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High pericardial and peri-aortic adipose tissue burden in pre-diabetic and diabetic subjects

Fei-Shih Yang1, Chun-Ho Yun12, Tung-Hsin Wu2, Ya-Ching Hsieh3, Hiram G Bezerra4, Chuan-Chuan Liu567, Yih-Jer Wu1089, Jen-Yuan Kuo89, Chung-Lieh Hung589*, Charles Jia-Yin Hou89, Hung-I Yeh89, Jason Jeun-Shenn Lee2, Bernard E Bulwer1112 and Ricardo C Cury13

Author Affiliations

1 Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan

2 Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan

3 Department of Anesthesia, Peking University First Hospital, Beijing, China

4 Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, USA

5 Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei, Taiwan

6 Health Evaluation Center, Mackay Memorial Hospital, Taipei, Taiwan

7 Department of Medical Technology, Yuanpei University of Science and Technology, Hsin-Chu, Taiwan

8 Department of Internal Medicine, Division of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan

9 Department of Medicine, Mackay Medical College, and Mackay Medicine Nursing and Management College, Taipei, Taiwan

10 Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan

11 Diagnostic Medical Sonography, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA

12 Noninvasive Cardiovascular Research, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA

13 Department of Radiology, Cardiovascular MRI and CT Program, Baptist Cardiac and Vascular Institute, Miami, FL, USA

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BMC Cardiovascular Disorders 2013, 13:98  doi:10.1186/1471-2261-13-98

Published: 11 November 2013



Central obesity in relation to insulin resistance is strongly linked to the development of type 2 diabetes. However, data regarding the association between pericardial and peri-aortic adiposity, a potential estimate of visceral adipose tissue burden, and pre-diabetes status remains unclear.

The aim of this study was to examine whether the degree of pericardial and thoracic peri-aortic adipose tissue, when quantified by multi-detector computed tomography (MDCT), differs significantly in a normal, pre-diabetic, and overtly diabetic population.


We studied 562 consecutive subjects including 357 healthy, 155 pre-diabetic, and 50 diabetic patients selected from participants who underwent annual health surveys in Taiwan. Pre-diabetes status was defined by impaired fasting glucose or impaired glucose intolerance according to American Diabetes Association guidelines. Pericardial (PCF) and thoracic peri-aortic (TAT) adipose tissue burden was assessed using a non-contrast 16-slice multi-detector computed tomography (MDCT) dataset with off-line measurement (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). Body fat composition, serum high-sensitivity C-reactive protein (hs-CRP) level and insulin resistance (HOMA-IR) were also assessed.


Patients with diabetes and pre-diabetes had greater volume of PCF (89 ± 24.6, 85.3 ± 28.7 & 67.6 ± 26.7 ml, p < 0.001) as well as larger TAT (9.6 ± 3.1 ml vs 8.8 ± 4.2 & 6.6 ± 3.5 ml, respectively, p < 0.001) when compared to the normal group, although there were no significant differences in adiposity between the diabetic and pre-diabetic groups. For those without established diabetes in our study, increasing TAT burden, but not PCF, appear to correlate with insulin resistance (HOMA-IR) and hs-CRP in the multivariable models.


Pre-diabetic and diabetic subjects, compared to normoglycemia, were associated with significantly higher pericardial and peri-aortic adipose tissue burden. In addition, visceral fat accumulation adjacent to the thoracic aorta seemed to exert a significant impact on insulin resistance and systemic inflammation.

Pre-diabetes; Diabetes mellitus; MDCT; Pericardial adipose tissue; Peri-aortic adipose tissue; Insulin resistance