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Epicardial Adipose Tissue Changes After Bariatric and Metabolic Surgery: a Systematic Review and Meta-analysis

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Abstract

Epicardial adipose tissue (EAT) is a visceral fat depot located between the myocardium and visceral epicardium. Emerging evidence suggests that excessive EAT is linked to increased risk of cardiovascular conditions and other metabolic diseases. A literature search was conducted from the earliest studies to the 26th of November 2022 on PubMed, Embase, and the Cochrane. All the studies evaluating changes in EAT, pericardial adipose tissue (PAT), or total cardiac fat loss before and after BS were included. From 623 articles, 35 were eventually included in the systematic review. Twenty-one studies showed a significant reduction of EAT after BS, and only one study showed a non-significant reduction (p = 0.2).

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References

  1. Wu FZ, Huang YL, Wu CC, et al. Differential effects of bariatric surgery versus exercise on excessive visceral fat deposits. Medicine (Baltimore). 2016;95(5):e2616.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kokkinos A, Alexiadou K, Liaskos C, et al. Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obes Surg. 2013;23(1):31–8.

    Article  PubMed  Google Scholar 

  3. Sarmiento-Cobos M, Valera R, Botero Fonnegra C, et al. Ventricular conduction improvement after pericardial fat reduction triggered by rapid weight loss in subjects with obesity undergoing bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2022;18(2):288–94.

    Article  Google Scholar 

  4. Gaborit B, Jacquier A, Kober F, et al. Effects of bariatric surgery on cardiac ectopic fat: lesser decrease in epicardial fat compared to visceral fat loss and no change in myocardial triglyceride content. J Am Coll Cardiol. 2012;60(15):1381–9.

    Article  PubMed  Google Scholar 

  5. Launbo N, Zobel EH, von Scholten BJ, et al. Targeting epicardial adipose tissue with exercise, diet, bariatric surgery or pharmaceutical interventions: A systematic review and meta-analysis. Obes Rev. 2021;22(1):e13136.

    Article  PubMed  Google Scholar 

  6. Secchi F, Asteria C, Monti CB, et al. Quantification of epicardial adipose tissue in obese patients using an open-bore MR scanner. Eur Radiol Exp. 2022;6(1):25.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rabkin SW, Campbell H. Comparison of reducing epicardial fat by exercise, diet or bariatric surgery weight loss strategies: a systematic review and meta-analysis. Obes Rev. 2015;16(5):406–15.

    Article  CAS  PubMed  Google Scholar 

  8. Villasante Fricke AC, Iacobellis G. Epicardial adipose tissue: clinical biomarker of cardio-metabolic risk. Int J Mol Sci. 2019;20(23):5989.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Scarano Pereira JP, Owen E, Martinino A, et al. Epicardial adipose tissue, obesity, and the occurrence of atrial fibrillation: an overview of pathophysiology and treatment methods. Expert Rev Cardiovasc Ther. 2022;20(4):307–22.

    Article  CAS  PubMed  Google Scholar 

  10. Salman AA, Salman MA, Soliman A, et al. Changes of epicardial fat thickness after laparoscopic sleeve gastrectomy: a prospective study. Ann Med. 2021;53(1):523–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Packer M. Disease-treatment interactions in the management of patients with obesity and diabetes who have atrial fibrillation: the potential mediating influence of epicardial adipose tissue. Cardiovasc Diabetol. 2019;18(1):121.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mahajan R, Wong CX. Obesity and metabolic syndrome in atrial fibrillation: cardiac and noncardiac adipose tissue in atrial fibrillation. Card Electrophysiol Clin. 2021;13(1):77–86.

    Article  CAS  PubMed  Google Scholar 

  13. Jones NR, Taylor KS, Clare JT, et al. Weight change and the risk of incident atrial fibrillation: a systematic review and meta-analysis. Heart. 2019;105(23):1799–805. https://heart.bmj.com/content/105/23/1799. Accessed 28 Nov 2022

  14. Adami GF, Carbone F, Montecucco F, et al. Adipose tissue composition in obesity and after bariatric surgery. Obes Surg. 2019;29(9):3030–8.

    Article  PubMed  Google Scholar 

  15. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29(372):n71.

    Article  Google Scholar 

  16. Lo CKL, Mertz D, Loeb M. Newcastle-Ottawa scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;1(14):45.

    Article  Google Scholar 

  17. Su B, Qin W, Xue F, et al. The relation of passive smoking with cervical cancer. Medicine (Baltimore). 2018;97(46):e13061.

    Article  PubMed  Google Scholar 

  18. Abstracts of the 47th Annual Meeting of the EASD, Lisbon 2011. Diabetologia. 2011;54(1):1.

  19. Vasques ACJ, Pareja JC, Souza JRM, et al. Epicardial and pericardial fat in type 2 diabetes: favourable effects of biliopancreatic diversion. Obes Surg. 2015;25(3):477–85.

    Article  PubMed  Google Scholar 

  20. van Schinkel LD, Sleddering MA, Lips MA, et al. Effects of bariatric surgery on pericardial ectopic fat depositions and cardiovascular function. Clin Endocrinol (Oxf). 2014;81(5):689–95.

    Article  PubMed  Google Scholar 

  21. Hunt SC, Davidson LE, Adams TD, et al. Associations of visceral, subcutaneous, epicardial, and liver fat with metabolic disorders up to 14 years after weight loss surgery. Metab Syndr Relat Disord. 2021;19(2):83–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Willens HJ, Byers P, Chirinos JA, et al. Effects of weight loss after bariatric surgery on epicardial fat measured using echocardiography. Am J Cardiol. 2007;99(9):1242–5.

    Article  PubMed  Google Scholar 

  23. Kaya BC, Elkan H. The impact of weight loss after laparoscopic sleeve gastrectomy on early markers of atherosclerotic vascular disease: a prospective study. Kardiologia Pol Pol Heart J. 2020;78(7–8):674–80.

    Article  Google Scholar 

  24. Hannukainen JC, Lautamäki R, Pärkkä J, et al. Reversibility of myocardial metabolism and remodelling in morbidly obese patients 6 months after bariatric surgery. Diabetes Obes Metab. 2018;20(4):963–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Cekici Y, Kaya BC, Elkan H. The effect of laparoscopic sleeve gastrectomy on subclinical atherosclerosis in patients with severe obesity. Obes Surg. 2021;31(2):738–45.

    Article  PubMed  Google Scholar 

  26. Sarmiento-Cobos M, Aleman R, Gomez CO, et al. Weight loss following bariatric surgery decreases pericardial fat thickness lowering the risk of develo** coronary artery disease. Surg Obes Relat Dis. 2021;17(2):390–7.

    Article  PubMed  Google Scholar 

  27. Frea. Subclinical left ventricular dysfunction in severe obesity and reverse cardiac remodeling after bariatric surgery. 2022. https://www.jcecho.org/article.asp?issn=2211-4122;year=2020;volume=30;issue=1;spage=22;epage=28;aulast=Frea. Accessed 28 Nov 2022

  28. Mikhalkova D, Holman SR, Jiang H, et al. Bariatric surgery–induced cardiac and lipidomic changes in obesity-related heart failure with preserved ejection fraction. Obesity. 2018;26(2):284–90.

    Article  CAS  PubMed  Google Scholar 

  29. Altin C, Erol V, Aydin E, et al. Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: a prospective study. Nutr Metab Cardiovasc Dis. 2018;28(5):501–9.

    Article  CAS  PubMed  Google Scholar 

  30. HIT Poster session 1. Eur Heart J Cardiovasc Imaging. 2017;18(suppl_3):iii21–5.

  31. Integrated Physiology/Obesity. Diabetes. 2014;63(Supplement_1):A655–65.

  32. Abstracts of the 49th Annual Meeting of the EASD. Diabetologia. 2013;56(1):1–566.

  33. Kovac N, Grymyr LMD, Gerdts E, Nadirpour S, Nedrebø BG, Hjertaas JJ, et al. Markers of subclinical atherosclerosis in severe obesity and one year after bariatric surgery. J Clin Med. 2022;11(8):2237.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schneiter S, Warrier R, Lefkovits L, et al. Effects of weight loss on left ventricle and pericardial fat assessed with cardiac magnetic resonance imaging in morbid obesity. Heart Lung Circ. 2010;1(19):S179.

    Article  Google Scholar 

  35. Foppa M, Pond KK, Jones DB, et al. Subcutaneous fat thickness, but not epicardial fat thickness, parallels weight reduction three months after bariatric surgery: A cardiac magnetic resonance study. Int J Cardiol. 2013;168(4):4532–3.

    Article  PubMed  Google Scholar 

  36. Castillo A, Rivera E, Typhair C, et al. Echocardiographic assessment of epicardial fat pad and cardiac remodeling after bariatric surgery. J Am Coll Cardiol. 2021;77(18_Supplement_1):1342.

    Article  Google Scholar 

  37. Tokhi B, Humphrey T, Harris E, et al. Effects of bariatric surgery on epicardial fat pat remodeling. J Am Coll Cardiol. 2020;75(11, Supplement 1):1597.

    Article  Google Scholar 

  38. Abdesselam I, Dutour A, Kober F, et al. Time course of change in ectopic fat stores after bariatric surgery. J Am Coll Cardiol. 2016;67(1):117–9.

    Article  PubMed  Google Scholar 

  39. Luaces M, Cachofeiro V, Pedrazo JC, et al. Quantification of epicardial adipose tissue in morbidly obese patients before and after bariatric surgery. J Cardiovasc Magn Reson. 2014;16(1):P281.

    Article  PubMed Central  Google Scholar 

  40. Luaces M, Paiva M, Secades Gonzalez S, et al. Long-term changes in epicardial adipose tissue after bariatric surgery: a CMR study. J Am Coll Cardiol. 2013;61(10, Supplement):E1286.

    Article  Google Scholar 

  41. Graziani F, Leone AM, Cialdella P, et al. Effects of bariatric surgery on cardiac remodeling: clinical and pathophysiologic implications. Int J Cardiol. 2013;168(4):4277–9.

    Article  PubMed  Google Scholar 

  42. Oral Sessions. Obes Facts. 2012;5(Suppl. 1):32–54.

  43. Henry JA, Abdesselam I, Sorimachi H, et al. 13 The long-term effects of adipose depot change following bariatric surgery on cardiac geometry. Heart. 2022;108(Suppl 1):A11.

    Google Scholar 

  44. 2019 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Baltimore, Maryland, USA, 3–6 April 2019: 2019 Posters. Surg Endosc. 2019;33(1):130–413.

  45. Daud A, Dranow E, Ibrahim M. Effect of weight loss surgery on pericardial fat volume assessed by chest computed tomography. J Am Coll Cardiol. 2021;77(18_Supplement_1):1364.

    Article  Google Scholar 

  46. Sarmiento-Cobos M, Cogollo VJ, Rivera CE, et al. Cardio-metabolic impact of bariatric surgery and its allometric effect on the heart’s shape, Anatomy, and Physiology. J Am Coll Surg. 2020;231(4, Supplement 2):e71.

    Article  Google Scholar 

  47. Cobos MS, Rivera CE, Montorfano L, et al. Improvement in ventricular conduction after reduction in pericardial fat triggered by rapid weight loss in severely obese patients undergoing bariatric intervention. J Am Coll Surg. 2019;229(4):S24.

    Article  Google Scholar 

  48. Zhou M, Wang H, Chen J. Epicardial adipose tissue and atrial fibrillation: possible mechanisms, potential therapies, and future directions. Pacing Clin Electrophysiol. 2020;43(1):133–45.

    Article  PubMed  Google Scholar 

  49. Can we decrease epicardial and pericardial fat in patients with diabetes? - Emir M. Muzurović, Snežana Vujošević, Dimitri P. Mikhailidis, 2021 https://journals.sagepub.com/doi/10.1177/10742484211006997. Accessed 28 Nov 2022

  50. Scarano-Pereira JP, Martinino A, Manicone F, et al. Response to: ‘recent advances in the mechanisms underlying the beneficial effects of bariatric and metabolic surgery’. Surg Obes Relat Dis. 2021;S1550-7289(21):00494–9.

    Google Scholar 

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Author information

Author notes

  1. Olga Wolf and Sjaak Pouwels contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain

    Juan Pablo Scarano Pereira

  2. Faculty of Medicine, Università la Sapienza di Roma, Rome, Italy

    Matteo Calafatti

  3. Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA

    Alessandro Martinino

  4. Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands

    Dharmanand Ramnarain & Sjaak Pouwels

  5. Department of Intensive Care Medicine, Saxenburgh Medical Centre, Hardenberg, The Netherlands

    Dharmanand Ramnarain

  6. Department of Surgical Endoscopy, Sana Hospitals, Germany and Obesity Center NRW, Huerth, Germany

    Christine Stier

  7. Department of Surgery, Whittington Health NHS Trust, London, UK

    Chetan Parmar

  8. Apollo Hospitals Education and Research Foundation, Hyderabad, India

    Chetan Parmar

  9. Department of Bariatric and Metabolic Surgery, Sana Klinikum, Offenbach am Main, Hessen, Germany

    Sylvia Weiner

  10. Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands

    Lukas R. Dekker

  11. Helios Obesity Center West, Helios St. Elisabeth Hospital Oberhausen, Oberhausen, NRW, Germany

    Till Hasenberg

  12. Helios University Hospital Wuppertal, Wuppertal, NRW, Germany

    Till Hasenberg

  13. Faculty of Health, University of Witten/Herdecke, Witten, Germany

    Till Hasenberg & Sjaak Pouwels

  14. Department of Plastic, Reconstructive and Aesthetic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany

    Olga Wolf

  15. Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Klinik, Josefstraße 3, 46045, Oberhausen, NRW, Germany

    Sjaak Pouwels

Authors
  1. Juan Pablo Scarano Pereira
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  2. Matteo Calafatti
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  5. Christine Stier
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  6. Chetan Parmar
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  9. Till Hasenberg
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  10. Olga Wolf
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  11. Sjaak Pouwels
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Contributions

Initial idea: JPSP, SP

Literature search and data collection: JPSP, MC, AM, SP

Data analysis: JPSP, MC, AM, SP

Writing of the paper: JPSP, MC, AM, DR, CS, CP, SW, LD, TH, OW, SP

Final approval: JPSP, MC, AM, DR, CS, CP, SW, LD, TH, OW, SP

Corresponding author

Correspondence to Sjaak Pouwels.

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Key Points

- Epicardial adipose tissue (EAT) is a visceral fat depot located between the myocardium and visceral epicardium.

- Excessive EAT is linked to increased risk of cardiovascular conditions and other metabolic diseases.

- Our systematic review showed that a significant reduction of EAT after bariatric surgery is seen.

- This indicates a beneficial effect of bariatric surgery on EAT.

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Pereira, J.P.S., Calafatti, M., Martinino, A. et al. Epicardial Adipose Tissue Changes After Bariatric and Metabolic Surgery: a Systematic Review and Meta-analysis. OBES SURG 33, 3636–3648 (2023). https://doi.org/10.1007/s11695-023-06848-0

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