Importance of epicardial adipose tissue localization using cardiac magnetic resonance imaging in patients with heart failure with mid-range and preserved ejection fraction

G. van Woerden, D.J. van Veldhuisen, T.M. Gorter, V.P.M. van Empel, M.E.W. Hemels, E.J. Hazebroek, S.L. van Veldhuisen, T.P. Willems, M. Rienstra, B.D. Westenbrink*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)


Background Epicardial adipose tissue (EAT) has been implicated in the pathophysiology of heart failure (HF) with left ventricular ejection fraction (LVEF) >40%, but whether this is due to a regional or global effect of EAT remains unclear.

Hypothesis Regional EAT is associated with alterations in local cardiac structure and function.

Methods Patients with HF and LVEF >40% were studied. Cardiac Magnetic Resonance imaging was used to localize EAT surrounding the right ventricle (RV) and LV separately, using anterior- and posterior interventricular grooves as boundaries. Atrial- and ventricular EAT were differentiated using the mitral-valve position. All EAT depots were related to the adjacent myocardial structure.

Results 102 consecutive HF patients were enrolled. The majority of EAT was present around the RV (42% of total EAT, p < .001). RV-EAT showed a strong association with increased RV mass (beta = 0.60, p < .001) and remained associated with RV mass after adjusting for total EAT, sex, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), renal function and blood glucose. LV-EAT showed a similar association with LV mass in univariable analysis, albeit less pronounced (beta = 0.24, p = .02). Atrial EAT was increased in patients with atrial fibrillation compared to those without atrial fibrillation (30 vs. 26 ml/m(2), p = .04), whereas ventricular EAT was similar (74 vs. 75 ml/m(2), p = .9).

Conclusions Regional EAT is strongly associated with local cardiac structure and function in HF patients with LVEF >40%. These data support the hypothesis that regional EAT is involved in the pathophysiology of HF with LVEF >40%.

Original languageEnglish
Pages (from-to)987-993
Number of pages7
JournalClinical Cardiology
Issue number7
Publication statusPublished - 1 Jul 2021


  • cardiac magnetic resonance imaging
  • EAT
  • HFmrEF
  • HFpEF

Cite this