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. 2023 Dec;10(6):3419-3429.
doi: 10.1002/ehf2.14483. Epub 2023 Sep 11.

Diverging role of epicardial adipose tissue across the entire heart failure spectrum

Valentina A Rossi  1   2 , Delia Nebunu  1 , Thomas Haider  1 , Natallia Laptseva  1   2 , Matthias P Naegele  1 , Frank Ruschitzka  1   2   3 , Isabella Sudano  1   2 , Andreas J Flammer  1   2   3
Affiliations

Diverging role of epicardial adipose tissue across the entire heart failure spectrum

Valentina A Rossi et al. ESC Heart Fail. 2023 Dec.

Abstract

Aims: Epicardial adipose tissue (EAT) is a metabolically highly active tissue modulating numerous pathophysiological processes. The aim of this study was to investigate the association between EAT thickness and endothelial function in patients with heart failure (HF) across the entire ejection fraction spectrum.

Methods and results: A total of 258 patients with HF with an ejection fraction across the entire spectrum [HF with reduced ejection fraction (HFrEF), n = 168, age 60.6 ± 11.2 years; HF with preserved ejection fraction (HFpEF), n = 50, mean age 65.1 ± 11.9 years; HF with mildly reduced ejection fraction (HFmrEF), n = 32, mean age 65 ± 12] were included. EAT was measured with transthoracic echocardiography. Vascular function was assessed with flicker-light-induced vasodilation of retinal arterioles (FIDart%) and flow-mediated dilatation (FMD%) in conduit arteries. Patients with HFrEF have less EAT compared with patients with HFpEF (4.2 ± 2 vs. 5.3 ± 2 mm, respectively, P < 0.001). Interestingly, EAT was significantly associated with impaired microvascular function (FIDart%; r = -0.213, P = 0.012) and FMD% (r = -0.186, P = 0.022), even after multivariate correction for confounding factors (age, body mass index, hypertension, and diabetes; standardized regression coefficient (SRC) = -0.184, P = 0.049 for FIDart% and SRC = -0.178, P = 0.043 for FMD%) in HFrEF but not in HFpEF.

Conclusions: Although less EAT is present in HFrEF than in HFpEF, only in HFrEF EAT is associated with vascular dysfunction. The diverging role of EAT in HF and its switch to a functionally deleterious tissue promoting HF progression provide the rationale to specifically target EAT, in particular in patients with reduced ejection fraction.

Keywords: Endothelial function; Epicardial adipose tissue; Flow-mediated dilatation; Heart failure; Retinal vascular function.

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Conflict of interest statement

A.J.F. declares fees from Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Fresenius, Imedos Systems, Medtronic, MSD, Mundipharma, Novartis, Pierre Fabre, Pfizer, Roche, Schwabe Pharma, Vifor, and ZOLL, as well as grant support by Novartis, AstraZeneca, and Berlin Heart unrelated to this article. F.R. has not received personal payments by pharmaceutical companies or device manufacturers in the last 3 years (remuneration for the time spent in activities, such as participation as steering committee member of clinical trials and member of the Pfizer Research Award selection committee in Switzerland, was made directly to the University of Zurich). The Department of Cardiology (University Hospital of Zurich/University of Zurich) reports research, educational, and/or travel grants from Abbott, Amgen, AstraZeneca, Bayer, Berlin Heart, B. Braun, Biosense Webster, Biosensors Europe AG, Biotronik, BMS, Boehringer Ingelheim, Boston Scientific, Bracco, Cardinal Health Switzerland, Corteria, Daiichi, Diatools AG, Edwards Lifesciences, Guidant Europe NV (BS), Hamilton Health Sciences, Kaneka Corporation, Kantar, Labormedizinisches Zentrum, Medtronic, MSD, Mundipharma Medical Company, Novartis, Novo Nordisk, Orion, Pfizer, Quintiles Switzerland Sarl, Roche Diagnostics, Sahajanand IN, Sanofi, Sarstedt AG, Servier, SIS Medical, SSS International Clinical Research, Terumo Deutschland, Trama Solutions, V‐Wave, Vascular Medical, Vifor, Wissens Plus, and ZOLL. The research and educational grants do not impact on his personal remuneration. All other authors have no conflict of interest related to the topic of the paper.

Figures

Figure 1
Figure 1
Difference in flicker‐light‐induced retinal arteriolar dilation in patients with heart failure with reduced ejection fraction (HFrEF) and reduced epicardial adipose tissue (EAT) thickness ≤ 3.9 mm vs. patients with HFrEF and increased EAT thickness > 3.9 mm. *P‐value < 0.05.
Figure 2
Figure 2
Difference in flicker‐light‐induced retinal arteriolar dilation in patients with heart failure with preserved ejection fraction (HFpEF) and reduced epicardial adipose tissue (EAT) thickness ≤ 5.5 mm vs. patients with HFpEF and increased EAT thickness > 5.5 mm. ns, not significant.
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