Association of Cardiac MRI ‐Derived Epicardial Adipose Tissue Index With Adverse Clinical Outcomes in Heart Failure With Preserved Ejection Fraction

ABSTRACT Background The clinical relevance of the epicardial adipose tissue index (EATI) is increasingly recognized, but its association with clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF) remains inadequately investigated. Purpose To evaluate the association between cardiac MRI‐derived EATI and major adverse cardiovascular events (MACE) in patients with HFpEF. Study Type Retrospective. Population Two hundred sixty‐five patients with HFpEF (135 male; mean age 55 years). Field Strength/Sequence 1.5 T/balanced steady‐state free precession. Assessment EATI was quantified on cardiac MRI cine images. MACE was defined as cardiac death or readmission for heart failure. Statistical Tests Welch t ‐test or Mann–Whitney U test, Cox proportional hazards regression, Kaplan–Meier analysis with log‐rank test, and global χ 2 model comparison. A p value < 0.05 was considered significant. Results During a median follow‐up of 33 months (22‐65), 42 patients experienced MACE. EATI was significantly higher in the MACE group than in the no‐MACE group (33.65 ± 13.91 vs. 26.13 ± 11.28 mL/m 2 , Z = −3.52, effect size r = −0.22). EATI was independently associated with MACE (multivariable HR = 1.04 [95% CI: 1.01–1.06]). Kaplan–Meier survival analysis confirmed that patients with low EATI had significantly higher event‐free survival rate. A model combining EATI with other clinical and conventional imaging risk factors ( χ 2 = 42.3) showed significantly improved model discrimination for identifying patients at risk of MACE compared with models with clinical variables ( χ 2 = 26.0) or clinical and conventional imaging variables ( χ 2 = 34.3). Data Conclusion Cardiac MRI‐derived EATI was independently associated with MACE in patients with HFpEF and showed favorable discriminatory performance compared with clinical and conventional imaging risk factors. Evidence Level 3. Technical Efficacy Stage 5.