Cardiac Adipose Tissue, Imaging Segmentation, and Quantification for Cardiovascular Disease Assessment—A Survey

Adipose tissue plays a complex role in cardiovascular health. Cardiac adipose tissue (CAT) has been shown to correlate with coronary artery disease (CAD). The amount of fat surrounding the heart can affect major heart vessels by contributing to plaque development. In conditions like cardiac steatosis or fatty heart disease, the infiltration or accumulation of fat within the heart’s muscle impairs its function. Both CAT and cardiac steatosis may play a role in heart failure (HF). This review explores the different types of fat deposits surrounding the heart, focusing on the potential contribution of CAT to cardiovascular disease (CVD). Three main imaging modalities for assessing cardiac fat are discussed, including magnetic resonance imaging (MRI), computed tomography (CT), and echocardiography. The segmentation and quantification of the fat for each imaging modality is also presented, correlating these measurements with CVD risk. Each imaging modality offers distinct advantages and limitations in segmenting and quantifying fat. While advancements have been made, challenges persist in accurately measuring and interpreting the fat distribution around the heart. Future research should focus on refining segmentation techniques, establishing standardized protocols, and elucidating the specific mechanisms linking adipose tissue to CVD risk. By overcoming these limitations, cardiac fat imaging can be a valuable tool for improved risk stratification, personalized treatment strategies, and ultimately, better cardiovascular health outcomes.