Introduction Epicardial adipose tissue (EAT) is a biologically active type of visceral fat between the pericardium and the myocardium. It is thought to have both cardioprotective and harmful functions but what mechanisms regulate this balance remain unclear. Limited literature exists on its prognostic role in aortic stenosis (AS). We investigated the association of EAT and survival in patients with AS.
Methods Consecutive patients (n=119, age 75.7±10.1 years, 70.6% male) with AS who underwent late-gadolinium contrast enhanced cardiovascular magnetic resonance (LGE-CMR) on an 1.5T Siemens were identified retrospectively. EAT was quantified on CMR and indexed to myocardial mass (Circle CVI, Calgary, Canada) (figure 1). Survival status was acquired from the Office of National Statistics. Univariate and multivariate linear regression analyses identified predictors of EAT and mortality.
Results Over a mean follow up of 4.2 ± 2.4 years, 61 (51%) patients died. On univariate analysis, age (HR 1.050, 95% CI 1.018-1.082, p=0.002), NYHA class (HR 1.421, 95% CI 1.004-2.012, p=0.048), indexed left ventricular end-diastolic volume (LVEDV) (HR 1.009, 95% CI 1.001-1.017, p=0.025), indexed left ventricular end-systolic volume (LVESV) (HR 1.010, 95% CI 1.002-1.018, p=0.014), LnNT-proBNP (HR 1.265, 95% CI 1.035-1.547, p=0.022), high sensitivity troponin I (HR 1.000, 95% CI 1.000-1.000, p=0.001), osteopontin (HR 1.002, 95% CI 1.001-1.003, p=0.001), osteoprotegerin (HR 1.143, 95% CI 1.052-1.242, p=0.002), ST2 (HR 1.013, 95% CI 1.006-1.021, p=0.001) and albumin (HR 0.931, 95% CI 0.887-0.977, p=0.004) were all associated with increased mortality. EAT volume indexed to myocardial mass was not associated with mortality (HR 0.646, 95% CI 0.135-3.097, p=0.585). On stepwise forward regression analysis, only undergoing any intervention (TAVI or AVR) remained a significant predictor of increased survival (HR 0.308, 95% CI 0.159-0.597, p<0.001) (table 1). ST2 (HR 1.020, 95% CI 1.003-1.037, p=0.022) and LnNT-proBNP (HR 1.285, 95% CI 1.036-1.594, p=0.022) were the only significant predictors for poor mortality (table 1).
Discussion Higher volume of EAT indexed to myocardial mass was not associated with mortality in patients with AS. The variables that did remain significant after adjustment were ST2, NT-proBNP and undergoing intervention.
Conclusions Higher EAT volume indexed to myocardial mass was not significantly associated with mortality after adjusting for other variables in patients with AS.
Conflict of Interest None
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