Journal Article Systematic Review Meta-Analysis Review Epublish
PubMed: 42489846 DOI: 10.1007/s13679-026-00734-3
The Role of Echocardiography in the Assessment of Epicardial Adipose Tissue: A Systematic Review and Meta-analysis.
Curr Obes Rep 15(1)
Authors: Barbara Pala, Mariagrazia Piscione, Francesco Cribari, Serena De Mitri, Paola Gualtieri, De Lorenzo Antonino, Luigi Barrea, Marco Alfonso Perrone, Iacobellis Gianluca, Laura Di Renzo
Affiliations
- PhD School of Applied Medical-surgical Sciences, Tor Vergata University of Rome, Via Montpellier, 1, Rome, 00133, Italy.
- UOC Cardiologia Ospedale IDI- IRCCS, Via Monti di Creta, 104, Rome, 00167, Italy.
- ASL 2 Abruzzo, Santissima Annunziata Hospital, Via dei Vestiti, Chieti, 66100, Italy.
- UOC Cardiologia Ospedale IDI- IRCCS, Via Monti di Creta, 104, Rome, 00167, Italy.
- Section of Food Science, Clinical Nutrition and Pharmaceutical Sciences, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy.
- Dipartimento di Psicologia e Scienze della Salute, Università Telematica Pegaso, Naples, Italy.
- Division of Cardiology and CardioLab, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Via Montpellier,1, Rome, 00133, Italy.
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA.
Abstract
BACKGROUND
Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot implicated in cardiometabolic and cardiovascular (CV) disease. Although cardiac magnetic resonance (CMR) and cardiac computed tomography (cCT) enable accurate volumetric quantification of EAT, their cost, limited availability, and-particularly for cCT-radiation exposure, restrict their use in preventive and longitudinal settings. Transthoracic echocardiography (TTE) is widely accessible and radiation-free, but its validity as a surrogate of volumetric EAT assessment and its broader clinical role remain incompletely defined.
OBJECTIVES
To systematically synthesize disease-specific evidence linking TTE-derived EAT thickness with major CV phenotypes and to quantitatively assess its association with volumetric EAT measured by CMR or cCT.
METHODS
A systematic search of PubMed and PubMed Central (January 2000-December 2025) identified adult studies evaluating associations between TTE-derived EAT thickness and coronary artery disease (CAD), atrial fibrillation (AF), or heart failure with preserved ejection fraction (HFpEF), and correlations between TTE-derived EAT thickness and CMR- or cCT-derived EAT volume. Correlation coefficients were pooled using a random-effects model after Fisher's z-transformation. An exploratory meta-analysis assessed associations with major adverse cardiovascular events (MACE).
RESULTS
Seventeen disease-specific studies consistently demonstrated associations between increased TTE-derived EAT thickness and CAD severity, AF burden and recurrence, and adverse HFpEF phenotypes. Five validation studies were included; four comparing TTE with CMR were pooled, yielding a moderate-to-strong correlation (r = 0.77, 95% CI 0.65-0.93; p < 0.01; I² = 92.9%). Several studies reported associations between TTE- EAT thickness and cCT-derived EAT parameters. However, only one cCT study met our predefined criteria for inclusion in the quantitative validation analysis, whereas the remaining cCT studies were retained in the qualitative synthesis because of substantial methodological heterogeneity in cCT acquisition, segmentation approaches, and outcome definitions. Exploratory prognostic analysis suggested a directional association between increased TTE-derived EAT thickness and MACE.
CONCLUSIONS
TTE-derived EAT thickness correlates with volumetric EAT and is consistently associated with major CV phenotypes. Standardization and prospective outcome-driven validation are required before routine clinical implementation.
MeSH
Phenotype, Heart Failure, Diastolic, Echocardiography, Obesity, Tissues, Adipose Tissue