Epicardial Adipose Tissue Volume Predicts Outcomes in Elderly Patients with Type 2 Myocardial Infarction

Q: What are the key findings of this study?

High epicardial adipose tissue volume (>130 cm³) independently predicted increased 30-day all-cause mortality in elderly patients with type 2 MI.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 myocardial infarction (MI) (n=3359). Intervention: High epicardial adipose tissue (EAT) volume (>130 cm³) vs. Low epicardial adipose tissue (EAT) volume (≤130 cm³). Primary outcome: 30-day all-cause mortality (HR 1.59, 95% CI 1.451–1.752, p=<0.001).

Q: What does this research mean for the field?

High epicardial adipose tissue volume independently predicts increased 30-day all-cause and cardiovascular mortality in elderly patients with type 2 myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jinling Ma; Xuan Zhou; Xian Li; Jinxin Wang

doi:10.2147/cia.s648845

November 1, 2026Clinical Interventions in AgingOpen Access

Epicardial Adipose Tissue Volume Predicts Outcomes in Elderly Patients with Type 2 Myocardial Infarction

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Key result

High epicardial adipose tissue volume linked to ~59% higher 30-day mortality in type 2 MI.

HR 1.59
95% CI 1.451–1.752
P<0.001
n=3,359

Why the study?

The risk stratification value of epicardial adipose tissue (EAT) volume measured by non-contrast chest CT and its correlation with NT-proBNP in elderly patients with type 2 MI required investigation.

Does high epicardial adipose tissue volume (>130 cm3) measured on non-contrast chest CT predict 30-day all-cause and cardiovascular mortality in elderly patients (≥80 years) with type 2 myocardial infarction and LVEF ≥50%?

Key Points

To evaluate the risk stratification utility of epicardial adipose tissue (EAT) volume measured via non-contrast chest CT and examine its relationship with NT-proBNP in elderly patients with type 2 myocardial infarction.
Retrospective cohort study of consecutive patients aged 80 years or older diagnosed with type 2 MI, LVEF >=50%, and available NT-proBNP within 24 hours of admission who underwent non-contrast chest CT (N=3359).
EAT volume was measured semi-automatically between the pulmonary artery bifurcation and left ventricular apex using attenuation thresholds from -190 to -30 Hounsfield units, categorized as low (<=130 cm3) or high (>130 cm3).
Multivariable Cox regression models evaluated associations between high EAT volume and 30-day all-cause (primary) and cardiovascular (secondary) mortality, adjusting for comorbidities, Charlson Comorbidity Index, polypharmacy, and NT-proBNP > 8330 pg/mL.
During the 30-day follow-up, 506 patients (15.1%) died from all causes and 374 (11.1%) experienced cardiovascular death; non-survivors had a higher prevalence of EAT >130 cm3 (57.7% vs 24.6%, P < 0.001).
In fully adjusted multivariable Cox regression (Model 3), high EAT volume independently predicted 30-day all-cause mortality (HR 1.59, 95% CI 1.451-1.752, P < 0.001) and cardiovascular mortality (HR 1.57, 95% CI 1.436-1.727, P < 0.001).
EAT volume was negatively correlated with NT-proBNP, and patients with both high EAT volume and NT-proBNP > 8330 pg/mL experienced higher all-cause and cardiovascular mortality than those with either high marker alone (P < 0.001).

Study Design

Type

Cohort (n=3,359)

Blinding

Blinded outcome assessment (researchers measuring EAT were blinded to clinical data)

Multicenter

No

Structured PICO

Does high epicardial adipose tissue volume (>130 cm3) measured on non-contrast chest CT predict 30-day all-cause and cardiovascular mortality in elderly patients (≥80 years) with type 2 myocardial infarction and LVEF ≥50%?

P

Population

3,359 elderly Chinese patients (mean age 87.2 years, 27.1% female) hospitalized with type 2 myocardial infarction and preserved ejection fraction (LVEF ≥50%), followed retrospectively for 30 days.

E

Exposure

High epicardial adipose tissue (EAT) volume (>130 cm3) measured semi-automatically by non-contrast chest CT scan (attenuation threshold -190 to -30 HU from pulmonary artery bifurcation to left ventricular apex), evaluated alone and in combination with elevated NT-proBNP (>8330 pg/mL).

C

Comparator

Low epicardial adipose tissue (EAT) volume (≤130 cm3) measured by non-contrast chest CT scan.

O

Outcome

All-cause mortality at 30 days follow-up, obtained from medical records or telephone consultations.hard clinical

Main Result

Hazard Ratio: 1.59 (95% CI 1.451–1.752)

Absolute Event Rate: 29.4% vs 9%

p-value: p=<0.001

In elderly patients aged ≥80 years with type 2 MI and preserved ejection fraction, elevated epicardial adipose tissue volume (>130 cm3) on non-contrast chest CT independently predicts 30-day all-cause and cardiovascular mortality, offering incremental prognostic value when combined with high NT-proBNP levels.

Limitations

Retrospective, observational design susceptible to selection bias, unmeasured comorbidities, and residual misclassification between type 2 MI and acute myocardial injury.
Indications for chest CT were not standardized, and CT attenuation measurements could be affected by scanner variability and reconstruction parameters.
Restricted to patients with preserved ejection fraction (LVEF ≥50%), limiting applicability to patients with reduced ejection fraction.
Lack of adjustment for serum biomarkers (e.g., troponin, C-reactive protein), medications, lifestyle factors, body mass index, and frailty.
Cut-off values for high EAT volume (>130 cm³) and elevated NT-proBNP (>8330 pg/mL) were determined based on local experience and lack external validation.
Single-center Chinese cohort, which may limit generalizability to other ethnic populations with different visceral adiposity distributions.
Retrospective, observational study design with potential selection bias, unmeasured confounding, and possible residual misclassification between type 2 MI and acute myocardial injury.
Non-standardized indications for chest CT and potential variability in CT attenuation measurements across different scan parameters and manufacturers.
Study restricted to selected patients with LVEF ≥50% from a Chinese population, limiting generalizability to other LVEF groups and non-Chinese ethnicities.
Lack of adjustment for serum biomarkers (troponin, C-reactive protein), medications, lifestyle factors, body mass index, or frailty scale.
Lack of established, standardized cut-off values for high EAT volume (>130 cm3) and NT-proBNP (>8330 pg/mL), requiring external prospective validation.

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Implication

May inform short-term prognosis in elderly type 2 MI but should not change practice; hypothesis-generating and requires prospective validation.

Abstract

Background: Epicardial adipose tissue (EAT) volume measured by non-contrast chest CT scan has shown significant potential for predicting risk. This study aimed to identify the risk stratification value of EAT volume in elderly patients with type 2 myocardial infarction (MI) and to investigate the correlation between EAT volume and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods: A cohort of consecutive patients aged 80 years or older who were diagnosed with type 2 MI, had available NT-proBNP measurements within 24 hours of admission, and underwent non-contrast chest CT were retrospectively enrolled. The clinical outcomes were 30-day all-cause and cardiovascular mortality. Results: A total of 3359 patients were included. During 30-day follow-up, subjects who experienced all-cause and cardiovascular death had a higher prevalence of high EAT volume and elevated NT-proBNP levels. After multivariable Cox regression analysis, high EAT volume was significantly independently associated with all-cause and cardiovascular mortality. EAT volume was negatively correlated with NT-proBNP levels. Moreover, The Kaplan–Meier survival curves confirmed that patients with both high EAT volume and NT-proBNP > 8330pg/mL had higher all-cause and cardiovascular mortality than those with NT-proBNP > 8330 pg/mL or high EAT volume alone. Conclusion: Measurement of EAT volume by chest CT scan could serve as a potential risk stratification tool for elderly individuals with type 2 MI. Moreover, the combination of high EAT volume and elevated NT-proBNP levels may provide incremental predictive value for adverse outcomes beyond either marker alone.

Discussion

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Cite This Study

Ma et al. (2026) conducted a cohort in Type 2 myocardial infarction (MI) (n=3,359). High epicardial adipose tissue (EAT) volume (>130 cm³) vs. Low epicardial adipose tissue (EAT) volume (≤130 cm³) was evaluated on 30-day all-cause mortality (HR 1.59, 95% CI 1.451–1.752, p=<0.001). High epicardial adipose tissue volume (>130 cm³) independently predicted increased 30-day all-cause mortality in elderly patients with type 2 MI.

synapsesocial.com/papers/6af5bf07e94012e8747ad9c9 https://doi.org/10.2147/cia.s648845

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Epicardial Adipose Tissue Volume Predicts Outcomes in Elderly Patients with Type 2 Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Epicardial Adipose Tissue Volume Predicts Outcomes in Elderly Patients with Type 2 Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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