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

Abstract

BACKGROUND: Obesity, in particular, visceral adipose tissue has 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 centre in Mexico City. EAT thickness, sub-thoracic and pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with critical COVID-19 and mortality 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 adverse 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, C-reactive protein, and 4C 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.

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“…The thoracic CT was performed using a 64-slice scanner (GE MEDICAL SYSTEMS Revolution EVO). Epicardial adipose tissue (EAT) thickness was measured at 3 points (right atrioventricular fossa, left atrioventricular fossa, and anterior interventricular fossa) in the reformatted 4-chamber view using the multiplanar reconstruction (MPR) tool on the workstation (23)(24)(25)(26). The maximum thickness of the EAT was determined from the surface of the myocardium to the pericardium (measured perpendicular to the pericardium).…”

“…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).…”