Association of Pericardial Fat with Cardiac Structure, Function, and Mechanics: The Multi-Ethnic Study of Atherosclerosis

J Am Soc Echocardiogr. 2022 Jun;35(6):579-587.e5. doi: 10.1016/j.echo.2022.01.005. Epub 2022 Jan 19.


Background: Pericardial fat has been associated with adverse cardiovascular outcomes through adiposity-associated inflammation and insulin resistance, which in turn are linked to cardiac dysfunction. We sought to evaluate the association between pericardial fat volume and cardiac structure and function in adults without baseline cardiovascular disease.

Methods: We analyzed data from the Multi-Ethnic Study of Atherosclerosis. Linear regression was used to examine the association between pericardial fat volume (by cardiac computed tomography during exam 1, 2000-2002) and cardiac function by echocardiography, six-minute walk distance (6MWD), and symptom severity as assessed using the Kansas City Cardiomyopathy Questionnaire-12 (exam 6, 2016-18).

Results: Among 3,032 participants, each 1 SD (39.3 cm3) increase in pericardial fat volume was associated with lower (worse) absolute left atrial reservoir strain (β = -0.98%; 95% CI, -1.29, -0.68; P < .001), right ventricular free wall strain (β = -0.75%; 95% CI, -1.00, -0.51; P < .001), and right atrial reservoir strain (β = -0.59%; 95% CI, -1.00, -0.19; P < .01) after adjustment for potential confounders. Greater pericardial fat volume was associated with lower 6MWDs (β = -5.70 m; 95% CI, -10.34, -1.06; P = .02) but not with Kansas City Cardiomyopathy Questionnaire-12 scores or N-terminal pro b-type natriuretic peptide after multivariable adjustment.

Conclusions: In a population-based cohort of adults, pericardial fat volume was independently associated with subclinical atrial and right ventricular dysfunction and reduced 6MWD. These distinct changes in cardiac structure and function suggest a potential mechanistic role for pericardial fat in early heart failure.

Keywords: Early heart failure; Echocardiography; Myocardial strain analysis; Pericardial fat.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adipose Tissue / diagnostic imaging
  • Adiposity
  • Adult
  • Atherosclerosis* / diagnosis
  • Cardiomyopathies*
  • Humans
  • Pericardium / diagnostic imaging