Why the study?
Myocardial steatosis and fibrosis may play a role in the pathophysiology of HFpEF, prompting investigation into the prognostic significance of epicardial fat and diffuse fibrosis.
Do high epicardial adipose tissue and extracellular volume measured by cardiac magnetic resonance imaging predict cardiovascular events in patients with heart failure with preserved ejection fraction?
Cohort (n=163)
Do high epicardial adipose tissue and extracellular volume measured by cardiac magnetic resonance imaging predict cardiovascular events in patients with heart failure with preserved ejection fraction?
Increased epicardial adipose tissue and extracellular volume detected by cardiac magnetic resonance imaging are significant prognostic markers for cardiovascular events in patients with HFpEF.
Background Myocardial steatosis and fibrosis may play a role in the pathophysiology of heart failure with preserved ejection fraction. We therefore investigated the prognostic significance of epicardial fat (epicardial adipose tissue [EAT]) and myocardial diffuse fibrosis. Methods and Results Myocardial fibrosis, estimated as extracellular volume (ECV), and EAT were measured using cardiac magnetic resonance imaging in 163 subjects with heart failure with preserved ejection fraction. We also evaluated cardiac structure and diastolic and systolic function by echocardiography and cardiac magnetic resonance imaging. After 24 months' follow‐up, 39 (24%) subjects had experienced cardiovascular events, including hospitalization for heart failure, acute coronary syndrome, and cardiovascular death. Median EAT and mean ECV were significantly higher in subjects with cardiovascular events than survivors (EAT, 35 [25–45] versus 31 [21–38], P =0.006 and ECV, 28.9±3.16% versus 27.2±3.56%, P =0.04). Subjects with high EAT (≥42 g) had increased risk of cardiovascular events (hazard ratio [HR], 2.528 [95% CI, 1.704–4.981]; P =0.032). High ECV (>29%) was also significantly associated with poorer outcomes (HR, 1.647 [95% CI, 1.263–2.548]; P =0.013). With respect to secondary end points, high EAT and high ECV were associated with increased risk of the incident acute coronary syndrome (HR, 1.982 [95% CI, 1.008–4.123]; P =0.049) and hospitalization for heart failure (HR, 1.789 [95% CI, 1.102–6.987]; P =0.033), respectively. Conclusions Our study suggested that increased epicardial fat and ECV detected by cardiac magnetic resonance imaging have an impact on cardiovascular prognosis, in particular acute coronary syndrome and hospitalization for heart failure, respectively.
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Lin et al. (2023) conducted a cohort in Heart failure with preserved ejection fraction (n=163). High epicardial adipose tissue (EAT) and high extracellular volume (ECV) vs. Lower EAT and ECV was evaluated on Cardiovascular events (hospitalization for heart failure, acute coronary syndrome, and cardiovascular death) (HR 2.528 (high EAT); HR 1.647 (high ECV), 95% CI 1.704-4.981 (high EAT); 1.263-2.548 (high ECV), p=0.032 (high EAT); 0.013 (high ECV)).
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