Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study

doi:10.4330/wjc.v16.i3.149

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World Journal of Cardiology

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World J Cardiol. Mar 26, 2024; 16(3): 149-160
Published online Mar 26, 2024. doi: 10.4330/wjc.v16.i3.149

Table 1 Baseline characteristics and laboratory findings of the obesity in populations with and without heart failure with preserved ejection fraction, n (%)

Parameter	HFpEF+ (n = 17)	HFpEF- (n = 45)	P value
Age (yr)	42.94 ± 3.37	36.60 ± 1.80	0.0819
> 60A	3 (17.6)	1 (0.02)	0.0275^a
Male gender	11 (64.7)	25 (55.6)	0.5227
BSA (m²)	2.17 ± 0.07	2.13 ± 0.04	0.639
Weight (kg)	102.60 ± 5.49	103.00 ± 4.37	0.9667
BMI (kg/m²)	35.78 ± 1.28	33.5 ± 0.99	0.2093
Systolic blood pressure (mmHg)	139.80 ± 4.73	130.90 ± 1.84	0.0370^a
Diastolic blood pressure (mmHg)	86.59 ± 3.21	82.51 ± 1.61	0.2174
Complications
Diabetes	9 (20.0)	4 (23.5)	0.7653
Hypertension	6 (35.3)	6 (13.3)	0.052
Hyperlipidemia	8 (47.1)	13 (28.9)	0.1652
Hyperuricemia	4 (23.5)	12 (26.7)	0.8051
Fatty liver	10 (58.8)	13 (28.9)	0.0253^a
Biomarkers
BNP (pg/mL)	22.67 ± 5.21	21.63 ± 2.95	0.86
Laboratory investigations
Serum cholesterol (mmol/L)	5.01 ± 0.26	5.06 ± 0.16	0.8666
Serum triglycerides (mmol/L)	2.13 ± 0.21	1.85 ± 0.17	0.3609
Serum HDL (mmol/L)	1.06 ± 0.06	1.17 ± 0.03	0.0766
Serum LDL (mmol/L)	3.05 ± 0.20	3.12 ± 0.13	0.7818

^aP < 0.05.

Data were given as means ± standard deviations. HFpEF: Heart failure with preserved ejection fraction; BSA: Body surface area; BMI: Body mass index; BNP: Brain natriuretic peptide; HDL: High-density lipoprotein; LDL: Low-density lipoprotein.

Table 2 Cardiac magnetic resonance parameters of chamber size, function, epicardial adipose tissue volume of the obesity in populations with and without heart failure with preserved ejection fraction

CMR parameters	HFpEF+ (n = 17)	HFpEF- (n = 45)	P value
Conventional parameters
LVEF (%)	0.60 ± 0.03	0.64 ± 0.01	0.0797
LV mass index (g/m²)	61.38 ± 4.55	52.68 ± 1.40	0.0181^a
LVEDD (mm)	52.74 ± 1.80	50.20 ± 0.57	0.0833
LVMWT (mm)	10.32 ± 0.40	9.66 ± 0.25	0.1765
LVEDVi (mL/m²)	74.00 ± 5.52	69.16 ± 1.72	0.2716
LVESVi (mL/m²)	32.12 ± 5.87	24.84 ± 0.78	0.0592
LA AP diameter (mm)	41.37 ± 1.53	42.15 ± 0.87	0.6518
LA LR diameter (mm)	67.85 ± 2.55	70.63 ± 1.18	0.2686
Epicardial adipose tissue
EAT volume (mL)	160.00 ± 7.13	139.80 ± 5.39	0.0449^a
EATi (mL/m²)	74.20 ± 3.16	65.37 ± 2.23	0.0360^a
EAT mass (g)	147.20 ± 6.56	128.60 ± 4.98	0.0451^a
EAT mass index (g/m²)	68.26 ± 2.91	60.10 ± 2.06	0.0359^a
EAT/LA AP diameter ratio	3.56 ± 0.18	3.11 ± 0.14	0.0843
EAT/LA LR diameter ratio	2.19 ± 0.11	1.84 ± 0.08	0.0203^a
EAT/LV mass ratio	1.21 ± 0.09	1.17 ± 0.06	0.7737
EAT/LV volume ratio	0.99 ± 0.08	0.92 ± 0.04	0.4158

^aP < 0.05.

Data were given as means ± standard deviations. AP: Anterior-posterior diameter; CMR: Cardiovascular magnetic resonance; LA: Left atrial; LR: left-right diameter; LVEDVi: Left ventricular end-diastolic volume index; LVEF: Left ventricular ejection fraction; LVESVi: Left ventricular end-systolic volume index; LVMWT: LV maximal wall thickness; LVEDD: Left ventricular end-diastolic diameter; EAT: Epicardial adipose tissue; EATi: Epicardial adipose tissue index.

Table 3 Relationships between epicardial adipose tissue and morphological and functional parameters in heart failure with preserved ejection fraction positive group

Pearson’s correlation (r, P)	EAT volume (mL)	EATi (mL/m²)	EAT mass (g)	EAT mass index (g/m²)
LVEF (%)	-0.101, 0.698	0.245, 0.343	-0.101, 0.698	0.245, 0.343
LV mass index (g/m²)	0.286, 0.265	-0.039, 0.881	0.286, 0.265	-0.039, 0.882
LVEDD (mm)	0.083, 0.751	-0.102, 0.696	0.083, 0.751	-0.102, 0.697
LVMWT (mm)	0.022, 0.932	-0.314, 0.219	0.022, 0.932	-0.314, 0.219
LVEDVi (mL/m²)	-0.018, 0.946	-0.213, 0.412	-0.018, 0.946	-0.213, 0.412
LVESVi (mL/m²)	0.028, 0.916	-0.213, 0.411	0.028, 0.916	-0.213, 0.411
LA AP diameter (mm)	0.354, 0.179	0.158, 0.558	0.354, 0.179	0.158, 0.558
LA LR diameter (mm)	0.231, 0.389	0.193, 0.474	0.231, 0.389	0.193, 0.474

All P > 0.05. AP: Anterior-posterior diameter; CMR: Cardiovascular magnetic resonance; LA: Left atrial; LR, Left-right diameter; LVEDVi: Left ventricular end-diastolic volume index; LVEF: Left ventricular ejection fraction; LVESVi: Left ventricular end-systolic volume index; LVMWT: LV maximal wall thickness; LVEDD: Left ventricular end-diastolic diameter; EAT: Epicardial adipose tissue; EATi: Epicardial adipose tissue index.

Table 4 Variables associated with the heart failure with preserved ejection fraction in obesity population

Variables	Lower/upper
Variables	Univariate analysis (OR, 95%CI, P value)	Multivariate analysis (OR, 95%CI, P value)
Age (yr)	1.040 (0.994, 1.088) 0.087	1.046 (0.979, 1.117) 0.183
BMI (kg/m²)	1.057 (0.969, 1.154) 0.213
BMI > 35 kg/m²	2.812 (0.558, 14.179) 0.210
Diabetes	1.231 (0.323, 4.689) 0.761
Hypertension	3.545 (0.952, 13.201) 0.059	4.580 (1.008, 20.803) 0.049^a
LVEF (%)	0.002 (0.000, 7.482) 0.136
LVEDVi (mL/m²)	1.020 (0.984, 1.058) 0.288
LVESVi (mL/m²)	1.063 (0.958, 1.178) 0.249
LA AP diameter (mm)	0.977 (0.884, 1.080) 0.646
LA LR diameter (mm)	0.963 (0.900, 1.030) 0.267
EAT mass index (g/m²)	1.049 (1.002, 1.098) 0.042^a	0.963 (1.054, 0.880) 0.416
EAT mass (g)	1.020 (1.000, 1.041) 0.051
EATi (mL/m²)	1.045 (1.002, 1.090) 0.042^a
EAT volume (mL)	1.019 (1.000, 1.038) 0.051
EAT/LA AP diameter ratio	1.794 (0.915, 3.519) 0.089
EAT/LA LR diameter ratio	3.989 (1.171, 13.584) 0.027^a	9.226 (1.070, 79.512) 0.043^a
EAT/LV mass ratio	1.236 (0.300, 5.098) 0.770
EAT/LV volume ratio	2.299 (0.317, 16.658) 0.410

^aP < 0.05.

HDL: High-density lipoprotein; LDL: Low-density lipoprotein; EAT: Epicardial adipose tissue; EATi: Epicardial adipose tissue index; CI: Confidence interval; OR: Odds ratio.

Table 5 Intra-observer and inter-observer reproducibility for epicardial adipose tissue parameters

	Intra-observer			Inter-observer
	CV (%)	ICC	95%CI	CV (%)	ICC	95%CI
EAT volume (mL)	24.6	0.929	(0.885, 0.939)	18.4	0.900	(0.746, 0.963)
EATi (mL/m²)	23.0	0.913	(0.846, 0.951)	17.6	0.903	(0.753, 0.964)
EAT mass (g)	26.3	0.931	(0.878, 0.962)	17.9	0.900	(0.746, 0.963)
EAT mass index (g/m²)	23.7	0.913	(0.846, 0.951)	31.0	0.978	(0.941, 0.992)
EAT/LA AP diameter ratio	35.9	0.734	(0.561, 0.846)	18.5	0.882	(0.696, 0.957)
EAT/LA LR diameter ratio	28.4	0.710	(0.526, 0.831)	19.9	0.928	(0.807, 0.974)
EAT/LV mass ratio	34.7	0.870	(0.774, 0.927)	31.3	0.978	(0.941, 0.992)
EAT/LV volume ratio	29.4	0.929	(0.874, 0.961)	31.6	0.973	(0.928, 0.963)

EAT: Epicardial adipose tissue; EATi: Epicardial adipose tissue index; LA: Left atrial; AP: Anterior-posterior; LR: Left-right; LV: Left ventricular; ICC: Intra-class correlation coefficient.

Citation: Shao JW, Chen BH, Abu-Shaban K, Baiyasi A, Wu LM, Ma J. Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study. World J Cardiol 2024; 16(3): 149-160
URL: https://www.wjgnet.com/1949-8462/full/v16/i3/149.htm
DOI: https://dx.doi.org/10.4330/wjc.v16.i3.149