The role of cardiac adipose tissue in coronary artery disease: a narrative review of cardiac imaging studies.

Background and Objective: Cardiac adipose tissue's (CAT) role in the pathogenesis of coronary artery disease (CAD) has become a hot topic in the literature in recent years. Cardiac computed tomography (CCT), a cutting-edge imaging modality, has become vital in quantifying and characterizing CAT. CAT is divided into paracardial adipose tissue (PAT), epicardial adipose tissue (EAT), and pericoronary adipose tissue (PCAT). Despite numerous studies investigating the association of EAT and PCAT with CAD, their connection remains equivocal. In this review, we clarify the relationship between EAT and PCAT with atherosclerotic burden, high-risk plaque, major adverse cardiovascular events, and the prediction of CAD through the use of CCT. Methods: A thorough literature research spanning from January 2004 to May 2024 of the PubMed database was conducted. Only publications in English which included reviews, clinical trials, meta-analyses, and systematic reviews on CAT's association with CAD were considered. The 63 articles in the review honed in on the influence of CAT metrics obtained mainly by CCT with multiple stages of CAD. Key Content and Findings: Current evidence supports the interaction between dysfunctioning EAT and PCAT and the release of several molecules within the neighboring coronary arteries which is linked with the development and progression of CAD. EAT is related to coronary plaque synthesis. PCAT underlines ongoing inflammation within the plaques. CAT evaluation provides significant incremental value compared to existing assessment methods. It enables enhanced prognostic judgment and further stratified management of CAD patients. Conclusions: CAT metrics have the potential to become future biomarkers of CAD. Additional investigations are required to explore the potential of these metrics as composite scores CAD risk prediction.