Abstract
Epicardial adipose tissue (EAT) has been investigated in patients with both systolic and diastolic heart failure and suggested to play a pathogenic role, although results are not univocal. Experimental studies suggest a potential protective role of the brown fat features of EAT against the systolic heart failure. A function of EAT p53 and adiponectin has been also suggested in patients with heart failure. A neuromodulatory role of EAT in heart failure has been also considered. Clinically, diastolic heart failure is commonly associated with higher EAT. The role of EAT in the systolic heart failure is more controversial, as it could be influenced by concomitant confounders, such as coronary artery disease, diabetes and obesity. Some studies found that EAT volume was higher in patients with systolic heart failure, whereas other studies showed that either CT, MRI or ultrasound measured epicardial fat was actually lower in subjects with systolic heart failure. Epicardial fat may incur in fibrotic changes during chronic and advanced cardiac failure. Whether EAT plays a role in the long-term prognosis of heart failure requires future investigation.