How to Measure Epicardial Adipose Tissue in Echocardiography, its Role in Cardiovascular Disease and the Results of the EPI-FAT Survey

Epicardial adipose tissue (EAT) is increasingly recognized as a marker of cardiometabolic risk and adverse cardiovascular outcomes. Although echocardiography represents the most accessible imaging modality for EAT assessment, standardized measurement and clinical implementation remain limited. After summarizing current evidence on echocardiographic EAT assessment, we report the results of the nationwide Epicardial-Fat (EPI-FAT) Survey promoted by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), aimed at evaluating current knowledge and clinical practice among Italian echocardiographers. A structured online questionnaire exploring demographic characteristics, clinical practice, technical knowledge, multimodality imaging, clinical awareness, and future perspectives regarding EAT assessment was distributed to SIECVI members between March and April 2026. A total of 342 cardiologists completed the survey. Routine EAT assessment was uncommon: only 5.1% of respondents always measured EAT during echocardiography and 7.1% routinely reported it in echocardiographic reports. Considerable variability was observed regarding imaging view, timing of measurement, and acquisition protocol. Conversely, awareness of the clinical significance of EAT was high, with more than 90% of respondents recognizing its association with major cardiovascular diseases. Although awareness of the clinical relevance of EAT is high among Italian echocardiographers, standardized assessment is still infrequently implemented in daily practice. Technical familiarity with recommended echocardiographic measurements appears to be one of the main determinants of its adoption, highlighting the need for dedicated educational initiatives and standardized imaging protocols.