key: cord-0921252-f3d2o4zr
authors: Zhao, Yuhao; Chen, Mulei; Yang, Xinchun; Zhao, Lei
title: COVID-19 letter to the editor: Epicardial fat inflammation as possible enhancer in COVID-19?()
date: 2021-02-04
journal: Metabolism
DOI: 10.1016/j.metabol.2021.154722
sha: a59588f42bb66bf9dab99fd43e85b52307912a84
doc_id: 921252
cord_uid: f3d2o4zr

nan

To the editor:

We have read with interest the report by Kajetan Grodecki et al. in which epicardial adipose tissue (EAT) volume and radiological attenuation associated with the quantitative burden of coronavirus disease 2019 (COVID-19) and an increasing EAT volume or attenuation independently predict clinical deterioration or death [1] .

This article may provide a method for risk stratification of COVID-19 patients, which has great clinical significance.

We currently know that inflammation plays a major role in the development and progression of COVID-19. EAT, the metabolically active visceral fat, is considered as a novel marker of inflammation. The imbalance between anti-and pro-inflammatory adipokine secretion from EAT take part in the cytokine storm in critically ill COVID-19 patients [2] . However, caution is still needed in accepting the independent prognostic role of EAT volume or attenuation. C-reactive protein (CRP), serum Journal Pre-proof expressed at higher levels in EAT in heart explants removed from obese patients [5] .

In addition, Bois et al. reported lower ACE2 endothelial expression in COVID-19 cases versus influenza A/B or non-virally mediated deaths [6] . This reduction in ACE2 was associated with EAT inflammation, partly due to the virus taking advantage of more ACE2-binding sites for internalization of the virus into adipocytes and then triggering an augmented inflammatory signaling cascade. Bois et al. also showed that a high proportion of COVID-19 deaths were accompanied with cardiac amyloidosis [6] , which may be an additional risk factor for severe clinical condition.

It is of great significance to find out a specific biomarker to predict adverse outcomes in patients with COVID-19. EAT play a role in COVID-19 patients may probably become a clinically measurable and modifiable therapeutic target, but more studies are needed to explore this intriguing relationship.

Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19

Does epicardial fat contribute to COVID-19 myocardial inflammation?

Epicardial adipose tissue, inflammatory biomarkers and COVID-19: Is there a possible relationship?

Predictors of progression from moderate to severe coronavirus disease 2019: a retrospective cohort

Epicardial adipose tissue: fuel for COVID-19-induced cardiac injury?

COVID-19-Associated Nonocclusive Fibrin Microthrombi in the Heart