Epicardial fat enhances prediction of exercise-induced hypertension and ventricular arrhythmias in asymptomatic normotensive individuals

BACKGROUND: Exercise-induced hypertension (EIH) is recognized as an independent cardiovascular risk factor. Epicardial fat thickness (EFT) has been implicated in various cardiovascular pathologies. However, the relationship between EFT, EIH, and ventricular arrhythmias remains poorly characterized. This study aimed to investigate the predictive value of EFT for both EIH and premature ventricular beats (PVB). METHODS: A total of 2658 participants were initially screened for eligibility, and normotensive participants of age > 18 were considered for enrollment. All participants underwent a comprehensive clinical evaluation. Data were analyzed considering EIH and PVB. Multivariable logistic regression, ROC and decision curve analysis (DCA) were performed to evaluate the clinical utility of predictive models with and without EFT parameters. RESULTS: ROC curve analysis demonstrated that EFT had moderate ability for predicting EIH (AUC 0.73, 95% CI 0.69-0.78). Multivariable logistic regression revealed that EFT was independently associated with EIH (OR 2.27, 95% CI 1.72-2.98). For the prediction of PVB among individuals with EIH, EFT demonstrated good accuracy (AUC 0.78, 95% CI 0.69-0.86). Among patients with EIH, epicardial fat was strongly associated with increased odds of arrhythmias (OR 3.58, 95% CI 2.35-5.46, p < 0.001). DCA revealed that incorporating EFT scores into predictive models provided superior net benefit improving the clinical utility of the predictive model. CONCLUSIONS: EFT is an independent predictor of both exercise-induced hypertension and ventricular arrhythmias, with strong predictive value for premature ventricular beats in patients with EIH. The incorporation of EFT into risk prediction models provides superior clinical net benefit compared to traditional risk factors alone.