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CMR assessment of epicardial fat volume in human morbid obesity at 3 T: relationship to cardiac function and morphology


Ectopic fat accumulation within and around the myocardium is involved in the pathogenesis of obesity-related cardiomyopathy and cardiovascular disease. Earlier MR studies have been restricted to a mildly obese population due to magnet bore size limitations. For this study, a 70 cm bore 3 tesla MR system offered the possibility to assess left-ventricular (LV) morphology and function along with EFV in patients with severe obesity.


To assess epicardial fat volume (EFV) in severely obese patients with CMR at 3 T, and to determine its potential correlations with left-ventricular function and morphology.


CMR was performed with a Siemens Verio 3 T system in 24 obese patients (15 with morbid obesity and 9 with diabetes, mean BMI = 42.3 ± 5.7 kg/m2) and in 14 healthy controls (mean BMI = 22.4 ± 2.1 kg/m2). The scanner was equipped with a 32-channel phased-array coil. Sixteen short-axis slices covering the heart and its surrounding adipose tissue were obtained within four breathholds using a balanced SSFP cine sequence with 4-fold GRAPPA k-space reduction (FOV = 340 × 340 mm2, TE = 1.2 ms, TR = 61 ms, matrix = 134 × 192, slice thickness 6 mm). The absolute volume of epicardial fat was assessed by manual delineation on every slice from base to apex. Parameters of LV function and morphology were obtained using the same short-axis dataset. All patients underwent an intraabdominal CT scan for visceral adipose tissue (VAT) assessment and biological evaluation.


EFV was increased twofold between lean (64 ± 29 mL) and obese non-diabetic (123 ± 44 mL) subjects. Another twofold increase in EFV was observed in obese diabetic patients (240 ± 140 mL) (p < 0.0001). EFV was strongly correlated with age (r = 0.71, p < 0.0001), VAT (r = 0.89, p < 0.0001), BMI (r = 0.68, p < 0.0001), waist circumference (r = 0.73, p < 0.0001), fasting plasma triglycerides (r = 0.62, p = 0.018), and negatively correlated with thigh circumference (r = -0.45, p = 0.03) and superficial subcutaneous abdominal fat (r = -0.44, p = 0.03). Patients with metabolic syndrome (MS) had higher EFV than patients without MS (p < 0.0001). After multivariate adjustment, only VAT remained independently associated with EFV. EFV was negatively correlated with stroke volume (r = -0.46, p = 0.005), cardiac output (r = -0.46, p = 0.005) and LV end diastolic volume (r = -0.46, p = 0.004), Figure 1.

Figure 1
figure 1

Epicardial fat in a diabetic obese patient on a short-axis view (left), manual segmentation by drawing the key lines dividing epicardial from paracardial fat and myocardium (middle), and an image from a healthy volunteer (right).


CMR at 3 T allowed quantification of epicardial fat volume and LV morphology and function in severely obese subjects. A significant correlation was shown between LV function and EFV.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Gaborit, B., Kober, F., Moro, PJ. et al. CMR assessment of epicardial fat volume in human morbid obesity at 3 T: relationship to cardiac function and morphology. J Cardiovasc Magn Reson 12 (Suppl 1), P268 (2010).

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