The role of epicardial and pericoronary adipose tissue in cardiometabolic disease

Epicardial adipose tissue (EAT) is a metabolically active fat depot which modulates coronary arterial function. The measurement of EAT volume and attenuation from non-contrast cardiac computed tomography (CT) provides valuable information on cardiometabolic risk. Pericoronary adipose tissue (PCAT), a subset of EAT which directly surrounds the coronary vessels, may function as a sensor of coronary inflammation. PCAT attenuation on coronary CT angiography associates with coronary plaque morphology, stages of coronary artery disease, and risk of future cardiac events. Quantification of EAT and PCAT has incremental and complementary prognostic value over and above current risk assessment tools. This review covers the biological role of EAT in healthy and dysfunctional states, and CT-based assessment of EAT and PCAT towards the development of clinically meaningful imaging biomarkers.