Accumulating evidence suggests that ectopic/visceral adiposity may play a key role in the pathogenesis of nonischaemic cardiovascular diseases associated with type 2 diabetes. Epicardial adipose tissue (EAT) is a complex visceral fat depot, covering 80% of the cardiac surface with anatomical and functional contiguity to the myocardium and coronary arteries. EAT interacts with the biology of the underlying myocardium by secreting a wide range of adipokines. Magnetic resonance imaging (MRI) is the reference modality for structural and functional imaging of the heart. The technique is now also emerging as the reference imaging modality for EAT quantification. With this narrative review, we (a) surveyed contemporary clinical studies that utilized cardiovascular MRI to characterize EAT (studies published 2010–2023); (b) listed the clinical trials monitoring the response to treatment in EAT size as well as myocardial functional and structural parameters and (c) discussed the potential pathophysiological role of EAT in the development of diabetic cardiomyopathy. We concluded that increased EAT quantity and its inflammatory phenotype correlate with early signs of left ventricle dysfunction and may have a role in the pathogenesis of cardiac disease in diabetes with and without coronary artery disease.

中文翻译：

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通过心血管磁共振成像镜头观察心外膜脂肪组织在糖尿病心肌病中的作用——叙述性综述

越来越多的证据表明，异位/内脏肥胖可能在与 2 型糖尿病相关的非缺血性心血管疾病的发病机制中发挥关键作用。心外膜脂肪组织 (EAT) 是一种复杂的内脏脂肪库，覆盖心脏表面的 80%，在解剖学和功能上与心肌和冠状动脉相邻。EAT 通过分泌多种脂肪因子与底层心肌的生物学相互作用。磁共振成像 (MRI) 是心脏结构和功能成像的参考方式。该技术现在也正在成为 EAT 量化的参考成像模式。通过这篇叙述性回顾，我们 (a) 调查了利用心血管 MRI 来表征 EAT 的当代临床研究（2010-2023 年发表的研究）；(b) 列出了监测 EAT 大小以及心肌功能和结构参数对治疗反应的临床试验，(c) 讨论了 EAT 在糖尿病心肌病发展中的潜在病理生理学作用。我们的结论是，EAT 数量的增加及其炎症表型与左心室功能障碍的早期症状相关，并且可能在患有或不患有冠状动脉疾病的糖尿病患者的心脏病发病机制中发挥作用。