{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:25:08Z","timestamp":1781717108169,"version":"3.54.5"},"reference-count":44,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,12]],"date-time":"2022-08-12T00:00:00Z","timestamp":1660262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy","award":["MITO-MB-CURAT:2POSTDOC\/1387\/03.02.2020"],"award-info":[{"award-number":["MITO-MB-CURAT:2POSTDOC\/1387\/03.02.2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The current minireview aims to assess the implications of epicardial fat secretory function in the development of coronary artery disease. The epicardial adipose tissue (EAT) is a visceral fat depot that has been described as a cardiovascular risk factor. In addition to its mechanical protection role and physiological secretory function, it seems that various secretion products of the epicardial fat are responsible for metabolic disturbances at the level of the cardiac muscle when in association with pre-existing pathological conditions, such as metabolic syndrome. There is a pathological reduction in sarcomere shortening, abnormal cytosolic Ca2+ fluxes, reduced expression of sarcoplasmic endoplasmic reticulum ATPase 2a and decreased insulin-mediated Akt-Ser473-phosphorylation in association with abnormal levels of epicardial fat tissue. Activin A, angiopoietin-2, and CD14-positive monocytes selectively accumulate in the diseased myocardium, resulting in reduced cardiomyocyte contractile function. At the same time, it is believed that these alterations in secretory products directly decrease the myocyte function via molecular changes, thus contributing to the development of coronary disease when certain comorbidities are associated.<\/jats:p>","DOI":"10.3390\/jcm11164718","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T01:47:21Z","timestamp":1660528041000},"page":"4718","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The Role and Implications of Epicardial Fat in Coronary Atherosclerotic Disease"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1658-7526","authenticated-orcid":false,"given":"Laurentiu","family":"Braescu","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marinica","family":"Gaspar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darius","family":"Buriman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Maria","family":"Aburel","sequence":"additional","affiliation":[{"name":"Department of Functional Sciences\u2014Pathophysiology, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Translational Research and Systems Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian-Petru","family":"Merce","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-4315","authenticated-orcid":false,"given":"Felix","family":"Bratosin","sequence":"additional","affiliation":[{"name":"Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klokov Sergei","family":"Aleksandrovich","sequence":"additional","affiliation":[{"name":"NV Sklifosovsky Research Institute for Emergency Medicine, Bolshaya Sukharevskaya Ploshchad 3, 129090 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satish","family":"Alambaram","sequence":"additional","affiliation":[{"name":"Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-9601","authenticated-orcid":false,"given":"Cristian","family":"Mornos","sequence":"additional","affiliation":[{"name":"Discipline of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1038\/ncpcardio0319","article-title":"Epicardial adipose tissue: Anatomic, biomolecular and clinical relationships with the heart","volume":"2","author":"Iacobellis","year":"2005","journal-title":"Nat. Clin. Pract. Cardiovasc. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1038\/oby.2008.575","article-title":"Epicardial and pericardial fat: Close, but very different","volume":"17","author":"Iacobellis","year":"2009","journal-title":"Obesity"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.ahj.2007.03.019","article-title":"Human epicardial adipose tissue: A review","volume":"153","author":"Sacks","year":"2007","journal-title":"Am. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1467-789X.2006.00293.x","article-title":"Epicardial fat: Properties, function, and relationship to obesity","volume":"8","author":"Rabkin","year":"2007","journal-title":"Obes. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1007\/s11892-008-0005-2","article-title":"Do cardiac and perivascular adipose tissue play a role in atherosclerosis?","volume":"8","author":"Iacobellis","year":"2008","journal-title":"Curr. Diab. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.atherosclerosis.2007.08.016","article-title":"Quantification of epicardial and peri-coronary fat using cardiac computed tomography: Reproducibility and relation with obesity and metabolic syndrome in patients suspected of CAD","volume":"197","author":"Gorter","year":"2008","journal-title":"Atherosclerosis"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.atherosclerosis.2010.05.034","article-title":"Perivascular adipose tissue as a cause of atherosclerosis","volume":"214","author":"Verhagen","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Krishnan, A., Chilton, E., Raman, J., Saxena, P., McFarlane, C., Trollope, A.F., Kinobe, R., and Chilton, L. (2021). Are Interactions between Epicardial Adipose Tissue, Cardiac Fibroblasts and Cardiac Myocytes Instrumental in Atrial Fibrosis and Atrial Fibrillation?. Cells, 10.","DOI":"10.3390\/cells10092501"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.3389\/fphys.2018.00002","article-title":"Fatty Infiltration of the Myocardium and Arrhythmogenesis: Potential Cellular and Molecular Mechanisms","volume":"9","author":"Anumonwo","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.echo.2009.10.013","article-title":"Echocardiographic epicardial fat: A review of research and clinical applications","volume":"22","author":"Iacobellis","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.tem.2011.07.003","article-title":"Epicardial adipose tissue: Emerging physiological, pathophysiological and clinical features","volume":"22","author":"Iacobellis","year":"2011","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1055\/s-0029-1231081","article-title":"Epicardial adipose tissue and intracoronary adrenomedullin levels in CAD","volume":"45","author":"Iacobellis","year":"2009","journal-title":"Horm. Metab. Res."},{"key":"ref_13","first-page":"e18","article-title":"Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes","volume":"101","author":"Bertaso","year":"2013","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1152\/japplphysiol.00621.2010","article-title":"Epicardial fat gene expression after aerobic exercise training in pigs with coronary atherosclerosis: Relationship to visceral and subcutaneous fat","volume":"109","author":"Company","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.3389\/fphys.2018.01752","article-title":"Linking Arrhythmias and Adipocytes: Insights, Mechanisms, and Future Directions","volume":"9","author":"Pabon","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.1161\/01.CIR.0000099542.57313.C5","article-title":"Human epicardial adipose tissue is a source of inflammatory mediators","volume":"108","author":"Mazurek","year":"2003","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1152\/physrev.00006.2004","article-title":"Myocardial substrate metabolism in the normal and failing heart","volume":"85","author":"Stanley","year":"2005","journal-title":"Physiol. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1016\/j.amjcard.2010.01.368","article-title":"Relation of echocardiographic epicardial fat thickness and myocardial fat","volume":"105","author":"Malavazos","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_19","first-page":"225","article-title":"Adipose tissu.e in the mammalian heart and pericardium; structure, foetal development and biochemical properties. Comp","volume":"94","author":"Marchington","year":"1989","journal-title":"Biochem. Physiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1089\/met.2008.0056","article-title":"Fatty acid composition of epicardial and subcutaneous human adipose tissue","volume":"7","author":"Pezeshkian","year":"2009","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s10741-017-9644-1","article-title":"Epicardial adipose tissue as a metabolic transducer: Role in heart failure and coronary artery disease","volume":"22","author":"Patel","year":"2017","journal-title":"Heart Fail. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1210\/en.2006-0940","article-title":"The inhibitory effect of leptin on angiotensin II-induced vasoconstriction in vascular smooth muscle cells is mediated via a nitric oxide-dependent mechanism","volume":"148","author":"Zalba","year":"2007","journal-title":"Endocrinology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/j.1365-2265.2011.04140.x","article-title":"Coronary artery disease is associated with higher epicardial Renitol binding protein 4 (RBP4) and lower glucose transporter (GLUT) 4 levels in epicardial and subcutaneous adipose tissue","volume":"76","author":"Rubio","year":"2012","journal-title":"Clin. Endocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/S0195-668X(02)00426-8","article-title":"Eccentric atherosclerotic plaques with positive remodelling have a pericardial distribution: A permissive role of epicardial fat? A three-dimensional intravascular ultrasound study of left anterior descending artery lesions","volume":"24","author":"Prati","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1055\/s-0028-1100412","article-title":"Epicardial adipose tissue adiponectin expression is related to intracoronary adiponectin levels. Horm","volume":"41","author":"Iacobellis","year":"2009","journal-title":"Metab. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.carpath.2004.08.005","article-title":"The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts","volume":"13","author":"Corradi","year":"2004","journal-title":"Cardiovasc. Pathol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kim, J.E., Kim, J.S., Jo, M.J., Cho, E., Ahn, S.Y., Kwon, Y.J., and Ko, G.J. (2022). The Roles and Associated Mechanisms of Adipokines in Development of Metabolic Syndrome. Molecules, 27.","DOI":"10.3390\/molecules27020334"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.numecd.2008.05.002","article-title":"Epicardialadipose tissue thickness by echocardiography is a marker for the presence and severity of coronary artery disease","volume":"19","author":"Eroglu","year":"2009","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ijcard.2008.11.127","article-title":"Reproducibility of echocardiographic measurements of epicardial fat thickness","volume":"141","author":"Saura","year":"2010","journal-title":"Int. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1038\/oby.2008.6","article-title":"Threshold values of high-risk echocardiographic epicardial fat thickness","volume":"16","author":"Iacobellis","year":"2008","journal-title":"Obesity"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.amjcard.2008.04.002","article-title":"Relation of epicardial and pericoronary fat to coronary atherosclerosis and coronary artery calcium in patients undergoing coronary angiography","volume":"102","author":"Gorter","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.atherosclerosis.2012.02.029","article-title":"Association of pericardial fat and coronary. High-risk lesions as determined by cardiac CT","volume":"222","author":"Schlett","year":"2012","journal-title":"Atherosclerosis"},{"key":"ref_33","first-page":"85","article-title":"Epicardial and thoracic fat-Non-invasive measurement and clinical implications","volume":"2","author":"Dey","year":"2012","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1002\/clc.20840","article-title":"Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease","volume":"34","author":"Iwasaki","year":"2011","journal-title":"Clin. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e018080","DOI":"10.1161\/JAHA.120.018080","article-title":"Association of Epicardial Fat Volume With Increased Risk of Obstructive Coronary Artery Disease in Chinese Patients With Suspected Coronary Artery Disease","volume":"10","author":"Yu","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1210\/jc.2007-2579","article-title":"Epicardial adipose tissue as a source of nuclear factor-kappaB and c-Jun N-terminal kinase mediated inflammation in patients with coronary artery disease","volume":"94","author":"Baker","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Gruzdeva, O.V., Dyleva, Y.A., Belik, E.V., Sinitsky, M.Y., Stasev, A.N., Koko, A.N., Brel, N.K., Krivkina, E.O., Bychkova, E.E., and Tarasov, R.S. (2022). Relationship between Epicardial and Coronary Adipose Tissue and the Expression of Adiponectin, Leptin, and Interleukin 6 in Patients with Coronary Artery Disease. J. Pers. Med., 12.","DOI":"10.3390\/jpm12020129"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12933-021-01225-6","article-title":"Epicardial adipose tissue volume and coronary calcification among people living with diabetes: A cross-sectional study","volume":"20","author":"Cosson","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1177\/1479164119827602","article-title":"Echocardiographic association of epicardial fat with carotid intima-media thickness in patients with type 2 diabetes","volume":"16","author":"Yafei","year":"2019","journal-title":"Diab. Vasc. Dis. Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Daud\u00e9, P., Ancel, P., Confort Gouny, S., Jacquier, A., Kober, F., Dutour, A., Bernard, M., Gaborit, B., and Rapacchi, S. (2022). Deep-Learning Segmentation of Epicardial Adipose Tissue Using Four-Chamber Cardiac Magnetic Resonance Imaging. Diagnostics, 12.","DOI":"10.3390\/diagnostics12010126"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"745805","DOI":"10.3389\/fped.2021.745805","article-title":"Identification of Cardiovascular Risk Factors in Obese Adolescents With Metabolic Syndrome","volume":"9","author":"Lee","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"24","DOI":"10.2174\/1573403X14666180918102031","article-title":"Basic Concepts of Contrast Injection Protocols for Coronary Computed Tomography Angiography","volume":"15","author":"Oda","year":"2019","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e28060","DOI":"10.1097\/MD.0000000000028060","article-title":"Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction-a meta-analysis on over 6600 patients and rationale for the EPIC-ACS study","volume":"100","author":"Hendricks","year":"2021","journal-title":"Medicine"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.atherosclerosis.2021.02.008","article-title":"Epicardial fat and coronary artery disease: Role of cardiac imaging","volume":"321","author":"Guglielmo","year":"2021","journal-title":"Atherosclerosis"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4718\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:07:55Z","timestamp":1760141275000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,12]]},"references-count":44,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11164718"],"URL":"https:\/\/doi.org\/10.3390\/jcm11164718","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,12]]}}}