have reported that increased epicardial is associated with adverse metabolic profile, cardiovascular risk factors, and coronary atherosclerosis in patients with cardiovascular diseases and in general population. We and others have previously reported the association of increased epicardial fat with left ventricular (LV) hypertrophy and diastolic dysfunction as well as the development of heart failure (HF) and coronary artery disease in these populations. In some studies, however, the association did not reach statistical significance. The inconsistent results may be due to limited power, different imaging modalities for quantifying epicardial fat volume, and different outcome definitions. Accordingly, we aim to perform the systematic review and meta-analysis of studies on the association of epicardial fat with cardiac structure and function and cardiovascular outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This systematic review and meta-analysis will include observational studies examining the association of epicardial fat with cardiac structure and function or the cardiovascular outcomes. <jats:underline>Relevant studies will be identified by searching electronic databases including PubMed, Web of Science, and Scopus and by manual screening of reference lists of relevant reviews and retrieved studies. The primary outcome will be cardiac structure and function. The secondary outcome will be cardiovascular events including death from cardiovascular causes, hospitalization for HF, nonfatal myocardial infarction, and unstable angina.<\/jats:underline><\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>The results of our systematic review and meta-analysis will provide evidence regarding the clinical usefulness of epicardial fat assessment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Systematic review registration<\/jats:title>\n<jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/INPLASY202280109\" xlink:type=\"simple\">INPLASY 202280109<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283482","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T17:42:57Z","timestamp":1681494177000},"page":"e0283482","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of epicardial fat with cardiac structure and function and cardiovascular outcomes: A protocol for systematic review and 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with left atrial remodeling, augmented contractile performance in asymptomatic population.","volume":"3","author":"YH Lai","year":"2016","journal-title":"Echo Res Pract"},{"key":"pone.0283482.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.","volume":"4","author":"D Moher","year":"2015","journal-title":"Syst Rev"},{"key":"pone.0283482.ref012","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1080\/08037050410021397","article-title":"Associations among plasma adiponectin, hypertension, left ventricular diastolic function and left ventricular mass index.","volume":"13","author":"SJ Hong","year":"2004","journal-title":"Blood Press"},{"key":"pone.0283482.ref013","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1210\/en.2009-0806","article-title":"Adiponectin deficiency, diastolic dysfunction, and diastolic heart 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diastolic function in patients with coronary artery disease","volume":"84","author":"VP Puurunen","year":"2016","journal-title":"Peptides"},{"key":"pone.0283482.ref017","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1093\/ejechocard\/jep002","article-title":"Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives.","volume":"10","author":"F Natale","year":"2009","journal-title":"Eur J Echocardiogr"},{"key":"pone.0283482.ref018","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1016\/j.ijcard.2012.06.013","article-title":"Echocardiographic epicardial fat thickness is associated with arterial stiffness.","volume":"167","author":"BJ Kim","year":"2013","journal-title":"Int J Cardiol"},{"key":"pone.0283482.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00004872-199917010-00001","article-title":"Arterial stiffness.","volume":"17","author":"MF O\u2019Rourke","year":"1999","journal-title":"J Hypertens"},{"key":"pone.0283482.ref020","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1253\/jcj.49.245","article-title":"Altered loading sequence as an underlying mechanism of afterload dependency of ventricular relaxation in hearts in situ","volume":"49","author":"M Hori","year":"1985","journal-title":"Jpn Circ J"},{"key":"pone.0283482.ref021","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1161\/01.CIR.93.11.2080","article-title":"Change in aortic end-systolic pressure by alterations in loading sequence and its relation to left ventricular isovolumic relaxation","volume":"93","author":"F Kohno","year":"1996","journal-title":"Circulation"},{"key":"pone.0283482.ref022","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1161\/01.RES.30.1.67","article-title":"Experimental subendocardial ischemia in dogs with normal coronary arteries","volume":"30","author":"GD Buckberg","year":"1972","journal-title":"Circ Res"},{"key":"pone.0283482.ref023","first-page":"H719","article-title":"Different effects of two types of ischemia on myocardial systolic and diastolic function","volume":"248","author":"WJ Paulus","year":"1985","journal-title":"Am J Physiol"},{"key":"pone.0283482.ref024","doi-asserted-by":"crossref","DOI":"10.3390\/ijms232214415","article-title":"Role of Cardiac Natriuretic Peptides in Heart Structure and Function.","volume":"23","author":"R Sarzani","year":"2022","journal-title":"Int J Mol Sci"}],"container-title":["PLOS 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