Prognostic value of epicardial and pericardial adipose tissue in patients with chronic heart failure

Background Central obesity, rather than overall obesity, may influence heart failure (HF) outcomes. Alternative anthropometric measures remain limited in assessing the actual amount and distribution of visceral adiposity. We hypothesize that epicardial and pericardial adipose tissue (EAT and PAT) are easily obtainable on standard echocardiography and provide prognostic value in patients with HF. Methods In total, 572 patients with HF with reduced, mildly reduced and preserved ejection fraction (HFrEF, HFmrEF, and HFpEF, respectively) were included. EAT (the adipose tissue between the myocardium and the visceral layer of the pericardium) and PAT (the adipose tissue outside the parietal layer of the pericardium) thickness were measured on echocardiography and expressed in mm. Patients were followed for the combined outcome of all-cause mortality and HF hospitalization. Results Mean age was 67 ± 14 years, 38% were women, 346 had HFrEF, 100 had HFmrEF and 126 had HFpEF. Mean body mass index (BMI) was 27 ± 6 kg/m 2 , mean EAT thickness 4.8 ± 2.1 mm, and mean PAT thickness 5.7 ± 2.8 mm. During a median follow-up of 3.2 ± 1.9 years, both EAT and PAT thickness were associated with an increased risk for the combined outcome [HR 1.15 (95% CI 1.03–1.30), p = 0.006 and HR 1.25 (95% CI 1.10–1.41), p < 0.001, respectively], whereas BMI was not. In a multivariable model, only PAT thickness remained associated with poor outcome [HR 1.49 per SD (95% CI 1.10–2.03), p = 0.011]. Conclusion Increased PAT thickness, more than EAT, assessed on routine echocardiography, may serve as a valuable prognostic marker in chronic HF.