The prognostic value of Epicardial and Pericoronary Adipose Tissue in Heart Failure with Preserved Ejection Fraction Using Coronary Computed Tomography Angiography.

Objectives: To assess the prognostic significance of epicardial adipose tissue volume (EATv) and pericoronary adipose tissue attenuation (PCATa) in patients with heart failure with preserved ejection fraction (HFpEF).

Methods: This retrospective study was based on HFpEF and controls who underwent coronary computed tomography angiography (CCTA) screening to rule out coronary disease. Comparisons of EATv and PCATa were made between HFpEF patients and a control group, employing statistical analyses including Kaplan-Meier and Cox regression to assess prognostic significance.

Results: A total of 224 patients were retrospectively analyzed. The EATv was 56.1 cm3 ± 11.9 and PCATa in the right coronary artery (PCATa-RCA) was -74.7 HU ± 3.82 in HFpEF patients, which increased significantly compared with controls. Among them, 112 HFpEF patients (mean age: 71.9 ± 8.5 years; 40% male) were followed up for a median of 27 ± 0.6 months (range 2-47 months). EATv and PCATa-RCA were predictive of outcome with an optimal threshold of 56.29 cm3 and -71.17 HU, respectively. In Kaplan-Meier analysis, the high EATv and PCATa-RCA attenuation had significantly higher rates of composite outcomes (log-rank test, all P < 0.01). EATv and PCATa-RCA were independently predictive of outcome following adjustment for confounding variables (EATv: hazard ratio [HR] 1.03; 95% confidence interval [CI] (1.01-1.06); p < 0.01, PCTAa-RCA: HR 1.44; 95% CI 1.27-1.62; p < 0.001)).

Conclusions: Increased EATv and PCATa-RCA are associated with worse clinical outcomes in HFpEF patients.

Advances in knowledge: This study highlights the potential of CCTA-derived adipose tissue metrics as novel, non-invasive biomarkers for risk stratification in HFpEF.