Epicardial adipose tissue as a determinant of heart failure prognosis: insights across ejection fraction phenotypes

Fig. 1. Heart failure phenotypes Heart failure is commonly categorized based on LVEF, into heart failure with preserved ejection fraction (HFpEF), LVEF > 50%), heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 40–49) and heart failure with reduced ejection fraction (HFrEF, LVEF < 40%). HFpEF is characterized by preserved EF, LV hypertrophy, diastolic dysfunction, while HFrEF by impaired EF, LV dilation, often LV wall thinning. Epicardial adipose tissue (a yellow layer covering the red LV myocardium) is increased in HFpEF and often reduced in HFrEF. HFmrEF is a transitional phenotype that shares features of both HFrEF and HFpEF, representing worsening HFpEF or improving HFrEF. IHD, ischemic heart disease; LVEDV, left ventricular end-diastolic volume; LVEF, left ventricular ejection fraction. The left ventricular wall is shown as a red circle, enclosing the lumen, with a surrounding yellow layer of epicardial adipose tissue

Fig. 2. Mode of death in heart failure depending on specific ejection fraction range pump failure deaths dominate at low left ventricular ejection fraction (LVEF) and decrease progressively as LVEF increases. Sudden death shows a U-shaped / rising pattern toward higher LVEF ranges, consistent with heart failure with preserved ejection fraction (HFpEF) trial observations. Non-cardiac death steadily increases with higher LVEF and dominates at EF ≥ 50–60%. Other cardiovascular (CV) deaths remain relatively stable across LVEF strata. A schematic overview based on findings from multiple clinical trials and registry data [6–9]

Fig. 3. Relative risk of heart failure outcomes according to epicardial adipose tissue (EAT) amount, stratified by A left ventricular ejection fraction and B body mass index Each outcome is represented by a colored circle (see legend for color coding), with circle size proportional to the number of participants in the corresponding study (numbered references). A relative risk of − 1 indicates that the outcome occurred twice as frequently in participants with higher versus lower EAT volume or thickness. Abbreviations: CV, cardiovascular; HFH, heart failure hospitalizations; LV, left ventricle; LVEF, left ventricular ejection fraction (indicates average LVEF in a specific study); MACE, major adverse cardiovascular events; VA, ventricular arrhythmias