Epicardial vs Visceral Adiposity in Patients with HFpEF

Dr. Kamal Kishor, Interventional Cardiologist, HOD, Dept. of Cardiology, Rama Heart Centre, Karnal, Haryana, India

“Understanding how fat is distributed in HFpEF may offer a clearer path to better risk prediction and more tailored treatment strategies.”

A recent study published in ESC heart failure examined how different adipose tissue (AT) depots contribute to heart failure with preserved ejection fraction (HFpEF), a condition in which obesity is highly prevalent and fat distribution may influence disease mechanisms.

Researchers prospectively enrolled 68 patients with HFpEF, defined by a left ventricular ejection fraction greater than 40%. All participants underwent cardiac magnetic resonance imaging to measure epicardial adipose tissue (EAT) and total-body computed tomography to quantify visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and to measure waist circumference. Linear regression was used to assess the relationship between EAT and other fat depots.

The average patient age was 73 years, and 50% of the were women. Obesity was present in 38% of the cohort, while most patients had increased waist circumference (91%) and elevated VAT (85%). Although men and women had similar body mass index and waist circumference, fat distribution differed markedly. Men showed significantly higher volumes of EAT and VAT, whereas women had higher SAT. After adjusting for age, sex, and BMI, EAT showed a modest but significant association with VAT, while no meaningful association was found with SAT.

These findings conclude a clear sex-related difference in fat distribution among patients with HFpEF. Higher levels of VAT and EAT in men may help explain observed gender differences in cardiovascular risk and HFpEF progression .Evaluating adipose distribution could improve risk assessment and guide personalized treatment, warranting further targeted research.

(Source: Lobeek M, Csecs I, Westenbrink BD, et al. Epicardial, visceral and subcutaneous adipose tissue in heart failure with preserved ejection fraction. ESC Heart Fail. 2025;12(5):3353-3360. doi:10.1002/ehf2.15396.; https://pmc.ncbi.nlm.nih.gov/articles/PMC12450799/)