Epicardial adipose tissue thickness is associated with increased COVID-19 severity and mortality

Abstract

Background Increased adiposity and visceral obesity have been linked to adverse COVID-19 outcomes. The amount of epicardial adipose tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 adverse outcomes. Methods We included 748 patients with COVID-19 attending a reference center in Mexico City. EAT thickness, sub-thoracic and extra-pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with COVID-19 mortality and severe COVID-19 (defined as mortality and need for invasive mechanical ventilation), according to the presence or absence of obesity. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with COVID-19 outcomes. Results EAT thickness was associated with increased risk of COVID-19 mortality (HR 1.18, 95% CI 1.01–1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, fibrinogen, C-reactive protein, and 4 C severity score, independent of obesity. EAT mediated 13.1% (95% CI 3.67–28.0%) and 5.1% (95% CI 0.19–14.0%) of the effect of age and 19.4% (95% CI 4.67–63.0%) and 12.8% (95% CI 0.03–46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction during COVID-19. Conclusion EAT is an independent risk factor for severe COVID-19 and mortality independent of obesity. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 outcomes.

Epicardial adipose tissue volume and CT-attenuation as prognostic factors for pulmonary embolism and mortality in critically ill patients affected by COVID-19

“…Our finding is partially in line with the previous reports from Mehta et al and Grodecki et al [1,10]. and this is not surprising considering that SARS-CoV-2 enters into cells using the ACE2 receptor, which is highly expressed in EAT and other visceral adipose depots [22].…”

“…Previous studies have shown that COVID-19 morbidity and mortality may be related to epicardial adipose tissue (EAT) [1] and visceral adipose tissue (VAT) [2], which may act as SARS-CoV-2 reservoir, thereby prolonging the viral spread inside the thorax [3].…”

Serum Vitamin D Levels Are Associated With Increased COVID-19 Severity and Mortality Independent of Whole-Body and Visceral Adiposity

“…The 80th gender-specific percentile of EAT thickness was obtained and used as the threshold to define increased EAT thickness. In addition, chest CT findings were recorded and used to evaluate severity of COVID infection ( 25 ).…”

Effectiveness of a nation-wide COVID-19 vaccination program in Mexico

“…Comorbidities – Prevalence of diabetes and obesity in Mexican population are high and the impact of their impact on the course of the COVID-19 pandemic in Mexico have been widely reported 1,33,34 . To this end, we also evaluated vaccine effectiveness for individuals with diabetes and, secondarily, obesity.…”