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besity is associated with insulin resistance and atherosclerotic cardiovascular disease. However, the risk of these depends on adipose tissue distribution in the body, and mainly on the increase and ectopic accumulation of visceral fat.
Increased visceral adipose tissue (VAT) not only involves greater adipocyte size, but also an increased expression of pro-inflammatory adipocytokines with harmful effects at both local and systemic levels.
The quantification of VAT has therefore gained importance in recent years because it allows for a better stratification of both individual and overall cardio metabolic risk. Recently, scientific interest has focused on the study of certain extra-abdominal visceral fat deposits, including epicardial adipose tissue (EAT), which because of its close relation to the myocardium and coronary arteries has provided a new understanding of the association between obesity and cardiovascular disease.
This review article will address the morphological, biochemical, and clinical characteristics that make EAT a valuable tool for the comprehensive evaluation of cardiovascular risk. True volume assessment of EAT is feasible using cardiac CT. The three dimensional (3D) image reconstruction with multidetector-row CT (MDCT) has the best spatial resolution among the imaging modalities. It is of note that the specificity and sensitivity of measurements with MDCT are the best when compared to alternative imaging methods.
Based on several studies it became widely accepted that EAT should be considered as a source of inflammatory mediators that might directly influence the myocardium and coronary arteries.
Mitral annulus calcification, aortic valve calcification, and calcific aortic valve stenosis represent a degenerative process that occurs mainly in the elderly. Calcific deposits lead to cardiac conduction disturbances in these patients.
Along with other calcific valvar processes, mitral annular calcification is associated with a high prevalence of risk factors for the development of coronary atherosclerosis.
As such, it may also be a manifestation of generalized atherosclerosis in the elderly population. However, age is more closely related to this condition and to other forms of valvar calcification than any other factors, and this may strengthen its association with coronary artery disease in a younger population.
Aortic stenosis (AS) is the most frequent valvular disease in adults after hypertension and coronary artery disease, it is the third most common cause of myocardial damage. Calcific AS has long been considered as a passive and degenerative process but recent data challenged this concept, showing that AVC is an active and highly regulated process, with histological similarities to atherosclerosis.
Selective coronary angiography is the standard clinical method for measuring the extent of anatomic coronary atherosclerotic disease. Alternative, noninvasive procedures would be attractive because of the potential for broader applications.
Electron beam computed tomography (EBCT) permits direct high resolution imaging of the coronary arteries in the beating heart. EBCT currently represents the only noninvasive method for accurate quantification of coronary artery calcium. Quantification of coronary calcium by CT has been shown to provide a measure of mural atherosclerotic plaque burden. Recent data from the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort of individuals without known cardiovascular disease, found that a CACS > 300 was associated with a hazard ratio for future coronary heart disease (CHD) events of nearly 10. MSCT angiography allows for excellent visualization of anatomical details of coronary artery and its branches, and is the only imaging modality which has been widely used in the diagnosis of CAD with high diagnostic accuracy being achieved.