Gianluca Iacobellis (editor) - Epicardial Adipose Tissue: From Cell to Clinic (Contemporary Cardiology)

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The idea of looking at the epicardial adipose tissue hit me about 20 years ago. At the beginning, it was purely an observation. I was completing my fellowship in endocrinology but had an obvious passion for the heart and its potential as an endocrine organ. When my father, a professor of cardiology, was performing echocardiograms, I started noticing a consistent link between the patients belly and that echo-free space in the echocardiographic imaging. The more abdominally obese the patient, the bigger the echo-free space. That would have been the epicardial fat.

So, first, I developed and validated the ultrasound technique to measure epicardial fat. However, my curiosity was not yet satisfied. I searched the literature on the epicardial adipose tissue but found scarce and dusty information, mostly from old textbooks of human and comparative anatomy. It was clearly a neglected adipose tissue, just silently standing by the heart. At least, it was so believed. Few anatomists from the nineteenth century were questioning the meaning and causes of the fatty heart. The comparative anatomy was actually more intriguing, as I learned that some animals, particularly those who hibernate, had a large fat cushion that could protect the heart during the hibernation. I thought that was fascinating but basically unexplored in humans.

So my pioneering work in this field began. This books intent is to summarize the enormous and continuously growing scientific-based evidence on the multifaceted aspects of epicardial fat and its clinical applications. Novel discoveries regarding epicardial fat occur on an almost daily basis. I have done my best to present the most updated literature and to report the newest findings in this book. The purpose of this volume is not only to provide an overview of the anatomical, biomolecular, genetic, imaging, and clinical features of epicardial fat but also to stimulate further research and any clinical implications generated by current research. The book will literally take you from cell to clinic, from the lab to your patient.

I have had the privilege to be accompanied by renowned colleagues and friends who greatly contributed to this book with their expertise and dedication. You will read that epicardial fat is actually a very active endocrine (or, better, paracrine) organ that cross-talks with the myocardium and the coronary arteries, as no muscle fascia separates the fat from these contiguous structures. You will be amused by the unique transcriptome of the epicardial fat, so enriched with genes encoding for pro-inflammatory, pro-fibrotic, and atherogenic factors. This volume wants to reach out to a broad spectrum of readers and specialists. Having a biomarker that is peculiar, unique, measurable, and ultimately modifiable is appealing to any basic scientist and clinician. Epicardial fat can play a key role in the development and progression of eliminating diseases such as the coronary artery disease and atrial fibrillation, as nicely described here by worldwide experts in these fields.

We can now, quantitatively and qualitatively, measure this fat depot with routine, noninvasive imaging procedures and predict the cardiovascular risk, as comprehensively discussed in three focused chapters. Experts in the field will guide you through the neuromodulation of the epicardial fat. A beautiful chapter is dedicated to the perivascular fat, so different but also so similar to the epicardial fat. You will also read and learn about the dual role of the epicardial fat, both detrimental and protective. As aJanus Bifrons, epicardial fat will show you its dichotomous face.

The topic is certainly innovative, the results are promising, but further investigations are necessary to address key questions. In my view, future research on epicardial fat will take two main streamscausality and utility. First, it will be focused on understanding the independent causative role of epicardial fat in coronary artery disease and atrial fibrillation. Currently, we have evidence that epicardial fat is a sensitive target of drugs modulating the fat. Future studies will explore how the pharmacological manipulation of epicardial fat could eventually restore its physiological and protective properties. Breaking from traditional schemes, the research on the epicardial adipose tissue can open new and important avenues. This book will guide you through this exciting journey.