Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19

Abstract

We sought to examine the association of epicardial adipose tissue (EAT) quantified on chest computed tomography (CT) with the extent of pneumonia and adverse outcomes in patients with coronavirus disease 2019 (COVID-19). Methods: We performed a post-hoc analysis of a prospective international registry comprising 109 consecutive patients (age 64 ± 16 years; 62% male) with laboratory-confirmed COVID-19 and noncontrast chest CT imaging. Using semi-automated software, we quantified the burden (%) of lung abnormalities associated with COVID-19 pneumonia. EAT volume (mL) and attenuation (Hounsfield units) were measured using deep learning software. The primary outcome was clinical deterioration (intensive care unit admission, invasive mechanical ventilation, or vasopressor therapy) or in-hospital death. Results: In multivariable linear regression analysis adjusted for patient comorbidities, the total burden of COVID-19 pneumonia was associated with EAT volume (β = 10.6, p = 0.005) and EAT attenuation (β = 5.2, p = 0.004). EAT volume correlated with serum levels of lactate dehydrogenase (r = 0.361, p = 0.001) and C-reactive protein (r = 0.450, p < 0.001). Clinical deterioration or death occurred in 23 (21.1%) patients at a median of 3 days (IQR 1-13 days) following the chest CT. In multivariable logistic regression analysis, EAT volume (OR 5.1 [95% CI 1.8-14.1] per doubling p = 0.011) and EAT attenuation (OR 3.4 [95% CI 1.5-7.5] per 5 Hounsfield unit increase, p = 0.003) were independent predictors of clinical deterioration or death, as was total pneumonia burden (OR 2.5, 95% CI 1.4-4.6, p = 0.002), chronic lung disease (OR 1.3 [95% CI 1.1-1.7], p = 0.011), and history of heart failure (OR 3.5 [95% 1.1-8.2], p = 0.037). Conclusions: EAT measures quantified from chest CT are independently associated with extent of pneumonia and adverse outcomes in patients with COVID-19, lending support to their use in clinical risk stratification.

Epicardial adipose tissue characteristics, obesity and clinical outcomes in COVID-19: A post-hoc analysis of a prospective cohort study

“…Similar to BMI, EAT volume -which moderately correlated with BMI -neither predicted critical illness nor differed among groups. This finding is in contrast with those from a smaller study by Grodecki and colleagues in which EAT volume was independently associated with adverse outcomes in patients with COVID-19 in logistic regression models, despite a moderate correlation of BMI, which did not differ between patients with or without clinical deterioration [14]. Consistent with that study, we found that EAT-At was a significant predictor of worse outcomes.…”

“…Few data are available on the relationship between EAT inflammation and troponin T levels, a marker of myocardial injury. Iacobellis and colleagues found an inverse relationship (r Z À0.45; P < 0.05) between EAT-At and troponin T levels in 41 COVID-19 patients, while Grodecki and colleagues found no correlation between EAT-At and troponin T in a cohort of 109 COVID-19 patients [14]. It is possible that these discrepancies are due to the smaller sample size of previous studies and, as already mentioned, to systemic factors involved in the pathophysiology of myocardial injury.…”

“…The role of EAT as an independent cardiovascular risk factor that associates with fatal and non-fatal cardiovascular events in the general population is well-established [12]. Recently, EAT has also been proposed as a pathophysiological driver of myocardial inflammation in COVID-19 [13], and preliminary data seem to confirm this hypothesis [14]. We aimed to investigate the relationship between EAT volume and attenuation (EAT-At), which reflects overall EAT inflammation and predicts all-cause and cardiac mortality [15], with disease severity in patients hospitalised for COVID-19.…”

Abdominal obesity phenotype is associated with COVID-19 chest X-ray severity score better than BMI-based obesity

“…The role of EAT in causing and worsening COVID‐19 cardiac complications has recently emerged [ 51 ]. It has been recently reported that EAT inflammation was linked to more severe COVID-19 in hospitalized patients with abdominal obesity phenotype [ 46 ] and it is associated with the quantitative burden of COVID-19 pneumonia [ 52 ].…”

COVID-19 letter to the editor: Epicardial fat inflammation as possible enhancer in COVID-19?

“…We have read with interest the report by Kajetan Grodecki et al in which epicardial adipose tissue (EAT) volume and radiological attenuation associated with the quantitative burden of coronavirus disease 2019 (COVID-19) and an increasing EAT volume or attenuation independently predict clinical deterioration or death [ 1 ]. This article may provide a method for risk stratification of COVID-19 patients, which has great clinical significance.…”