Association of Epicardial Adipose Tissue and Biventricular Strain in Heart Failure with Preserved and Reduced Ejection Fraction.

Abstract

Background and purpose: Epicardial adipose tissue (EAT) plays a crucial role in the progression of heart failure (HF). This study employs cardiac magnetic resonance (CMR) imaging to investigate potential differences in EAT between patients with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF), as well as the correlation between EAT and biventricular function (myocardial strain).

Methods: We collected data from patients diagnosed with HF at the Second Affiliated Hospital of Kunming Medical University between January 2021 and December 2023. All patients underwent CMR imaging and were categorized into two groups based on left ventricular ejection fraction (LVEF): the HFrEF group and the HFpEF group. Patients without heart failure served as the control group. We gathered clinical baseline data and utilized the CVI-42 post-processing software to obtain parameters related to cardiac structure and function, including LVEF, global radial strain (GRS), global longitudinal strain (GLS), EAT, pericardial adipose tissue (PeAT), paracardial adipose tissue (PaAT), and wall stress. We compared the differences in parameters among the three groups and conducted pairwise comparisons. Additionally, we performed correlation analyses of EAT and PeAT with GLS and body mass index (BMI) within the HFrEF and HFpEF cohorts.

Results: A total of 104 patients with HFrEF, 226 patients with HFpEF, and 172 patients without heart failure were ultimately included in the study. Significant statistical differences were observed among the three groups regarding age, smoking status, diabetes, brain natriuretic peptide (BNP) levels, BMI, EAT, PeAT, PaAT, wall stress, GLS and GRS of both ventricles (P < 0.05). The EAT volume in HFrEF patients (32 ± 14ml) was lower than that in HFpEF patients (51 ± 21ml) and the control group (33 ± 19ml). Additionally, PeAT and PaAT levels were higher in HFpEF patients compared to those in HFrEF and the control group. Correlation analysis revealed that in HFrEF patients, EAT accumulation was associated with better left ventricular (LV) function (LVGLS, r = 0.85, p < 0.01) and right ventricular (RV) function (RVGLS, r = 0.73, p < 0.01). Conversely, in HFpEF patients, EAT accumulation correlated with poorer LV (LVGLS, r = -0.67, p < 0.01) and RV (RVGLS, r = 0.55, p < 0.01) function.

Conclusion: EAT was greater in patients with HFpEF compared to HFrEF. In the HFpEF group, increased EAT was correlated with worsening biventricular function, while the opposite trend was observed in the HFrEF group.