Clinical Trials Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2024; 16(3): 149-160
Published online Mar 26, 2024. doi: 10.4330/wjc.v16.i3.149
Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study
Ju-Wei Shao, Bing-Hua Chen, Kamil Abu-Shaban, Ahmad Baiyasi, Lian-Ming Wu, Jing Ma
Ju-Wei Shao, Department of Radiology, The Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan Province, China
Bing-Hua Chen, Lian-Ming Wu, Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Kamil Abu-Shaban, Department of Radiology, University of Toledo College of Medicine, Toledo, OH 43623, United States
Ahmad Baiyasi, Department of Radiology, Wayne State University School of Medicine, Detroit, MI 48201, United States
Jing Ma, Department of Endocrinology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Co-first authors: Ju-Wei Shao and Bing-Hua Chen.
Co-corresponding authors: Jing Ma and Lian-Ming Wu.
Author contributions: Shao JW and Wu LM were scientific study designers; Ma J, Chen BH, and Wu LM were involved in data collection; Shao JW and Chen BH contributed to data analysis; and Shao JW, Abu-Shaban K, Baiyasi A, and Wu LM were involved in manuscript writing and revision; All authors read and approved the final manuscript; Special thanks to Booth TC for revising the manuscript. Ma J and Wu LM as co-corresponding authors are threefold. First, the research was conducted through a joint effort, with co-corresponding authorship rightly mirroring the shared workload and commitment needed for both the study's execution and the ensuing publication. This approach also facilitates efficient handling of post-submission processes, thereby bolstering the paper's integrity and excellence. Second, the research group comprised individuals with varied specialties and backgrounds, making the appointment of co-corresponding authors a representation of this multidisciplinary nature. This arrangement allows for a thorough and nuanced exploration of the subject matter, thereby deepening the reader's comprehension through diverse expert insights. At last, Ma Jing and Wu LM made equally significant contributions throughout the research journey. Selecting them as co-corresponding authors honors their joint efforts, underscoring the importance of teamwork and cooperative spirit inherent in this project.
Supported by National Natural Science Foundation of China, No. 81873887; National Natural Science Foundation of China Youth Project, No. 82101981; and Shanghai Jiao Tong University School of Medicine Double Hundred Outstanding Person Project, No. 20191904.
Institutional review board statement: This is a retrospective study. All the data are from our database. All patients were anonymised and the data collection was a health check.
Clinical trial registration statement: We didn't register this trial on the Clinical Trial Registration platform prior to this trial.
Informed consent statement: This is a retrospective study. All the data are from our database. All patients were anonymised and the data collection was a health check. We have signed Informed Consent Form for this study.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Ma, MD, PhD, Doctor, Professor, Department of Endocrinology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai 200127, China. majing202301@163.com
Received: November 23, 2023
Peer-review started: November 23, 2023
First decision: December 27, 2023
Revised: January 9, 2024
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: March 26, 2024
Abstract
BACKGROUND

Obesity has become a serious public health issue, significantly elevating the risk of various complications. It is a well-established contributor to Heart failure with preserved ejection fraction (HFpEF). Evaluating HFpEF in obesity is crucial. Epicardial adipose tissue (EAT) has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets. Hence, assessing EAT is of paramount importance. Cardiovascular magnetic resonance (CMR) imaging is acknowledged as the gold standard for analyzing cardiac function and morphology. We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.

AIM

To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction [HFpEF; left ventricular (LV) ejection fraction ≥ 50%] by measuring the epicardial adipose tissue (EAT) volumes and EAT mass in obese patients.

METHODS

Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF. The two groups were defined as HFpEF+ and HFpEF-. LV geometry, global systolic function, EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.

RESULTS

Forty-five patients of HFpEF- group and seventeen patients of HFpEF+ group were included. LV mass index (g/m2) of HFpEF+ group was higher than HFpEF- group (P < 0.05). In HFpEF+ group, EAT volumes, EAT volume index, EAT mass, EAT mass index and the ratio of EAT/[left atrial (LA) left-right (LR) diameter] were higher compared to HFpEF- group (P < 0.05). In multivariate analysis, Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.

CONCLUSION

EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients. It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker. Further prospective studies, are needed to validate these proof-of-concept findings.

Keywords: Heart failure with preserved ejection fraction, Epicardial adipose tissue, Obesity, Cardiac magnetic resonance

Core Tip: The purpose of this research is to assess the diagnostic utility of cardiovascular magnetic resonance for evaluating heart failure with preserved ejection fraction (HFpEF) by measuring the epicardial adipose tissue (EAT) volumes in obesity. There is a strong correlation between increased EAT volumes and HFpEF in obesity. Moreover, EAT/Left atrial left-right (LA LR) diameter ratio is highly associated with HFpEF in obesity. Given the significant findings, there may be some diagnostic utility in cardiac magnetic resonance for assessing obesity for HFpEF.