Epicardial fat remodeling in end-stage heart failure with reduced ejection fraction
Authors' conclusion
LV EAT in HFrEF contains smaller adipocytes and has higher density in CT images, exhibits pronounced cell size/density gradient and is more heterogeneous than in non-HF subjects. Thus LV EAT undergoes complex remodeling in HFrEF. Further studies are needed to elucidate the mechanisms driving this remodeling, determine whether it can be therapeutically targeted, and assess which parameters may have prognostic value in patients with HFrEF.
Study context
- Population
- Patients with end-stage heart failure with reduced ejection fraction (HFrEF) scheduled for left ventricular assist device (LVAD) or orthotopic heart transplantation (OHT), and non-HF controls; histology also from 20 unused healthy donor hearts
- Participants
- 70 vs 50
- Exposure
- HFrEF vs non-HF controls
- HFrEFn = 70
- Non-HFn = 50reference
- Outcome
- EAT characteristics
Methodological detailshistological, computed tomography (CT) imaging and radiomic analysis
- Histological, CT imaging and radiomic analysis
Main finding
As reported in the abstract
- Total epicardial adipose tissue (EAT) volume did not differ between non-HF and HFrEF
- EAT density on CT higher in HFrEF
- Periventricular EAT density gradient, densest voxels adjacent to myocardium (up to 1 mm); extended to almost 3 mm in LV EAT in HFrEF
- Adipocyte size gradient (smaller cells adjacent to myocardium) more pronounced in HFrEF than non-HF
- Median LV EAT adipocyte size smaller in HFrEF vs non-HF
- EAT fibrosis and blood vessel density did not differ between non-HF and HFrEF
- EAT more heterogeneous in HFrEF than non-HF on histological and radiomic analysis; most pronounced in LV EAT, RV and periatrial depots also affected
Observational data: associations, not effects.
Original publication
Epicardial fat remodeling in end-stage heart failure with reduced ejection fraction. Cardiovasc Diabetol. Published 15 February 2026. doi:10.
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