Different "weight" of cardiac and general adiposity in predicting left ventricle morphology.

Excess adiposity has been widely related to cardiac morphological changes. Nevertheless, the mechanistic link between increased adiposity and left ventricular (LV) morphology is controversial and not completely understood. In this context, several authors have recently debated the different "weight" of BMI as an index of general adiposity vs. the importance of the epicardial fat depot as a marker of local visceral adiposity in obesity-related LV changes. Studies in uncomplicated obesity suggest that the role of BMI in predicting LV abnormalities remains rather doubtful. In contrast, several lines of evidence suggest that cardiac adiposity could play an important part in the development of cardiac modifications. Epicardial fat as an index of cardiac adiposity could have a functional and mechanical role in obesity-related LV abnormalities. Epicardial fat is clinically correlated with LV mass, atrial dimensions, and diastolic function, but a causal effect of epicardial adipose tissue on cardiac chamber modifications remains to be demonstrated. Nevertheless, the close anatomical and functional relationship of epicardial adipose tissue to the adjacent myocardium should readily allow local, paracrine interactions between these tissues.