Impact of Epicardial Adipose Tissue on Heart Failure with Reduced Ejection Fraction: A Coronary computed tomography Angiography-Based Imaging Analysis

Abstract Objective This study aimed to explore the association between epicardial adipose tissue (EAT) volume quantified by coronary computed tomography angiography (CCTA) and prognosis in patients with heart failure with reduced ejection fraction (HFrEF). Patients and methods: In this retrospective study, 119 HFrEF patients undergoing CCTA between January 2022 and December 2023 were enrolled. EAT volume were semi-automatically quantified using CCTA sequences. The primary endpoint was the composite outcome of all-cause mortality and heart failure rehospitalization during follow-up. Cox regression and Kaplan–Meier analyses assessed the association between EAT volume and events. Conventional and time-dependent receiver operating characteristic (ROC) analyses were used to evaluate predictive performance, and the corresponding areas under the curve (AUC) were calculated. Results Over a median 649-day follow-up, 50 patients (42.0%) experienced endpoint events. Compared with patients without endpoint events, those with endpoints had lower EAT volume (56.55 ± 21.33 cm³ vs. 74.64 ± 25.19 cm³, P < 0.001) and higher EAT density (-72.94 ± 6.80 Hounsfield Units vs. -76.61 ± 5.07 Hounsfield Units, P = 0.002). Multivariate regression analysis showed that EAT volume was an independent prognostic predictor in HFrEF patients; lower EAT volume was associated with poorer prognosis, with a determined cut-off value of 65.53 cm³. Subgroup analysis revealed that patients with lower EAT volume combined with lower body mass index had the poorest prognosis compared with other subgroups. Conclusion In patients with HFrEF, EAT volume is an independent prognostic predictor with moderate predictive value, and its cut-off value may provide additional information for clinical management.