Distribution and prognostic value of pericoronary and epicardial adipose tissue in heart failure with preserved ejection fraction: a coronary CT angiography study

Abstract

Abstract Background The role of epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT), measured by coronary CT angiography (CCTA), as cardiometabolic risk factors in heart failure patients with preserved ejection fraction (HFpEF) remains unclear. In this study, we aimed to evaluate the CCTA-derived EAT and PCAT in HFpEF patients and examine their association with cardiac function and prognostic value.Methods Between January 2019 and July 2022, 100 HFpEF patients and 100 healthy controls underwent CCTA to investigate the association between EAT and PCAT and composite endpoints for HFpEF. The composite endpoint was defined as a combination of all-cause mortality and rehospitalization for HF. EAT volume and PCAT attenuation were measured using automatic threshold segmentation in CCTA images, with thresholds set between − 30 and − 190 HU. Univariate and multivariate Cox regression models were used, including EAT, PCAT, and a cardiac metabolic risk score (incorporating age, sex, smoking, metabolic syndrome, and family history). The optimal cut-off point was determined using the Youden index. Survival estimates were calculated using Kaplan-Meier curves with the log-rank test.Results A total of 200 patients, with a mean age of 68.3 ± 10.3 years and 58.0% male, were retrospectively analyzed. Among them, 100 HFpEF patients (mean age: 71.7 ± 9.9 years; 59% male) were followed up for a median of 15 ± 0.6 months (range 2–29 months). Compared to healthy controls, HFpEF patients had higher EAT volume (56.1 cm3 ± 11.9) and lower attenuations in the right coronary artery (RCA) (-74.7 HU ± 3.82), left anterior descending artery (LAD) (-72.9 HU ± 3.98), and left circumflex artery (LCX) (-71.5 HU ± 3.06). EAT and PCAT-RCA attenuation were predictive of outcome with an optimal threshold of 56.29 cm3 (AUC: 0.77; sensitivity: 72.0%; specificity: 74%) and − 69.31 HU (AUC: 0.793; sensitivity: 76.9%; specificity: 74.1%), respectively.Conclusions We conclude that, in heart failure patients, EAT and PCAT-RCA add independent and incremental prognostic value of predicting HFpEF progression, superior to clinical risk factors.