Interplay of Epicardial Fat and Left Atrial Phasic Strain predict the Development of HFpEF in Patients with Coronary Artery Disease

Alexander James Küng (Essen)1, I. Dykun (Essen)1, P. Lüdike (Essen)1, F. Al-Rashid (Essen)1, M. Totzeck (Essen)1, T. Rassaf (Essen)1, A.-A. Mahabadi (Essen)1

1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland



Epicardial Adipose Tissue (EAT) as visceral adipose tissue surrounding the myocardium and the coronary arteries is a predictor of heart failure with preserved ejection fraction (HFpEF). Likewise, it is associated with LA size and function. However, the interplay between EAT and LA function with HFpEF development has not been evaluated in detail. 



We aimed to determine the association between the amount of EAT with left atrial phasic strain. In addition, we evaluated the interplay of EAT and LA strain on the development of a HFpEF. 


Methods and results:

In our retrospective analysis we incorporated a cohort of 379 patients (mean age: 65,12 ± 11,49 years, 70% male), all diagnosed with coronary artery disease (prior revascularization therapy) but without pre-existing heart failure at the initial evaluation. These patients underwent comprehensive clinical and echocardiographic assessments between 2010 and 2013, followed by a subsequent evaluation in the years 2014 to 2018. EAT thickness was determined by two-dimensional TTE with measurements performed offline by a single reader on a dedicated workstation using the Philips QLAB software Version 2.3. The assessment of strain was performed using the TOMTEC- Arena 2D Cardiac Performance Analysis software (Philips Healthcare, Best, NL) based on two-dimensional grey-scale echocardiographic images. The LA reservoir, conduit and pump strain was measured as LA phasic strain. They were obtained using two-chamber view or four-chamber view, if the two-chamber view was unavailable. 

Logistic regression analysis was used for assessment of the association between the different strain phases and EAT thickness. EAT thickness was logarithmized due to its right-skewed distribution. In univariate logistic regression an increase of EAT was associated with a decrease of LA GLS (beta estimate [95% confidence interval] -2.07 [-4,12 – (-0.20), p = 0.048], LA Reservoir Strain -2.26 [-4.51 – (-0.002), p = 0,050] and LA Pump Strain  -1.97 [-3.57 – (-0.37), p =0.016], but not with LA Conduit Strain -0.18 [-1.88 – 1.52, p = 0.84]. In a binary logistic regression LA GLS and EAT are both independent predictors for the development of heart failure with preserved ejection fraction OR 0.55 [0.41 – 0.73, p < 0.001] and 3.00 [1.64 – 5.49, p < 0.001]



In a cohort of patients with coronary artery disease but without heart failure at baseline epicardial adipose tissue was associated with various left atrial strain parameters. LA global longitudinal strain and EAT independently predicted the development of heart failure with preserved ejection fraction. 

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