The role of epicardial adipose tissue in systemic sclerosis: A clinical and radiological analysis

Year 2025, EARLY ONLINE, 1 - 10

Dilek Tezcan , Halil Özer , Ömer Faruk Topaloğlu , Selda Hakbilen , Abidin Kılınçer , Sema Yılmaz

Abstract

Objectives: Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by progressive fibrosis, vasculopathy, and immune dysregulation, leading to multi-organ involvement. Cardiopulmonary complications are major determinants of morbidity and mortality in SSc. Epicardial adipose tissue (EAT), a metabolically active adipose tissue, has been implicated in systemic inflammation and cardiovascular risk. However, its role in SSc remains poorly understood. This study aims to evaluate the relationship between EAT and SSc patients.

Methods: This retrospective cross-sectional study was performed at Rheumatology department between 2020 and 2021. Patients were classified according to the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for SSc. Laboratory and radiology results were obtained from the electronic registration database. Data were analyzed and compared between groups. EAT was measured using non-contrast computed tomography (CT), and its correlations with clinical features, inflammatory markers, and thoracic CT abnormalities were evaluated.

Results: A total of 229 participants, 157 with SSc and 72 age-matched healthy controls, were included in the study. The mean EAT volume was 171.02±81.84 cm³. Correlation analysis revealed a significant positive correlation between EAT volume and interstitial lung disease (ILD) (r=0.260, P=0.001), C-reactive protein (CRP) levels (r= 0.250, P=0.002), disease duration (r=0.205, P=0.010), and age (r=0.528, P<0.001). ROC analysis showed a moderate discriminatory power of EAT volume with an area under the curve (AUC) of 0.647 (95% CI: 0.564-0.729, P<0.001).

Conclusions: Higher EAT volume was observed in SSc patients with ILD, suggesting a possible role of epicardial fat in pulmonary involvement in SSc.

Keywords

Epicardial adipose tissue , inflammation , interstitial lung disease , systemic sclerosis

Ethical Statement

This study was approved by the Selçuk University Faculty of Medicine Hospital Clinical Research Ethics Committee (Decision No: 2021/296; date: 26.05.2021). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study.

References

• 1. Denton CP, Khanna D. Systemic sclerosis. Lancet. 2017;390(10103):1685-1699. doi: 10.1016/S0140-6736(17)30933-9.
• 2. Jolfayi AG, Beheshti AT, Hosseini SM, et al. Epicardial adipose tissue features as a biomarker and therapeutic target in coronary artery disease. Sci Rep. 2025;15(1):14786. doi: 10.1038/s41598-025-99600-w.
• 3. Han R, Hou J, Xia P, Xing Y, Liu W. Predicting abnormal epicardial adipose tissue in psoriasis patients by integrating radiomics from non-contrast chest CT with serological biomarkers. BMC Med Imaging. 2025;25(1):240. doi: 10.1186/s12880-025-01755-5.
• 4. Spearman JV, Renker M, Schoepf UJ, et al. Prognostic value of epicardial fat volume measurements by computed tomography: a systematic review of the literature. Eur Radiol. 2015;25(11):3372-3381. doi: 10.1007/s00330-015-3765-5.
• 5. Bucher AM, Joseph Schoepf U, Krazinski AW, et al. Influence of technical parameters on epicardial fat volume quantification at cardiac CT. Eur J Radiol. 2015;84(6):1062-1067. doi: 10.1016/j.ejrad.2015.03.018.
• 6. Long BD, Stojanovska J, Brown RKJ, Attili AK, Jackson EA, Ognenovski V. Increased Epicardial Fat Volume Is Independently Associated with the Presence and Severity of Systemic Sclerosis. Acad Radiol. 2017;24(12):1473-1481. doi: 10.1016/j.acra.2017.07.003.
• 7. Yilmaz N, Baysal E, Karadag O. Increased Epicardial Adipose Tissue in Patients with Systemic Sclerosis. Ann Rheum Dis. 2014;73(Suppl 2):563. doi 10.1136/annrheumdis-2014-eular.1245.
• 8. Torres T, Bettencourt N, Mendonça D, et al. Epicardial adipose tissue and coronary artery calcification in psoriasis patients. J Eur Acad Dermatol Venereol. 2015;29(2):270-277. doi: 10.1111/jdv.12516.
• 9. Lima-Martínez MM, Campo E, Salazar J, et al. Epicardial fat thickness as cardiovascular risk factor and therapeutic target in patients with rheumatoid arthritis treated with biological and nonbiological therapies. Arthritis. 2014;2014:782850. doi: 10.1155/2014/782850.
• 10. Hakbilen S, Yılmaz S, Özer H, et al. Evaluation of epicardial fat thickness, a new indicator of the cardiovascular risk factor, in patients with systemic lupus erythematosus. Rheumatol Q. 2023;1(3):104-109. doi: 10.4274/qrheumatol.galenos.2023.68552.
• 11. Ekinci B, Mertoglu C, Coskun R, Arslan YK, Coban TA, Ozcicek F. The relationship between rheumatoid arthritis and epicardial fat thickness, and serum levels of chemerin, adropin, and betatrophin. Adv Clin Exp Med. 2025;34(5):709-715. doi: 10.17219/acem/190059.
• 12. Goh NS, Desai SR, Veeraraghavan S, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med. 2008;177(11):1248-1254. doi: 10.1164/rccm.200706-877OC.
• 13. Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108(20):2460-2466. doi: 10.1161/01.CIR.0000099542.57313.C5.
• 14. Packer M. Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium. J Am Coll Cardiol. 2018;71(20):2360-2372. doi: 10.1016/j.jacc.2018.03.509.
• 15. Temiz Karadag D, Sahin T, Tekeoglu S, Ozdemir Isik O, Yazici A, Cefle A. Epicardial adipose tissue thickness in systemic sclerosis patients without overt cardiac disease. Rheumatol Int. 2019;39(7):1191-1200. doi: 10.1007/s00296-019-04306-8.
• 16. Masson W, Lavalle-Cobo A, Barbagelata L, Lobo M, Nogueira JP. Relationship between epicardial adipose tissue, systemic inflammatory diseases, and subclinical atheromatosis: A systematic review. Reumatol Clin. 2023;19(7):363-373. doi: 10.1016/j.reumae.2022.10.003.
• 17. Uysal F, Akbal E, Akbal A, Cevizci S, Arık K, Gazi E. Epicardial Adipose Tissue Is Increased in Patients With Inflammatory Bowel Disease. J Ultrasound Med. 2016;35(9):1859-1864. doi: 10.7863/ultra.14.09040.
• 18. Iacobellis G. Epicardial adipose tissue in contemporary cardiology. Nat Rev Cardiol. 2022;19(9):593-606. doi: 10.1038/s41569-022-00679-9.
• 19. Shi H, Wu H, Winkler MA, et al. Perivascular adipose tissue in autoimmune rheumatic diseases. Pharmacol Res. 2022;182:106354. doi: 10.1016/j.phrs.2022.106354.
• 20. Lipson A, Alexopoulos N, Hartlage GR, et al. Epicardial adipose tissue is increased in patients with systemic lupus erythematosus. Atherosclerosis. 2012;223(2):389-393. doi: 10.1016/j.atherosclerosis.2012.06.006.
• 21. Karpouzas GA, Rezaeian P, Ormseth SR, Hollan I, Budoff MJ. Epicardial Adipose Tissue Volume As a Marker of Subclinical Coronary Atherosclerosis in Rheumatoid Arthritis. Arthritis Rheumatol. 2021;73(8):1412-1420. doi: 10.1002/art.41693.
• 22. Keleşoğlu Dinçer AB, Şahan HF. Increased epicardial adipose tissue thickness as a sign of subclinical atherosclerosis in patients with rheumatoid arthritis and ıts relationship with disease activity ındices. Intern Emerg Med. 2024;19(4):1015-1024. doi: 10.1007/s11739-024-03542-6.
• 23. Delkash P, Bayat B, Omidi F. Epicardial fat thickness in rheumatoid arthritis: Insights from echocardiographic analysis and autoimmune correlations. Int J Rheum Dis. 2024;27(8):e15272. doi: 10.1111/1756-185X.15272.
• 24. Alpaydın S, Buyukterzi Z, Akkurt HE, Yılmaz H. Impaired Left Ventricular Diastolic Functions and Thickened Epicardial Adipose Tissue in Rheumatoid Arthritis Patients is Correlated with DAS-28 Score. Acta Cardiol Sin. 2017;33(2):182-187. doi: 10.6515/acs20160608b.
• 25. Petra CV, Albu A, Pamfil C, Tamas MM, Vesa SC, Rednic S. The relationship between epicardial adipose tissue and arterial stiffness in patients with rheumatoid arthritis. Med Ultrason. 2019;21(4):427-434. doi: 10.11152/mu-2001.
• 26. Okçu M, Koçak FA, Şaş S, Güçlü K. Epicardial adipose tissue thickness and growth differentiation factor 15 in axial spondyloarthritis: A cross-sectional study. Saudi Med J. 2022;43(9):1020-1026. doi: 10.15537/smj.2022.43.9.20220304.
• 27. Resorlu H, Akbal A, Resorlu M, et al. Epicardial adipose tissue thickness in patients with ankylosing spondylitis. Clin Rheumatol. 2015;34(2):295-299. doi: 10.1007/s10067-014-2568-4.
• 28. Motawea KR, Kandil OA, Varney J, et al. Association of familial Mediterranean fever and epicardial adipose tissue: A systematic review and meta-analysis. Health Sci Rep. 2022;5(4):e693. doi: 10.1002/hsr2.693.
• 29. Chen X, Xiang H, Lu J, Yang M. Epicardial Adipose Tissue and Psoriasis: A Systematic Review and Meta-Analysis. J Clin Med. 2024;13(16):4761. doi: 10.3390/jcm13164761.
• 30. Wang X, Butcher SC, Myagmardorj R, et al. Epicardial adipose tissue in patients with systemic sclerosis. Eur Heart J Imaging Methods Pract. 2023;1(2):qyad037. doi: 10.1093/ehjimp/qyad037.
• 31. Mahabadi AA, Berg MH, Lehmann N, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol. 2013;61(13):1388-1395. doi: 10.1016/j.jacc.2012.11.062.
• 32. Ding Y, Lin F, Liu Z, Zhou X, Liang X. Targeting Epicardial/Pericardial Adipose Tissue in Cardiovascular Diseases: A Novel Therapeutic Strategy. Rev Cardiovasc Med. 2025;26(3):26128. doi: 10.31083/RCM26128.