Epicardial fat inflammation response to COVID-19 therapies

Abstract

Objective: Adipose tissue plays a role in the novel coronavirus disease 2019 (COVID-19). Epicardial adipose tissue (EAT), a unique visceral fat, presents with a high degree of inflammation in severe COVID-19. Whether and how adipose tissue may respond to the COVID-19 therapies is unknown.

Methods: The difference in computed tomography-measured EAT and subcutaneous (SAT) attenuation, defined as mean attenuation expressed in Hounsfield units (HU), was retrospectively analyzed in 72 patients (mean [SD] age was 59.6 [12.4] years, 50 patients [69%] were men) at the hospital admission for COVID-19 and 99 days (interquartile range = 71-129) after discharge.

Results: At the admission, EAT-HU was significantly correlated with blood glucose levels, interleukin 6, troponin T levels, and waist circumference. EAT-HU decreased from -87.21 (16.18) to -100.0 (11) (p < 0.001), whereas SAT-HU did not change (-110.21 [12.1] to -111.11 [27.82]; p = 0.78) after therapy. Changes in EAT-HU (expressed as ∆) significantly correlated with dexamethasone therapy (r = -0.46, p = 0.006) and when dexamethasone was combined with tocilizumab (r = -0.24, p = 0.04).

Conclusions: Dexamethasone therapy was associated with significant reduction of EAT inflammation in COVID-19 patients, whereas SAT showed no changes. Anti-inflammatory therapies targeting visceral fat may be helpful in COVID-19.

FIGURE 1

EAT and SAT density between admission and discharge. Changes in epicardial (EAT) and subcutaneous adipose tissue (SAT) density expressed in Hounsfield units (HU) between hospital admission (black columns) and approximately 3 months after discharge (gray columns). EAT‐HU changed significantly (p < 0.001), whereas SAT remained unchanged. Data are represented as median (interquartile range)

FIGURE 2

EAT‐HU changes in relation to therapy. Changes in epicardial adipose tissue (EAT) density expressed in Hounsfield units (HU) in relation to each single therapy. ∆EAT‐HU was higher in those who received dexamethasone (p < 0.01) compared with those treated with tocilizumab, hydroxychloroquine (HCQ), remdesevir, lopinavir, or ritonavir. Data are represented as median (interquartile range)