TY - JOUR
T1 - Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure
AU - Pugliese, Nicola R.
AU - Paneni, Francesco
AU - Mazzola, Matteo
AU - De Biase, Nicolò
AU - Del Punta, Lavinia
AU - Gargani, Luna
AU - Mengozzi, Alessandro
AU - Virdis, Agostino
AU - Nesti, Lorenzo
AU - Taddei, Stefano
AU - Flammer, Andreas
AU - Borlaug, Barry A.
AU - Ruschitzka, Frank
AU - Masi, Stefano
N1 - Publisher Copyright:
© 2021 European Society of Cardiology
PY - 2021/11
Y1 - 2021/11
N2 - Aims: We evaluated the impact of echocardiographic epicardial adipose tissue (EAT) on cardiovascular haemodynamics, 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 patients 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 (AVO2diff), regardless of body mass index. EAT was inversely correlated with peak VO2 and AVO2diff in HFpEF, while a direct association was observed in HFrEF, where lower EAT values were associated with worse left ventricular systolic dysfunction. In HFpEF, increased EAT was related to right ventriculo–arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) uncoupling. After 21 months of follow-up, 146 HF hospitalizations and 34 cardiovascular deaths were recorded in the 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 haemodynamic and metabolic profile, also affecting survival. Conversely, lower EAT values imply higher left ventricular dysfunction, global functional impairment and adverse prognosis in HFrEF.
AB - Aims: We evaluated the impact of echocardiographic epicardial adipose tissue (EAT) on cardiovascular haemodynamics, 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 patients 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 (AVO2diff), regardless of body mass index. EAT was inversely correlated with peak VO2 and AVO2diff in HFpEF, while a direct association was observed in HFrEF, where lower EAT values were associated with worse left ventricular systolic dysfunction. In HFpEF, increased EAT was related to right ventriculo–arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) uncoupling. After 21 months of follow-up, 146 HF hospitalizations and 34 cardiovascular deaths were recorded in the 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 haemodynamic and metabolic profile, also affecting survival. Conversely, lower EAT values imply higher left ventricular dysfunction, global functional impairment and adverse prognosis in HFrEF.
KW - Epicardial adipose tissue
KW - Exercise
KW - Heart failure
KW - Heart failure with preserved ejection fraction
KW - Prognosis
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U2 - 10.1002/ejhf.2337
DO - 10.1002/ejhf.2337
M3 - Article
C2 - 34427016
AN - SCOPUS:85114379016
SN - 1388-9842
VL - 23
SP - 1858
EP - 1871
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 11
ER -