Importance of epicardial adipose tissue as a predictor of heart failure with preserved ejection fraction

Abstract

OBJECTIVE: Epicardial adipose tissue is a special form of visceral fat surrounding the heart. It is associated with cardiac and metabolic diseases. Epicardial adipose tissue is associated with risk factors for heart failure with preserved ejection fraction, such as obesity, metabolic syndrome, hypertension, and diabetes. In this study, we examined the importance of Epicardial adipose tissue as a predictor of heart failure with preserved ejection fraction. METHODS: Patients who were admitted to the Dicle University Medicine Faculty Heart Hospital between November 2013 and August 2014 were recruited for the study. The heart failure group consisted of 30 patients who were admitted to the cardiac intensive care unit, and the control group consisted of 30 patients who were admitted to cardiology polyclinics. We care about patients' demographic and clinical features to be similar. Heart failure was diagnosed according to the European Cardiology Society 2012 heart failure guidelines. Epicardial adipose tissue was measured with a transthoracic parasternal long axis with an echocardiography device (GE Vivid S6). We compared the Epicardial adipose tissue measurements between the two groups. RESULTS: Epicardial adipose tissue was higher in patients with heart failure with preserved ejection fraction than in the control group (9.21±0.82 and 7.13±1.39 mm, respectively; p<0.001). Echocardiographic findings associated with left ventricular hypertrophy were intact ventricular septum (13.03±0.57 and 12.11±2.22 mm, respectively; p=0.013) and left ventricular mass index (131.13±18.00 and 117.90±20.30 g/m 2 , respectively; p=0.010). Findings associated with left ventricular diastolic dysfunction were as follows: left atrial volume index (60.71±21.53 and 44.92±9.93 mL/m 2 , respectively; p<0.001) and E/è (13.87±3.88 and 10.12±2.44, respectively; p<0.001) were higher in patients with heart failure with preserved ejection fraction than in the control group. Body mass index was not a significant indicator of obesity (p=0.097), but waist circumference was a significant indicator of visceral obesity (p<0.001). Logistic regression analyses indicated that Epicardial adipose tissue, age, left atrial volume index, left ventricular mass index, waist circumference, and E/é were significant in the Heart failure group; Epicardial adipose tissue was significant (p=0.012), and waist circumference significance was borderline (p=0.045). CONCLUSIONS: Epicardial adipose tissue was higher in patients with HF than in the control group, and Epicardial adipose tissue was a predictor of heart failure with preserved ejection fraction. In patients with heart failure with preserved ejection fraction, increased Epicardial adipose tissue means that Epicardial adipose tissue can be used as a biomarker of inflammation in the pathophysiology of heart failure with preserved ejection fraction.

Comment on “Importance of epicardial adipose tissue as a predictor of heart failure with preserved ejection fraction”

“…For instance, a study 2 encompassing 3,562 heart failure patients with preserved ejection fraction demonstrated a correlation between elevated NT-proBNP levels and baseline characteristics, including atrial fibrillation, NYHA IV symptoms, and lower estimated glomerular filtration rate. Yet, Table 2 of the present study 1 does not depict the relationship between NT-proBNP and heart failure with preserved ejection fraction. We are wondering whether all confounding factors, such as NT-proBNP, were included in the univariate and multivariable logistic regression or only a subset of the parameters from Table 1 1 was considered.…”

“…We read the recent study performed by Ateş et al 1 . with great interest, which underscores the importance of epicardial adipose tissue as a predictor for heart failure with preserved ejection fraction.…”

“…First, there is some ambiguity regarding the variables included in the univariate and multivariable logistic regression analyses in this study 1 . As indicated in Table 2 of the study 1 , variables such as age, epicardial adipose tissue (EAT), left ventricular mass index (LVMI), waist circumference, left atrial volume index (LAVI), and E/é were incorporated into both univariate and multivariable logistic regression analyses.…”

“…First, there is some ambiguity regarding the variables included in the univariate and multivariable logistic regression analyses in this study 1 . As indicated in Table 2 of the study 1 , variables such as age, epicardial adipose tissue (EAT), left ventricular mass index (LVMI), waist circumference, left atrial volume index (LAVI), and E/é were incorporated into both univariate and multivariable logistic regression analyses. However, it remains unclear whether other factors like hemoglobin, NT-proBNP (N-terminal pro-brain natriuretic peptide), and glomerular filtration rate (GFR) were also included in the logistic regression analysis.…”

The role of epicardial adipose tissue dysfunction in cardiovascular diseases: an overview of pathophysiology, evaluation, and management

“…Another study found that HF patients have higher EAT than the control group. Hence, EAT can be considered as a prognostic predictor of HF with preserved ejection fraction (HFpEF) ( 92 ). In a prospective multinational PROMIS-HfpEF cohort, increased EAT has been shown to be associated with cardiac structural alterations, adiposity, inflammation, lower insulin sensitivity, and endothelial dysfunction related to HFpEF pathology ( 93 ).…”