Association of Cardiac MRI ‐Derived Epicardial Adipose Tissue Index With Adverse Clinical Outcomes in Heart Failure With Preserved Ejection Fraction

BACKGROUND: The clinical relevance of the epicardial adipose tissue index (EATI) is increasingly recognized, but its association with clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF) remains inadequately investigated. PURPOSE: To evaluate the association between cardiac MRI-derived EATI and major adverse cardiovascular events (MACE) in patients with HFpEF. STUDY TYPE: Retrospective. POPULATION: Two hundred sixty-five patients with HFpEF (135 male; mean age 55 years). FIELD STRENGTH/SEQUENCE: 1.5 T/balanced steady-state free precession. ASSESSMENT: EATI was quantified on cardiac MRI cine images. MACE was defined as cardiac death or readmission for heart failure. STATISTICAL TESTS: Welch t-test or Mann-Whitney U test, Cox proportional hazards regression, Kaplan-Meier analysis with log-rank test, and global χ2 model comparison. A p value < 0.05 was considered significant. RESULTS: During a median follow-up of 33 months (22-65), 42 patients experienced MACE. EATI was significantly higher in the MACE group than in the no-MACE group (33.65 ± 13.91 vs. 26.13 ± 11.28 mL/m2, Z = -3.52, effect size r = -0.22). EATI was independently associated with MACE (multivariable HR = 1.04 [95% CI: 1.01-1.06]). Kaplan-Meier survival analysis confirmed that patients with low EATI had significantly higher event-free survival rate. A model combining EATI with other clinical and conventional imaging risk factors (χ2 = 42.3) showed significantly improved model discrimination for identifying patients at risk of MACE compared with models with clinical variables (χ2 = 26.0) or clinical and conventional imaging variables (χ2 = 34.3). DATA CONCLUSION: Cardiac MRI-derived EATI was independently associated with MACE in patients with HFpEF and showed favorable discriminatory performance compared with clinical and conventional imaging risk factors. EVIDENCE LEVEL: 3. TECHNICAL EFFICACY: Stage 5. HFpEF is a prevalent heart failure phenotype associated with recurrent hospitalizations and mortality. Epicardial fat may drive adverse cardiac structural and functional remodeling, but its relationship with clinical outcomes in this condition remains unclear. This study used cardiac MRI to measure epicardial fat in 265 patients with HFpEF. Over a median follow‐up of 33 months, MACE occurred in 42 patients. After adjustment for clinical and imaging covariates, greater EAT burden was independently associated with these endpoints. These findings highlight the clinical relevance of MRI‐derived EAT measurement.