Đuzel Čokljat A, Grubić Rotkvić P, Čokljat D, Ferri Certić J, Babić Z. Epicardial adipose tissue in diabetic myocardial disorder: Role of echocardiography. World J Diabetes 2025; 16(10): 107640 [PMID: 41113497 DOI: 10.4239/wjd.v16.i10.107640]
Corresponding Author of This Article
Ana Đuzel Čokljat, MD, Department of Internal Medicine, General Hospital Dubrovnik, Ulica dr. Roka Mišetića 2, Dubrovnik 20000, Croatia. ana29.djuzel@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Oct 15, 2025; 16(10): 107640 Published online Oct 15, 2025. doi: 10.4239/wjd.v16.i10.107640
Epicardial adipose tissue in diabetic myocardial disorder: Role of echocardiography
Ana Đuzel Čokljat, Petra Grubić Rotkvić, Damir Čokljat, Jerko Ferri Certić, Zdravko Babić
Ana Đuzel Čokljat, Damir Čokljat, Jerko Ferri Certić, Department of Internal Medicine, General Hospital Dubrovnik, Dubrovnik 20000, Croatia
Petra Grubić Rotkvić, Department of Cardiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Zdravko Babić, Department of Cardiology, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
Co-corresponding authors: Ana Đuzel Čokljat and Petra Grubić Rotkvić.
Author contributions: Đuzel Čokljat A wrote the original draft, designed the study, and performed the literature search; Grubić Rotkvić P analyzed the data, and reviewed and edited the manuscript; Čokljat D and Ferri Certić J performed the literature search and reviewed the manuscript; Babić Z designed and supervised the study; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ana Đuzel Čokljat, MD, Department of Internal Medicine, General Hospital Dubrovnik, Ulica dr. Roka Mišetića 2, Dubrovnik 20000, Croatia. ana29.djuzel@gmail.com
Received: March 27, 2025 Revised: May 14, 2025 Accepted: August 4, 2025 Published online: October 15, 2025 Processing time: 202 Days and 15.3 Hours
Abstract
Epicardial adipose tissue (EAT) is an active form of visceral adipose tissue that can affect myocardial function due to shared circulation with the myocardium. Given its rapid metabolic activity, EAT is considered a potential therapeutic target for medications that modulate fat and is a potent marker of metabolic changes including those observed in diabetic cardiomyopathy. Recent investigations propose an association between EAT accumulation and chronic diseases such as type 2 diabetes mellitus (T2DM), atrial fibrillation, and heart failure with preserved ejection fraction. According to the method first described by Iacobellis et al, EAT thickness is identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium, measured in the parasternal short- and long-axis views at end-systole using ultrasound. Ultrasound of EAT is a safe, cost-effective, and readily available tool for cardiometabolic risk assessment. This minireview investigates the current role of echocardiography in the assessment of EAT thickness in patients with T2DM, regardless of the presence of overt heart failure. We also discuss whether changes in EAT thickness may be used as a significant marker of disease progression and if delta EAT thickness could serve as a surrogate of effective therapy.
Core Tip: Epicardial adipose tissue (EAT), as measured by two-dimensional echo, provides additional information for the assessment of diabetic myocardial disorder. It may serve as a novel tool for risk estimation of the progression from asymptomatic to symptomatic heart failure. Given its rapid metabolic activity, EAT may serve as a target for existing and emerging therapies. The proposed cardiovascular benefits of EAT lipolysis in the context of diabetes mellitus type 2 could help clarify the mechanisms underlying its therapeutic modulation. Excessive EAT can be regarded, de facto, as an indicator of diabetic pericardial disorder.
