Predictive value of left atrial diameter and epicardial adipose tissue in sleep apnea and heart failure with preserved ejection fraction

Objective This study aims to investigate the association of left atrial diameter (LAD) and epicardial adipose tissue (EAT) with heart failure with preserved ejection fraction (HFpEF) in patients with sleep apnea (SA) and to evaluate their potential as markers for risk stratification. Methods A total of 170 hospitalized patients with SA, diagnosed by polysomnography and who underwent cardiac CT between July 2022 and June 2023, were enrolled. Participants were divided into an HFpEF group ( n = 96) and a non-HFpEF group ( n = 74). Clinical data, including EAT relative volume and echocardiographic parameters, were collected and compared. Logistic regression and ROC curve analyses were used to assess factors associated with HFpEF and their discriminatory ability, and Cox regression was performed for prognostic evaluation. Results Patients with HFpEF had significantly higher LAD, apnea–hypopnea index, EAT relative volume, and NT-proBNP levels than those without HFpEF (all P < 0.05). Multivariate logistic regression showed that female sex, NT-proBNP level, LAD, and EAT relative volume were independently associated with HFpEF in SA patients. A combined model incorporating these four factors yielded an area under the curve of 0.971 (95% CI: 0.942–1.000) for discriminating HFpEF. Cox regression analysis revealed that NT-proBNP was independently associated with poor prognosis among SA patients with HFpEF. Conclusion LAD was positively correlated with EAT relative volume, AHI, and NT-proBNP levels. Both LAD and EAT relative volume were significantly associated with HFpEF in SA patients and may serve as potential markers for identifying high-risk individuals.