Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure.

Aims We evaluated the impact of echocardiographic epicardial adipose tissue (EAT) on cardiovascular hemodynamics, metabolic profile and prognosis in heart failure (HF) using combined cardiopulmonary-echocardiography exercise stress. Methods and results We analysed EAT thickness of HF patients with reduced (HFrEF, n=205) and preserved (HFpEF, n=188) ejection fraction, including 44 controls. HFpEF patients displayed the highest EAT, while HFrEF had lower values than controls. EAT showed an inverse correlation with natriuretic peptides, Troponin T and C-reactive protein in HFrEF, while having a direct association with Troponin-T and C-reactive protein in HFpEF. EAT was independently associated with peak oxygen consumption (VO2 ) and peripheral extraction (AVO2 diff), regardless of body mass index. EAT was inversely correlated with peak VO2 and AVO2 diff in HFpEF, while a direct association was observed in HFrEF, where lower EAT values were associated with worse left ventricle systolic dysfunction. In HFpEF, increased EAT was related to right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) uncoupling. After a 21-month follow-up, we reported 146 HF hospitalisations and 34 cardiovascular deaths in HF population. Cox multivariable analysis supported an independent differential role of EAT in HF cohorts (interaction p=0.01): higher risk of adverse events for increasing EAT in HFpEF (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.04-1.37) and for decreasing EAT in HFrEF (HR 0.75, 95% CI 0.54-0.91). Conclusion In HFpEF, EAT accumulation is associated with worse hemodynamic and metabolic profile, also affecting survival. Conversely, lower EAT values imply higher LV dysfunction, global functional impairment and adverse prognosis in HFrEF. This article is protected by copyright. All rights reserved.