Key result
Greater epicardial adipose tissue in HFrEF is linked to impaired microvascular function.
Why the study?
Epicardial adipose tissue (EAT) modulates multiple pathophysiological processes, but its association with endothelial function across the entire heart failure ejection fraction spectrum was unknown.
Observational (n=258)
No
Effect estimate: SRC -0.184
p-value: p=0.049
Epicardial adipose tissue thickness is independently associated with systemic vascular dysfunction in HFrEF but not HFpEF, suggesting a diverging pathophysiological role across the heart failure spectrum.
Supports divergent EAT effects on microvascular function across HF phenotypes; hypothesis-generating and should not yet change practice.
AIMS: Epicardial adipose tissue (EAT) is a metabolically highly active tissue modulating numerous pathophysiological processes. The aim of this study was to investigate the association between EAT thickness and endothelial function in patients with heart failure (HF) across the entire ejection fraction spectrum. METHODS AND RESULTS: A total of 258 patients with HF with an ejection fraction across the entire spectrum [HF with reduced ejection fraction (HFrEF), n = 168, age 60.6 ± 11.2 years; HF with preserved ejection fraction (HFpEF), n = 50, mean age 65.1 ± 11.9 years; HF with mildly reduced ejection fraction (HFmrEF), n = 32, mean age 65 ± 12] were included. EAT was measured with transthoracic echocardiography. Vascular function was assessed with flicker-light-induced vasodilation of retinal arterioles (FIDart%) and flow-mediated dilatation (FMD%) in conduit arteries. Patients with HFrEF have less EAT compared with patients with HFpEF (4.2 ± 2 vs. 5.3 ± 2 mm, respectively, P < 0.001). Interestingly, EAT was significantly associated with impaired microvascular function (FIDart%; r = -0.213, P = 0.012) and FMD% (r = -0.186, P = 0.022), even after multivariate correction for confounding factors (age, body mass index, hypertension, and diabetes; standardized regression coefficient (SRC) = -0.184, P = 0.049 for FIDart% and SRC = -0.178, P = 0.043 for FMD%) in HFrEF but not in HFpEF. CONCLUSIONS: Although less EAT is present in HFrEF than in HFpEF, only in HFrEF EAT is associated with vascular dysfunction. The diverging role of EAT in HF and its switch to a functionally deleterious tissue promoting HF progression provide the rationale to specifically target EAT, in particular in patients with reduced ejection fraction.
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Rossi et al. (2023) conducted an observational in Heart failure (n=258). Epicardial adipose tissue (EAT) thickness vs. Lower EAT thickness was evaluated on Association between EAT thickness and microvascular function (FIDart%) in HFrEF (SRC -0.184, p=0.049). Although patients with HFrEF had less epicardial adipose tissue than those with HFpEF, increased EAT thickness in HFrEF was independently associated with impaired microvascular function (SRC = -0.184, P = 0.049).
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