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. 2025 Oct;12(5):3353-3360.
doi: 10.1002/ehf2.15396. Epub 2025 Aug 19.

Epicardial, visceral and subcutaneous adipose tissue in heart failure with preserved ejection fraction

Michelle Lobeek  1 , Lea P A Timmann  1 , Dirk J van Veldhuisen  1 , Just Dronkers  1 , Riemer H J A Slart  2   3 , Michiel Rienstra  1 , Alain R Viddeleer  4 , Thomas M Gorter  1
Affiliations

Epicardial, visceral and subcutaneous adipose tissue in heart failure with preserved ejection fraction

Michelle Lobeek et al. ESC Heart Fail. 2025 Oct.

Abstract

Aims: Obesity is common in patients with heart failure with preserved ejection fraction (HFpEF), and adipose tissue (AT) plays a key role in its pathophysiology. We examined the distribution and association of visceral AT (VAT), subcutaneous AT (SAT) and epicardial AT (EAT) in HFpEF using multimodality imaging.

Methods: Heart failure patients with left ventricular ejection fraction >40% were prospectively enrolled. All patients underwent cardiac magnetic resonance (CMR) imaging and total body computed tomography (CT). EAT was measured on CMR, and VAT, SAT and waist circumference (WC) were measured on CT. Linear regression analysis was used to assess associations between EAT and other AT depots.

Results: In total, 68 patients were included. Mean age was 73 ± 8 years; 34 (50%) were women. Twenty-six patients (38%) were obese, while 60 (91%) had increased WC and 58 (85%) had increased VAT. Body mass index (BMI) and WC were comparable between men and women, but men had more EAT (217 vs. 180 mL, P < 0.001) and VAT (306 vs. 196 cm2, P < 0.001), but less SAT (177 vs. 276 cm2, P < 0.001), as compared with women. After adjusting for age, gender and BMI, VAT was only associated with EAT, albeit modest (β = 0.40, P < 0.001, R2 = 0.40), but not with SAT.

Conclusions: The distribution of various AT depots is markedly different between men and women with HFpEF. Men have more VAT and EAT, but less SAT. The observed variation in AT depots may potentially contribute to gender-related differences in cardiovascular risk.

Keywords: AI‐assisted software; HFpEF; epicardial adipose tissue; multimodality imaging; obesity; subcutaneous adipose tissue; visceral adipose tissue.

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Conflict of interest statement

T. M. G. is supported by the Mandema‐Stipend of the Junior Scientific Masterclass 2020‐10 of the University Medical Centre Groningen. M. R. reports unrestricted grants from ZonMW, the Dutch Heart Foundation; DECISION project 848090001, the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation; EmbRACE (01‐002‐2022‐0118), RACE V (CVON 2014–9), RED‐CVD (CVON2017‐11); the Top Sector Life Sciences & Health to the Dutch Heart Foundation PPP Allowance; CVON‐AI (2018B017); and European Union's Horizon 2020 research and innovation program (EHRA‐PATHS 945260). The UMCG, which employs M. R., has received consultancy fees from Bayer and InCarda Therapeutics. All the other authors have nothing to disclose.

Figures

Figure 1
Figure 1
(A) Transversal CT image of one of the patients. (B) Abdominal AT and muscle compartments measured semi‐automatically using artificial intelligence‐assisted analysis (SarcoMeas AI v1.00). SAT is highlighted in blue, muscle tissue in red, intramuscular AT in green and VAT in yellow.
Figure 2
Figure 2
Distribution of epicardial adipose tissue (EAT), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in men and women. *P value < 0.05, ***P value < 0.001.
See this image and copyright information in PMC

References

    1. Rao VN, Fudim M, Mentz RJ, Michos ED, Felker GM. Regional adiposity and heart failure with preserved ejection fraction. Eur J Heart Fail 2020;22:1540‐1550. doi: 10.1002/ejhf.1956 - DOI - PMC - PubMed
    1. Koskinas KC, Van Craenenbroeck EM, Antoniades C, Bluher M, Gorter TM, Hanssen H, et al. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur Heart J 2024;32:ehae508. doi: 10.1093/eurjpc/zwae279 - DOI - PubMed
    1. Neeland IJ, Poirier P, Despres JP. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. Circulation 2018;137:1391‐1406. doi: 10.1161/CIRCULATIONAHA.117.029617 - DOI - PMC - PubMed
    1. Despres JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation 2012;126:1301‐1313. doi: 10.1161/CIRCULATIONAHA.111.067264 - DOI - PubMed
    1. Pandey A, Kondamudi N, Patel KV, Ayers C, Simek S, Hall ME, et al. Association between regional adipose tissue distribution and risk of heart failure among blacks. Circ Heart Fail 2018;11:e005629. doi: 10.1161/CIRCHEARTFAILURE.118.005629 - DOI - PubMed

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