Epicardial adipose tissue volume is an independent predictor of left ventricular reverse remodeling in patients with non-ischemic cardiomyopathy

https://doi.org/10.1016/j.ijcard.2022.03.051Get rights and content

Highlights

  • Patients with improved left ventricular ejection fraction have a better prognosis.

  • The higher the EAT volume, the more likely LV reverse remodeling will occur in patients with non-ischemic cardiomyopathy.

  • A decrease in EAT volume in patients with reduced cardiac function means that the stage of heart failure is already advanced.

Abstract

Background

In some patients with non-ischemic cardiomyopathy, left ventricular (LV) contraction is improved by optimal medical therapy, leading to LV reverse remodeling (RR). Patients with heart failure with improved ejection fraction and LVRR have a good prognosis, but the factors that predict RR are not fully understood. The relationship between body composition and cardiovascular disease has been reported. The present study aimed to assess the clinical predictors of LVRR in association with body composition.

Methods

We recruited patients who were diagnosed with non-ischemic cardiomyopathy between September 2017 and January 2020. Finally, 89 patients with a reduced LV ejection fraction were enrolled in this prospective study. Body composition, including ectopic fat, was measured in all patients using computed tomography. Echocardiography was performed 6 months after enrollment to evaluate LVRR.

Results

LVRR was observed in 39 patients (43.8%) after 6 months. In terms of the demographic findings, epicardial adipose tissue volume was greater in the LVRR group than in the non-LVRR group (135.2 cm3 [SD 128.4 cm3] vs. 88.9 cm3 [SD 54.6 cm3]; p = 0.040). The Kaplan–Meier analysis demonstrated that adverse cardiac events were significantly less frequent in the LVRR group than in the non-LVRR group (log-rank test, p = 0.013). The multivariate logistic regression analysis identified epicardial adipose tissue volume as an independent predictor of LVRR (odds ratio [OR]: 1.010, 95% confidence interval [CI]: 1.001–1.01; p = 0.036).

Conclusion

Epicardial adipose tissue volume is an independent predictor of LVRR in patients with non-ischemic cardiomyopathy.

Introduction

Heart failure (HF) is a leading cause of death in many countries [1,2]. It is caused by various factors, such as epicardial, myocardial, and endocardial disease; valvular disease; coronary artery disease; aortic disease; arrhythmia; and endocrine abnormalities. Because the treatment and evaluation methods for HF depend on left ventricular (LV) function, LV ejection fraction (EF) is used for classification and treatment selection in patients with HF. HF with preserved LVEF (typically considered as an LVEF of ≥50%) is defined as HFpEF, and HF with reduced LVEF (typically considered as an LVEF of ≤40%) is defined as HFrEF. Patients with an LVEF in the range of 41%–49% are defined as having HF with mid-range LVEF [3].

In some patients with non-ischemic cardiomyopathy, LV contraction is improved by optimal medical therapy (HF with improved EF [HFimpEF]). [4] These patients are known to have a better prognosis than patients in which LV contraction is not improved (HFrEF). [[5], [6], [7]] Predictors of LV reverse remodeling (RR) include younger age, presence of atrial fibrillation (AF), a smaller LV end-diastolic diameter (LVEDD), a higher LVEF at the first assessment [5], and diabetes mellitus [7].

The relationship between body composition and cardiovascular disease has also been reported. In a previous study, an increase in visceral fat area (VFA), but not subcutaneous fat area (SFA), was associated with a decrease in LV strain in participants without overt cardiac disease [8]. Epicardial adipose tissue (EAT) volume was considered to be independently associated with coronary artery stenosis [9] and new-onset AF [10]. In addition, sarcopenia was associated with a poor prognosis in patients with HF [11]. We recently reported the importance of assessing intramuscular fat (IMF) in the thigh in addition to assessing muscle mass in patients with non-ischemic cardiomyopathy [12]. However, many aspects of the relationship between body composition and LVRR are still unclear. In the present study, we investigated the relationship between body composition, functional status, and LVRR.

Section snippets

Study population

We recruited patients who were admitted for the first time to identify the cause of poor cardiac function between September 2017 and January 2020. Eligible patients were aged ≥18 years. During hospitalization, all patients underwent echocardiography and cardiac catheterization including coronary angiography for initial diagnosis. Patients with ischemic cardiomyopathy diagnosed by cardiac catheterization were excluded. Other exclusion criteria were 1) LVEF >40%; 2) severe valvular heart disease;

Patient population

A study flowchart is shown in Supplementary Fig. S1. Ninety-seven patients with a reduced LVEF were enrolled in this prospective study. Two patients died and 6 patients withdrew within 6 months; thus, 89 patients were analyzed. The clinical characteristics of the LVRR and non-LVRR groups are shown in Table 1. Thirty-nine patients (43.8%) were allocated to the LVRR group, and 50 patients (56.2%) were allocated to the non-LVRR group. There were no significant differences in age, sex. Most

Discussion

Our study demonstrated that EAT volume is an independent predictor of LVRR. A previous report demonstrated that EAT volume in patients with dilated cardiomyopathy is lower than in healthy controls [19]. However, to the best of our knowledge, this is the first report to demonstrate the apparent relationship between EAT volume and LVRR in patients with non-ischemic cardiomyopathy. Furthermore, what is unprecedented in this study is that CPX and muscle strength measurements were performed in all

Study limitations

This study has several limitations that should be noted. First, as a prospective study conducted at a single center with a relatively small number of patients, the results may not apply to the general population. Second, we analyzed patients with non-ischemic cardiomyopathy with a reduced LVEF, which might have included several different HF etiologies. In fact, 25% of these patients had dilated cardiomyopathy, while approximately 15% had AF. Third, scheduled catheter ablation was not included

Conclusion

In this study, epicardial adipose tissue volume was an independent predictor of LVRR in patients with non-ischemic cardiomyopathy.

The following are the supplementary data related to this article.

. Study population. EF, ejection fraction; LVEF, left ventricular ejection fraction. LVRR (left ventricular reverse remodeling): LVEF ≤40% at baseline and > 40% and EF improved ≥10% at 6 months. Non-LVRR: LVEF ≤40% throughout follow-up.

. Comparison of body composition parameters in the

Declaration of Competing Interest

This work was supported by a Grant-in-Aid for Young Scientists from the Japan Society for the Promotion of Science (A.S., 20K17091). The other authors have no conflicts of interest to declare.

Acknowledgment

Muscle strength was measured by Masashi Shimizu and Kodai Taniguchi, who are physiotherapists at Osaka City University Graduate School of Medicine. We thank Emily Woodhouse, PhD, from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript.

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    This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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