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Vol. 70. Issue 6.
Pages 515-516 (June 2017)
Letter to the Editor
DOI: 10.1016/j.rec.2016.12.042
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Out of Sight, out of Mind; Subcutaneous, Visceral, and Epicardial Adipose Tissue. Response
Ojos que no ven, corazón que no siente: el tejido adiposo subcutáneo, epicárdico y visceral. Respuesta
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Ricardo Ladeiras-Lopesa,b,
Corresponding author
ricardoladeiraslopes@gmail.com

Corresponding author:
, Francisco Sampaioa,b, Nuno Bettencourtb, Ricardo Fontes-Carvalhoa,b
a Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
b Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Rev Esp Cardiol. 2017;70:51510.1016/j.rec.2016.12.009
Levent Cerit
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To the Editor,

We have read with great interest the Letter to the Editor concerning our recently published paper on the association between an increased ratio of visceral to subcutaneous abdominal adipose tissue and higher risk of major adverse cardiovascular events, independently of traditional cardiovascular risk factors and coronary calcium.1

Epicardial adipose tissue (EAT) is an ectopic fat storage site in direct contact with adjacent coronary arteries and myocardium; therefore, it can have a paracrine effect on coronary atherosclerosis and myocardial function through the secretion of several adipokines that might regulate insulin resistance and inflammation.2

The putative association between EAT and visceral or subcutaneous abdominal fat is a promising research line that should continue to be addressed in future studies. Our group has already shown that EAT volume is positively correlated to coronary atherosclerotic burden, assessed by coronary artery calcium score, independently of abdominal visceral adipose tissue.3 Furthermore, in patients after a myocardial infarction, EAT volume was independently associated with decreased E’ velocity and increased E/E’ ratio, therefore suggesting impaired diastolic function.4

Thus, EAT seems to be associated not only with atherosclerotic burden and risk of cardiovascular disease, but also with maladaptive changes in myocardial function that increase the risk of heart failure. It is our opinion that ectopic adipose tissue, with special emphasis on EAT, greatly contribute to metabolic homeostasis and modulate activation of inflammatory cascades, therefore being a key player in cardiovascular health and disease.

References
[1]
R. Ladeiras-Lopes, F. Sampaio, N. Bettencourt, et al.
The Ratio Between Visceral and Subcutaneous Abdominal Fat Assessed by Computed Tomography Is an Independent Predictor of Mortality and Cardiac Events.
Rev Esp Cardiol., 70 (2017), pp. 331-337
[2]
H.S. Sacks, J.N. Fain.
Human epicardial adipose tissue: a review.
Am Heart J., 153 (2007), pp. 907-917
[3]
N. Bettencourt, A.M. Toschke, D. Leite, et al.
Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden.
Int J Cardiol., 158 (2012), pp. 26-32
[4]
R. Fontes-Carvalho, M. Fontes-Oliveira, F. Sampaio, et al.
Influence of epicardial and visceral fat on left ventricular diastolic and systolic functions in patients after myocardial infarction.
Am J Cardiol., 114 (2014), pp. 1663-1669
Copyright © 2017. Sociedad Española de Cardiología
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