Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging

Objective: Previous studies determined the amount of epicardial fat by measuring the right ventricular epicardial fat thickness. However, it is not proven whether this one-dimensional method correlates well with the absolute amount of epicardial fat. In this prospective study, a new cardiovascular magnetic resonance imaging (CMR) method using the three-dimensional summation of slices method was introduced to assess the total amount of epicardial fat. Research Methods and Procedures: CMR was performed in 43 patients with congestive heart failure and in 28 healthy controls. The absolute amount of epicardial fat was assessed volumetrically in consecutive short-axis views by means of the modified Simpson's rule. Additionally, the right ventricular epicardial fat thickness was measured in two different imaging planes: long-axis view (EFT-4CV) and consecutive short-axis views (EFT-SAX). Results: Using the volumetric approach, patients with congestive heart failure had less epicardial fat mass than controls (51 g vs. 65 g, p = 0.01). This finding was supported by EFT-SAX (2.9 mm vs. 4.3 mm, p < 0.0001) but not by EFT-4CV (3.5 Turn vs. 3.8 mm, p = not significant). Epicardial fat mass correlated moderately with EFT-SAX in both groups (r = 0.466, p = 0.012 in controls and r = 0.590, p < 0.0001 in patients) and with EFT-4CV in controls (r = 0.387, p = 0.042). There were no significant differences between EFT-4CV and EFT-SAX in controls (4.3 mm vs. 3.8 mm, p = 0.240). However, in the heart failure group, EFT-4CV was significantly higher compared with EFT-SAX (3.5 mm vs. 2.9 mm, p = 0.003). Interobserver variability and reproducibility were superior for the volumetric approach compared with thickness measurements. Discussion: Quantitative assessment of epicardial fat mass using the CMR-based volumetric approach is feasible and yields superior reproducibility compared with conventional methods.