Differential Association of Abdominal, Liver and Epicardial Adiposity with Anthropometry and Cardiac Remodeling in Asians

Abstract Background Heterogenous deposition and homeostasis roles of physiologic and ectopic adipose tissues underscore the implication of fat compartmentalization on cardiometabolic risk. We aimed to characterize the distribution of abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epicardial adipose tissue (EAT) and liver fat on magnetic resonance imaging (MRI), and evaluate their associations with anthropometric indices and adverse cardiac remodeling. Methods In this cross-sectional observational study, all 149 Asian adults (57.0±12.8 years; 65% males) with at least one cardiometabolic risk factor underwent fat and cardiovascular MRI. Anthropometric indices included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and bioimpedance body fat mass (BFM). Results We observed opposing associations of VAT and SAT with liver fat and EAT, therefore VAT/SAT ratio was explored as an integrated marker of visceral adiposity. VAT/SAT was associated with EAT (β=0.35, P<0.001) and liver fat (β=0.32, P=0.002) independent of confounders. Of the anthropometric measures assessed, only WHR was independently associated with VAT/SAT (β=0.16, P=0.03). Individuals with T2DM had higher VAT and lower SAT compared to those without T2DM, translating to a significantly higher VAT/SAT ratio. Independent association was observed between greater EAT volume and adverse features of cardiac remodeling: increased left ventricular mass (β=0.24, P=0.005), larger myocyte volume (β=0.25, P=0.002), increased myocardial fibrosis (β=0.19, P=0.032), higher concentricity (β=0.18, P=0.035) and elevated wall stress (β=−0.18, P=0.023). Conclusions VAT/SAT ratio is a promising marker for multiorgan visceral fat composition T2DM. EAT is uniquely associated with adverse cardiac remodeling, suggesting distinctive cardiometabolic properties from other fat depots.