Epicardial adipose tissue associated with adverse outcomes in HFmrEF and HFpEF
Epicardial Adipose Tissue and Outcome in Heart Failure With Mid-Range and Preserved Ejection FractionLiterature - Van Woerden G, Van Veldhuisen DJ, Manintveld OC et al. - Circ Heart Fail. 2021 Dec 22;CIRCHEARTFAILURE121009238. doi: 10.1161/CIRCHEARTFAILURE.121.009238.
Introduction and methods
Epicardial adipose tissue (EAT) is defined as the adipose tissue between the outer wall of the myocardium and the visceral layer of the pericardium. A previous study showed that patients with HFmrEF or HFpEF have higher EAT volumes than matched individuals with similar BMI but without HF . A recent study demonstrated that EAT is predictive of new-onset HFmrEF and HFpEF [2,3]. However, it remains unknown whether EAT is associated with adverse outcomes in HFmrEF and HFpEF.
Aim of the study
This study investigated the association between EAT volume and adverse prognosis in patients with HFmrEF and HFpEF.
105 patients who were enrolled in a prospective study  which evaluated the diagnostic value of an implantable loop recorder in patients with HFmrEF and HFpEF were part of the present analysis. Mean age was 72±8 years, 50% were women, mean LVEF was 53±8%. EAT was measured using cardiac magnetic resonance imaging. On each end-diastolic short-axis slide, EAT was manually delineated. EAT volumes were subsequently determined by summation of EAT volume of each slide using the modified Simpson rule . HR and 95% CI were described per SD increase in EAT.
The main composite outcome was all-cause mortality and first HF hospitalizations. Secondary outcomes were all-cause mortality and HF hospitalizations separately.
Main composite outcome
- During follow-up, 23% of patients (n=24) were hospitalized for HF and 15% of patients (n=16) died.
- EAT volume was significantly associated with higher risk of the composite outcome of all-cause mortality and HF hospitalization (HR 1.76, 95% CI 1.24-2.50, P=0.001).
- The association between EAT volume and all-cause mortality and HF hospitalizations remained significant after adjustment for age, sex, and BMI (P=0.009); after adjustment for NYHA functional class and NT-proBNP (P=0.030); after adjustment for previous MI, AF and renal dysfunction (0.003); and after adjustment for baseline HF medications (P=0.001).
- EAT volume was significantly associated with all-cause mortality (HR 2.06, 95% CI 1.26-3.37, P=0.004) and HF hospitalizations (HR 1.54, 95% CI 1.04-2.30, P=0.03), separately.
Obesity and EAT
- Patients with obesity (BMI ≥30 kg/m²) and high EAT (>100 mL/m²) had a significantly higher relative event rate compared to patients with obesity and low EAT (<100 mL/m²) (52% vs. 16%, respectively, Log Rank, P=0.02).
In this study, EAT volume was significantly associated with all-cause mortality and HF hospitalization in patients with HFmrEF and HFpEF.
The authors wrote: ‘EAT may be considered in the work-up and clinical follow-up of these patients with HF. Future studies should focus on therapies specifically designed for reducing the amount of EAT.’