Epicardial Adipose Tissue on Cardiac CT Across Heart Failure Subtypes

Purpose: This study evaluated epicardial adipose tissue (EAT) distribution in patients with different heart failure (HF) subtypes using contrast-enhanced cardiac computed tomography (CT), and explores its impact on clinical parameters and prognosis. Materials and Methods: We retrospectively analyzed 67 heart failure patients treated at our institution from January 2021 to December 2022. Patients were divided into: group A, heart failure with preserved ejection fraction (HFpEF, n=35); and group B, heart failure with mid-range and reduced ejection fraction (HFmrEF and HFrEF, n=32). In addition, 34 non-heart failure patients were included as controls (group C). Epicardial adipose tissue volume (EATV) and fat attenuation index (FAI) were measured using contrast-enhanced cardiac CT. Results: Group A showed the highest EATV, while group B had lower EATV than controls (65.37±19.51 vs. 48.88±15.38 vs. 60.10±10.19 cm 3 , P <0.001). EAT correlated negatively with NT-proBNP in HFrEF/HFmrEF patients, but positively in HFpEF patients. Both HF groups had significantly higher FAI than controls, and FAI correlated positively with C-reactive protein levels. Conclusion: EAT accumulation associates with elevated NT-proBNP in HFpEF, while lower EAT suggests higher NT-proBNP in HFmrEF/HFrEF. Increased FAI in heart failure patients correlates with higher C-reactive protein levels.