Epicardial Adipose Tissue, Functional Status, and Invasive Hemodynamics in Heart Failure With Preserved Ejection Fraction

Background: Epicardial adipose tissue (EAT) may play a role in the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). Objectives: This study examined associations between increased EAT, functional status, and invasive exercise hemodynamics in a large cohort of HFpEF patients. Methods: All patients underwent echocardiography, 6-minute walk distance (MWD) test, Kansas City Cardiomyopathy Questionnaire, and invasive hemodynamic assessment at rest and during ergometry. EAT thickness was measured alongside the right ventricle on echocardiography, expressed in mm and patients were divided according to EAT tertiles. Results: In total, 566 patients were examined with mean age 72 ± 8 years, 62% women, mean EAT thickness was 6.0 ± 2.4 mm and 11.5% had EAT ≥9 mm. With increasing EAT thickness tertiles, 6-MWD and Kansas City Cardiomyopathy Questionnaire overall summary score were significantly lower (320 [247-385] vs 315 [244-383] vs 287 [210-364] meters, P = 0.001; 51 [32-67] vs 45 [32-63] vs 41, [26-56], P = 0.003; respectively), whereas the latter was independent of body mass index (P = 0.004). At rest, invasive hemodynamics were not different across EAT tertiles. At peak exercise, patients in the highest EAT thickness tertile had higher pulmonary capillary wedge pressure and pulmonary capillary wedge pressure to right atrial pressure gradient, compared to patients in the first and second EAT thickness tertiles (36 ± 8 vs 34 ± 8 mm Hg, P = 0.009; 18 ± 7 vs 16 ± 7 mm Hg, P = 0.002, respectively). Conclusions: EAT thickness was associated with impaired quality of life, lower 6-MWD, and higher left-sided filling pressures at peak exercise. Excess EAT may therefore play an important role in functional status and exercise hemodynamics in patients with HFpEF.