Risk Stratification in Heart Failure with Mildly Reduced or Preserved Ejection Fraction Using Epicardial Adipose Tissue Volume and Triglyceride-Glucose Index

Background and Aims Patients with heart failure with mildly reduced or preserved ejection fraction remain at substantial risk of adverse clinical outcomes. This study aimed to evaluate the prognostic value of the triglyceride-glucose index, body mass index, and epicardial adipose tissue index and to determine whether their combination improves risk stratification. Methods and Results This multicenter retrospective study included 712 patients (316 with mildly reduced and 396 with preserved ejection fraction). Epicardial adipose tissue was quantified by cardiac magnetic resonance and indexed to body surface area. Cox regression and Kaplan–Meier analyses were performed for the composite endpoint of all-cause mortality or heart failure hospitalization. During a median follow-up of 25 months, 184 patients (25.8%) experienced the primary endpoint. Higher triglyceride-glucose index and epicardial adipose tissue index were independently associated with increased risk of adverse outcomes, whereas body mass index was not. Patients with concomitantly elevated triglyceride-glucose index and epicardial adipose tissue index had the highest risk. Adding these two indices to the clinical model improved discrimination and risk reclassification. Conclusion The triglyceride-glucose index and epicardial adipose tissue index were independently associated with adverse outcomes in patients with heart failure with mildly reduced or preserved ejection fraction. Their combination provided incremental prognostic information beyond traditional clinical factors, supporting their potential utility for improved risk stratification.