Epicardial adipose tissue related to left atrial and ventricular function in heart failure with preserved versus reduced and mildly reduced ejection fraction

Abstract

Aim Different associations between epicardial adipose tissue (EAT) and cardiac function have been suggested in patients with heart failure with preserved (HFpEF) versus reduced and mildly reduced ejection fraction (HFrEF/HFmrEF). However, few studies have directly compared the association between EAT and left atrial (LA) and left ventricular (LV) function in patients with HFpEF and HFrEF/HFmrEF. Methods and results We studied EAT thickness using transthoracic echocardiography in a multicentre cohort of 149 community‐dwelling controls without heart failure, 99 patients with HFpEF, and 366 patients with HFrEF/HFmrEF. EAT thickness was averaged from parasternal long‐axis and short‐axis views, respectively, and off‐line speckle tracking analysis was performed to quantify LA and LV function. Data were validated in an independent cohort of 626 controls, 243 patients with HFpEF, and 180 patients with HFrEF/HFmrEF. For LV function, LV global longitudinal strain (GLS) was measured in both derivation and validation cohorts. For LA function, LAGLS at reservoir, contractile and conduit phase were measured in the derivation cohort, and only LAGLS at reservoir phase was measured in the validation cohort. In the derivation cohort, EAT thickness was lower in HFrEF/HFmrEF (7.3 ± 2.5 mm) compared to HFpEF (8.3 ± 2.6 mm, p < 0.05) and controls (7.9 ± 1.8 mm, p < 0.05). Greater EAT thickness was associated with better LV and contractile LA function in HFrEF/HFmrEF, but not in HFpEF (p for interaction <0.05). These findings were confirmed in the validation cohort, where EAT thickness was lower in HFrEF/HFmrEF (6.7 ± 1.4 mm) compared to HFpEF (9.6 ± 2.8 mm; p < 0.05) and controls (7.7 ± 2.3 mm; p < 0.05). Greater EAT thickness was associated with better LV and reservoir LA function in patients with HFrEF/HFmrEF but worse LV and reservoir LA function in patients with HFpEF (p for interaction <0.05). Thickened EAT (EAT thickness >10 mm) was associated with LA dysfunction (LAGLS at reservoir phase <23%) in HFpEF, but not in HFrEF/HFmrEF. Conclusion Epicardial adipose tissue thickness is greater in patients with HFpEF than HFrEF/HFmrEF. Increased EAT thickness is associated with worse LA and LV function in HFpEF but the opposite in HFrEF/HFmrEF.

Impacts of obesity and metabolic health on global subclinical left cardiac function: TyG index may be a predictor of subclinical left cardiac dysfunction

“…Our analysis focuses on LA reservoir strain(LAs-s), LACI, and LVGLS as the key parameters of left cardiac function, considering their predictive abilities for LA dysfunction and LV dysfunction, respectively [19]. After multivariate adjustment, simple obesity substantially worsens overall left cardiac function(including LAs-s, LACI, and LV GLS) compared with non-obese individuals(p 0.05, Figure 1).…”

Connecting epicardial adipose tissue and heart failure with preserved ejection fraction: mechanisms, management and modern perspectives

“…However, some longitudinal studies have shown that higher EAT at baseline is associated with new‐onset HFpEF, 6,30 as well as a worse prognosis in those with established HFpEF, 7 independent of overall obesity and important comorbidities. An overview of the recent studies that investigated EAT in relation to HFpEF is shown in Table 1 6,7,23,25–27,30–41 . Of note, one study by Haykowsky et al 32 .…”

August 2022 at a glance: focus on heart failure with preserved ejection fraction and cardiac amyloidosis

“…Epicardial adipose tissue (EAT) may have a different prognostic impact in patients with HF according to their left ventricular ejection fraction (LVEF) 4 . Jin et al 5 . studied the thickness of EAT using transthoracic echocardiography in 99 patients with HFpEF, 366 patients with HF with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) and 149 controls without HF.…”