Cargando…

The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review

Cardiovascular diseases (CVDs) are a significant burden globally and are especially prevalent in obese and/or diabetic populations. Epicardial adipose tissue (EAT) surrounding the heart has been implicated in the development of CVDs as EAT can shift from a protective to a maladaptive phenotype in di...

Descripción completa

Detalles Bibliográficos
Autores principales: Krishnan, Anirudh, Sharma, Harman, Yuan, Daniel, Trollope, Alexandra F., Chilton, Lisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318726/
https://www.ncbi.nlm.nih.gov/pubmed/35877579
http://dx.doi.org/10.3390/jcdd9070217
_version_ 1784755361879687168
author Krishnan, Anirudh
Sharma, Harman
Yuan, Daniel
Trollope, Alexandra F.
Chilton, Lisa
author_facet Krishnan, Anirudh
Sharma, Harman
Yuan, Daniel
Trollope, Alexandra F.
Chilton, Lisa
author_sort Krishnan, Anirudh
collection PubMed
description Cardiovascular diseases (CVDs) are a significant burden globally and are especially prevalent in obese and/or diabetic populations. Epicardial adipose tissue (EAT) surrounding the heart has been implicated in the development of CVDs as EAT can shift from a protective to a maladaptive phenotype in diseased states. In diabetic and obese patients, an elevated EAT mass both secretes pro-fibrotic/pro-inflammatory adipokines and forms intramyocardial fibrofatty infiltrates. This narrative review considers the proposed pathophysiological roles of EAT in CVDs. Diabetes is associated with a disordered energy utilization in the heart, which promotes intramyocardial fat and structural remodeling. Fibrofatty infiltrates are associated with abnormal cardiomyocyte calcium handling and repolarization, increasing the probability of afterdepolarizations. The inflammatory phenotype also promotes lateralization of connexin (Cx) proteins, undermining unidirectional conduction. These changes are associated with conduction heterogeneity, together creating a substrate for atrial fibrillation (AF). EAT is also strongly implicated in coronary artery disease (CAD); inflammatory adipokines from peri-vascular fat can modulate intra-luminal homeostasis through an “outside-to-inside” mechanism. EAT is also a significant source of sympathetic neurotransmitters, which promote progressive diastolic dysfunction with eventual cardiac failure. Further investigations on the behavior of EAT in diabetic/obese patients with CVD could help elucidate the pathogenesis and uncover potential therapeutic targets.
format Online
Article
Text
id pubmed-9318726
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-93187262022-07-27 The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review Krishnan, Anirudh Sharma, Harman Yuan, Daniel Trollope, Alexandra F. Chilton, Lisa J Cardiovasc Dev Dis Review Cardiovascular diseases (CVDs) are a significant burden globally and are especially prevalent in obese and/or diabetic populations. Epicardial adipose tissue (EAT) surrounding the heart has been implicated in the development of CVDs as EAT can shift from a protective to a maladaptive phenotype in diseased states. In diabetic and obese patients, an elevated EAT mass both secretes pro-fibrotic/pro-inflammatory adipokines and forms intramyocardial fibrofatty infiltrates. This narrative review considers the proposed pathophysiological roles of EAT in CVDs. Diabetes is associated with a disordered energy utilization in the heart, which promotes intramyocardial fat and structural remodeling. Fibrofatty infiltrates are associated with abnormal cardiomyocyte calcium handling and repolarization, increasing the probability of afterdepolarizations. The inflammatory phenotype also promotes lateralization of connexin (Cx) proteins, undermining unidirectional conduction. These changes are associated with conduction heterogeneity, together creating a substrate for atrial fibrillation (AF). EAT is also strongly implicated in coronary artery disease (CAD); inflammatory adipokines from peri-vascular fat can modulate intra-luminal homeostasis through an “outside-to-inside” mechanism. EAT is also a significant source of sympathetic neurotransmitters, which promote progressive diastolic dysfunction with eventual cardiac failure. Further investigations on the behavior of EAT in diabetic/obese patients with CVD could help elucidate the pathogenesis and uncover potential therapeutic targets. MDPI 2022-07-05 /pmc/articles/PMC9318726/ /pubmed/35877579 http://dx.doi.org/10.3390/jcdd9070217 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Krishnan, Anirudh
Sharma, Harman
Yuan, Daniel
Trollope, Alexandra F.
Chilton, Lisa
The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review
title The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review
title_full The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review
title_fullStr The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review
title_full_unstemmed The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review
title_short The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review
title_sort role of epicardial adipose tissue in the development of atrial fibrillation, coronary artery disease and chronic heart failure in the context of obesity and type 2 diabetes mellitus: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318726/
https://www.ncbi.nlm.nih.gov/pubmed/35877579
http://dx.doi.org/10.3390/jcdd9070217
work_keys_str_mv AT krishnananirudh theroleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT sharmaharman theroleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT yuandaniel theroleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT trollopealexandraf theroleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT chiltonlisa theroleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT krishnananirudh roleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT sharmaharman roleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT yuandaniel roleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT trollopealexandraf roleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview
AT chiltonlisa roleofepicardialadiposetissueinthedevelopmentofatrialfibrillationcoronaryarterydiseaseandchronicheartfailureinthecontextofobesityandtype2diabetesmellitusanarrativereview