Key result
Epicardial adipose tissue >90 mm3 is linked to ~274% higher mortality in asymptomatic aortic stenosis.
Why the study?
The role of epicardial adipose tissue in aortic stenosis severity, progression, myocardial remodelling, and mortality in asymptomatic patients was not well understood.
Is epicardial adipose tissue volume associated with mortality and myocardial remodeling in patients with asymptomatic aortic stenosis?
RCT (n=124)
Is epicardial adipose tissue volume associated with mortality and myocardial remodeling in patients with asymptomatic aortic stenosis?
Hazard Ratio: 3.74 (95% CI 1.08–12.96)
p-value: p=0.037
Epicardial adipose tissue volume correlates with biomarkers of impaired myocardial health and is associated with an increased risk of all-cause mortality in asymptomatic aortic stenosis, though it does not correlate with disease severity or progression.
EAT volume signals higher mortality risk via myocardial impairment in asymptomatic AS without linking to valve progression; leaves open its value for risk stratification.
Background Epicardial adipose tissue represents a metabolically active visceral fat depot that is in direct contact with the left ventricular myocardium. While it is associated with coronary artery disease, little is known regarding its role in aortic stenosis. We sought to investigate the association of epicardial adipose tissue with aortic stenosis severity and progression, myocardial remodelling and function, and mortality in asymptomatic patients with aortic stenosis. Methods In a post hoc analysis of 124 patients with asymptomatic mild-to-severe aortic stenosis participating in a prospective clinical trial, baseline epicardial adipose tissue was quantified on CT angiography using fully automated deep learning-enabled software. Aortic stenosis disease severity was assessed at baseline and 1 year. The primary endpoint was all-cause mortality. Results Neither epicardial adipose tissue volume nor attenuation correlated with aortic stenosis severity or subsequent disease progression as assessed by echocardiography or CT (p>0.05 for all). Epicardial adipose tissue volume correlated with plasma cardiac troponin concentration (r=0.23, p=0.009), left ventricular mass (r=0.46, p<0.001), ejection fraction (r=−0.28, p=0.002), global longitudinal strain (r=0.28, p=0.017), and left atrial volume (r=0.39, p<0.001). During the median follow-up of 48 (IQR 26–73) months, a total of 23 (18%) patients died. In multivariable analysis, both epicardial adipose tissue volume (HR 1.82, 95% CI 1.10 to 3.03; p=0.021) and plasma cardiac troponin concentration (HR 1.47, 95% CI 1.13 to 1.90; p=0.004) were associated with all-cause mortality, after adjustment for age, body mass index and left ventricular ejection fraction. Patients with epicardial adipose tissue volume >90 mm3 had 3–4 times higher risk of death (adjusted HR 3.74, 95% CI 1.08 to 12.96; p=0.037). Conclusions Epicardial adipose tissue volume does not associate with aortic stenosis severity or its progression but does correlate with blood and imaging biomarkers of impaired myocardial health. The latter may explain the association of epicardial adipose tissue volume with an increased risk of all-cause mortality in patients with asymptomatic aortic stenosis. Clinicaltrials.gov ( NCT02132026 ).
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Geers et al. (2025) conducted an RCT in asymptomatic mild-to-severe aortic stenosis (n=124). Epicardial adipose tissue volume >90 mm3 vs. Epicardial adipose tissue volume ≤90 mm3 was evaluated on all-cause mortality (HR 3.74, 95% CI 1.08-12.96, p=0.037). Epicardial adipose tissue volume >90 mm3 was associated with a higher risk of all-cause mortality in patients with asymptomatic aortic stenosis (adjusted HR 3.74; 95% CI 1.08-12.96; p=0.037).
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