Clinical Significance of Cardiomegaly Caused by Cardiac Adiposity

Enlarged cardiac silhouette on chest x-ray (CXR) in the absence of cardiopulmonary disease is often dismissed as “pseudocardiomegaly.” We aimed to assess the impact of epicardial adipose tissue (EAT) on radiographic heart size and to determine the clinical significance of cardiomegaly caused by EAT. In total 112 patients (52 ± 13 years old, 53% women, body mass index 32 ± 8 kg/m2) with structurally normal hearts by transthoracic echocardiography underwent cardiac computed tomography (CCT). EAT volume was measured by CCT and cardiothoracic ratio (CTR) and cardiac transverse and lateral horizontal transverse diameters were measured on posteroanterior and lateral view CXR. EAT volume (mean 122 ± 49 ml) correlated directly with age, body mass index, hypertension, hyperlipidemia (p <0.05 for all comparisons), transverse diameter (r = 0.50, p <0.001), CTR (r = 0.45, p <0.001), and lateral horizontal transverse diameter (r = 0.38, p <0.001). EAT volume was larger in those with increased (n = 22) compared to those with normal (n = 90) CTR (154 ± 54 vs 115 ± 54 ml, p = 0.0005). Patients with cardiomegaly were also older (58 ± 13 vs 50 ± 12 years old, p = 0.009) and more often had diabetes (32% vs 9%, p = 0.03), hypertension (86% vs 46%, p = 0.001), hyperlipidemia (68% vs 44%, p = 0.04), or obstructive coronary artery disease by CCT (32% vs 11%, p = 0.04). Coronary artery calcium score was also higher in those with cardiomegaly (median 56 [first tertile 0, third tertile 298] vs 0 [0, 55], p = 0.006). In conclusion, cardiomegaly on CXR can be caused by excessive EAT. This is associated with several coronary risk factors and with coronary calcification and stenosis. Cardiomegaly in this setting may be regarded as another noninvasive marker of coronary atherosclerosis.