Exploring the impact of metabolic comorbidities on epicardial adipose tissue in heart failure with preserved ejection fraction
Year: 2025
Type: article
Study design: Observational Study
Abstract: Heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly prevalent worldwide due to aging and comorbidities. Epicardial adipose tissue (EAT), favored by diabetes and obesity, was shown to contribute to HFpEF pathophysiology and is an emerging therapeutic target. This study explored the relationship between ventricular EAT measured by cardiovascular magnetic resonance (CMR), metabolic factors, and imaging characteristics in controls, pre-HF patients, and HFpEF patients. Patients from a Belgian cohort enrolled from December 2015 to June 2017 were categorized by HF stage: pre-HF (n = 16), HFpEF (n = 104) and compared to matched controls (n = 26) and to pre-HF (n = 191) from the Beta3-LVH cohort. Biventricular EAT volume was measured in end-diastolic short-axis cine stacks. In the Belgian cohort, associations between EAT, HF stage, and various biological and imaging markers were explored. The clinical endpoint was a composite of mortality or first HF hospitalization in the HFpEF group. EAT significantly differed between groups, with higher values in HFpEF patients compared to pre-HF and controls (72.4 ± 20.8ml/m2vs. 55.0 ± 11.8ml/m2 and 48 ± 8.9ml/m2, p < 0.001) from the Belgian cohort and to pre-HF (52.0 ± 15.0 ml/m2, p < 0.001) from the Beta3-LVH cohort. Subsequent analyses focused on the Belgian cohort. In contrast to atrial fibrillation, diabetes prevalence and body mass index (BMI) did not differ between pre-HF and HFpEF patients. Multivariable logistic regression and random forest classification identified EAT, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and H2FPEF score as strong markers of HFpEF status. EAT was significantly correlated with H2FPEF score (r = 0.41, p = 0.003), BMI (r = 0.30, p < 0.001), high‐sensitive troponin T (r = 0.41, p < 0.001), NT-proBNP (r = 0.37, p < 0.001), soluble suppression of tumorigenicity-2 (sST2) (r = 0.30, p < 0.001), E/e’ ratio (r = 0.33, p < 0.001), and left ventricular global longitudinal strain (r = 0.35, p < 0.001). In HFpEF patients, diabetes, ischemic cardiomyopathy, and elevated sST2 were independently associated with elevated EAT. In contrast with diabetes and BMI, increased EAT was not associated with prognosis. EAT assessed by CMR was significantly higher in HFpEF patients compared to controls and pre-HF patients, irrespective of diabetes and BMI. EAT was moderately associated with HFpEF status. HFpEF patients with elevated EAT exhibited a marked diabetic, ischemic, and inflammatory profile, highlighting the potential role of drugs targeting EAT. Characterization of Heart Failure With Preserved Ejection Fraction; Assessment of Efficacy of Mirabegron, a New beta3-adrenergic Receptor in the Prevention of Heart Failure (Beta3_LVH). ClinicalTrials.gov. Identifier: NCT03197350; NCT02599480.
Source: Cardiovascular Diabetology
Authors: Nassiba Menghoum, Maria Chiara Badii, Martin Leroy, Marie Parra, Clotilde Roy, Sibille Lejeune, David Vancraeynest, Agnes Pasquet, Dulce Brito, Barbara Casadei, Christophe Depoix, Gerasimos Filippatos, Damien Gruson, Frank Edelmann, Vanessa M. Ferreira, Renaud Lhommel, Masliza Mahmod, Stefan Neubauer, Alexandre Persu, Stefan Piechnik, Kristian Hellenkamp, Ignatios Ikonomidis, Bartosz Krakowiak, Burkert Pieske, Elisabeth Pieske-Kraigher, Fausto Pinto, Piotr Ponikowski, Michele Senni, Jean-Noël Trochu, Nancy Van Overstraeten, Rolf Wachter, Bernhard L. Gerber, Jean-Luc Balligand, Christophe Beauloye, Anne-Catherine Pouleur
Institutions: Cliniques Universitaires Saint-Luc, UCLouvain, University of Lisbon, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, British Heart Foundation, Imperial College London, National and Kapodistrian University of Athens, University General Hospital Attikon, Universitätsmedizin Göttingen, University of Göttingen, University of Oxford, Wrocław University of Science and Technology, Wroclaw Medical University, Universitätsmedizin Rostock, University of Rostock, Vivantes Klinikum, Ospedale Papa Giovanni XXIII, University of Milano-Bicocca, Centre National de la Recherche Scientifique, Institut du Thorax, Nantes Université, University Hospital Leipzig
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,290
OpenAlex ID: W4408738701