Epicardial adipose tissue tied to mortality, HF hospitalization in patients with HFpEF
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Epicardial adipose tissue volume is associated with elevated risk for all-cause death and HF hospitalization in patients with HF with midrange and preserved ejection fraction, according to data published in Circulation: Heart Failure.
“A specific fat depot of interest in the pathophysiology of HF is epicardial adipose tissue (EAT). EAT is the regional fat depot surrounding the myocardium within the pericardial sac, and it was demonstrated that patients with HFmrEF/HFpEF have higher volumes of EAT compared with matched controls without HF, despite similar BMI,” Gijs van Woerden, MD, of the department of cardiology University Medical Center Groningen, the Netherlands, and colleagues wrote. “We, therefore, investigated the prognostic value of EAT volume measured with gold-standard cardiac magnetic resonance imaging in patients with HFmrEF and HFpEF.”
For the prospective multicenter study, researchers included 105 patients with HF and mean left ventricular ejection fraction of 53% (mean age, 72 years, 50% women). The primary outcome was a composite of all-cause death and first HF hospitalizations.
During a median follow-up of 24 months, a component of the primary composite outcome occurred in 30% of the cohort.
Using cardiac MRI, researchers reported that the presence of EAT was associated with elevated risk for all-cause death or HF hospitalization among patients with HFmrEF and HFpEF (HR = 1.76; 95% CI, 1.24-2.5; P = .001).
The association remained significant after adjustment for age, sex and BMI (adjusted HR = 1.61; 95% CI, 1.13-2.31; P = .009), and following adjustment for NYHA class and N-terminal pro-B-type natriuretic peptide level (aHR = 1.53; 95% CI, 1.04-2.24; P = .03).
Moreover, greater EAT volume was significantly associated with all-cause death (HR = 2.06; 95% CI, 1.26-3.37; P = .004) and HF hospitalization (HR = 1.54; 95% CI, 1.04-2.3; P = .03) compared with lower volume.
“Our data show that EAT accumulation is associated with worse outcome in patients with HFmrEF and HFpEF, and measurement of EAT may, therefore, be considered in the workup and clinical follow-up of these patients with HF. Future studies should focus on therapies specifically designed for reducing the amount of EAT,” the researchers wrote. “These potential therapies include intense lifestyle changes leading to significant weight reduction, specific drugs that reduce visceral adiposity such as GLP-1) receptor agonists, SGLT2 inhibitors, bariatric surgery or direct surgical resection specifically for patients without obesity with disproportionate high EAT.”
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