Epicardial fat volume assessment via cardiac computed tomography: a novel indicator in heart failure with preserved ejection fraction

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a complex condition characterized by high morbidity and mortality, frequently within multiple comorbidities like obesity. Pathophysiology of HFpEF is implicated by emerging evidence that epicardial adipose tissue (EAT) or epicardial fat serves an essential function. This research intends to determine the association between EAT volume and HFpEF using cardiac computed tomography and correlate it with echocardiographic parameters of diastolic dysfunction. Results This case–control study included 80 participants (40 HFpEF patients and 40 matched controls). HFpEF patients exhibited significantly higher EAT volume (147.9 ± 28.6 cm3) compared to controls (98.3 ± 20.4  cm3, P ≤ 0.001). EAT volume showed a strong positive correlation with increased left ventricular end-diastolic pressure (r = 0.9, P ≤ 0.001) and mean E/e′ ratio (r = 0.9, P ≤ 0.001). ROC analysis exhibited an optimal cutoff value of > 124 cm3 for EAT volume, with an area under the curve (AUC) of 0.9, yielding a sensitivity of 87.5% and specificity of 95% for diagnostic accuracy of HFpEF. Conclusions EAT volume is significantly elevated in HFpEF patients and correlates with diastolic dysfunction severity, and is independent predictor for HFpEF highlighting its potential as a noninvasive marker for diagnosing and monitoring HFpEF. EAT assessment may offer new insights into targeted therapeutic strategies for managing HFpEF.