EAT Thickness as a Predominant Feature for Evaluating Arterial Stiffness in Patients with Heart Failure with Preserved Ejection Fraction

Figures & data

Figure 1 Population selection flow diagram.

Notes: Infection was defined as pneumonia, bacteremia, sepsis or unknown causes with white blood cell (WBC)> 15×10⁹/L and procalcitonin (PCT) >2.5 ng/mL. Hepatic insufficiency was defined as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) > 3 times of upper limit of normal (ULN) value.

Figure 2 Ultrasound diagnostic apparatus assessment of epicardial adipose tissue (EAT) which was marked by the red arrow.

Abbreviations: LV, left ventricle; LA, left atrium; AO, aorta; RV, right ventricle.

Figure 3 The receiver operating characteristic (ROC) curve of the EAT for predicting arterial stiffness.

Notes: The area under the curve (AUC) for arterial stiffness was 0.759. The best cut-off of EAT thickness to predict arterial stiffness was 3.55 mm with the sensitivity of 67.1% and the specificity of 70.0% (95% CI 0.645-0.873).

Table 1 Characteristics of the Study Population According to EAT Thickness

	Total (n=102)	EAT<3.55mm (n=41)	EAT≥3.55mm (n=61)	P value
Demography
Gender/male (n, %)	44/102 (43%)	21/41 (51%)	23/61 (38%)	0.146
Age (years)	74 (68, 80)	73 (65, 78.5)	74.0 (70.0, 80.5)	0.144
Comorbidities
Hypertension (n, %)	53/102 (52%)	14/41 (34%)	39/61 (64%)	0.005
CAD (n, %)	45/102 (44%)	10/41 (24%)	35/61 (57%)	0.001
Diabetes (n, %)	32/102 (31%)	8/41 (20%)	24/61 (39%)	0.047
Hyperlipidemia (n, %)	12/102 (12%)	1/41 (2%)	11/61 (18%)	0.039
Personal history
Smoking (n, %)	18/102 (18%)	9/41 (22%)	9/61 (15%)	0.241
Alcohol consumption (n, %)	19/102 (19%)	7/41 (17%)	12/61 (20%)	0.877
Vital signs
Heart rate (bmp)	76 (68, 88)	74.50 (66, 85.75)	78 (69.50, 90)	0.193
SBP (mmHg)	135±24.45	132.87±24.03	136.83±24.81	0.441
DBP (mmHg)	77.35±13.85	75.74±15.64	78.41±12.56	0.357
baPWV (cm/s)	2005.46±502.05	1832.73±534.15	2121.55±447.21	0.004
Echocardiogram
E wave (cm/s)	70.10 (49.90, 89.00)	72.9 (45.90, 90.70)	69.85 (53.35, 86.85)	1.000
e’, septal (cm/s)	4.80 (4.00, 6.20)	5.15 (3.95, 6.48)	4.70 (3.95, 5.85)	0.374
e’, lateral (cm/s)	7.20 (5.17, 9.00)	7.70 (5.00, 10.20)	7.00 (5.20, 7.90)	0.219
Mean E/e’ (cm/s)	12.11 (9.19, 15.81)	10.83 (8.20, 16.31)	12.56 (9.72, 15.74)	0.257
*LAVI (mL/m^2)	38.80 (29.25, 62.15)	49.05 (29.75, 63.48)	35.20 (28.90, 60.70)	0.318
*LVMI (g/m^2)	122.63±32.92	126.58±31.65	119.90±33.78	0.377
^&LAVI (mL/m^2)	24.65 (18.49, 39.58)	29.31 (18.64, 38.42)	23.68 (17.94, 42.43)	0.472
^&LVMI (g/m^2.7)	56.41±16.71	56.89±15.55	56.09±17.57	0.896
EF (%)	60.45±5.30	60.47±5.63	60.43±5.12	0.974
Anthropometrics
Waist circumference (cm)	88.34±10.42	83.83±8.19	91.24±10.75	0.002
Waist/Hip ratio	0.92±0.06	0.89±0.06	0.93±0.07	0.012
AC (cm)	91.56±10.46	87.59±9.17	94.18±10.21	0.007
BMI (kg/m^2)	24.05±3.93	22.85±3.29	24.84±4.14	0.007
Body fat mass (%)	18.20 (12.95, 21.53)	16.20 (10.95, 19.45)	19.90 (13.70, 24.15)	0.028
Visceral fat area (cm^2)	134.48±27.72	124.86±27.43	140.47±26.46	0.018
Fat percentage (%)	27.71±9.91	25.07±9.60	29.42±9.83	0.064
Obesity degree (%)	12.49 (0.00, 26.58)	5.93 (−1.91, 19.39)	15.51 (3.61, 29.84)	0.027
EAT (mm)	4.05 (3.20, 5.85)	3.00 (2.45, 3.25)	5.40 (4.30, 7.00)	<0.001
Laboratories
CRP (mg/L)	4.22 (2.27, 10)	3.42 (2.26, 10)	4.30 (2.34, 10.23)	0.624
WBC (10^9/L)	6.92±2.46	6.49±2.13	7.18±2.62	0.207
FBG (mmol/L)	5.95 (5.10, 6.90)	5.30 (4.90, 6.80)	6.10 (5.40, 7.00)	0.021
HbA1c (%)	6.00 (5.65, 6.70)	5.75 (5.33, 6.38)	6.10 (5.80, 6.95)	0.004
TC (mmol/L)	3.93±1.07	3.59±1.08	4.14±1.01	0.014
TG (mmol/L)	1.17 (0.84, 1.96)	0.90 (0.67, 1.18)	1.28 (0.99, 2.11)	<0.001
LDL (mol/L)	2.29±0.93	2.06±0.86	2.44±0.95	0.067
H2FPEF risk score	4.00 (3.00, 5.00)	3.00 (2.00, 3.75)	4.00 (3.00, 6.00)	<0.001
HFA-PEFF risk score	6.00 (4.00, 6.00)	4.00 (4.00, 6.00)	6.00 (5.00, 6.00)	<0.001

Notes: *Adjusted by body surface area (BSA) using the following calculation formula: LVMI=LVM/BSA, LAVI=LAV/BSA. ^&adjusted by height using the following calculation formula: LVMI=LVM/height^2.7, LAVI=LAV/height².

Abbreviations: CAD, coronary artery disease; SBP, systolic blood pressure; DBP, diastolic blood pressure; LAVI, left atrial volume index; LVMI, left ventricular mass index; EF, ejection fraction; AC, abdominal circumference; BMI, body mass index; CRP, c-reactive protein; WBC, white blood cell; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; TC, total cholesterol; TG, triglyceride; LDL, low-density lipoprotein; EAT, epicardial adipose tissue; baPWV, brachial-ankle pulse wave velocity.

Table 2 Correlation Analysis Among Epicardial Fat Thickness, baPWV, and Other Variables

	BaPWV (cm/s)		EAT (mm)
	r	P value	r	P value
EAT (mm)	0.382	<0.001
Age (years)	0.294	0.003	0.151	0.131
Heart rate (bpm)	0.248	0.012	0.127	0.207
BMI (kg/m^2)	0.056	0.579	0.323	0.001
Waist circumference (cm)	0.234	0.045	0.500	<0.001
Waist/Hip ratio	0.133	0.258	0.473	<0.001
Body fat mass	0.126	0.284	0.315	0.006
Visceral fat area (cm^2)	0.401	<0.001	0.354	<0.001
Fat percentage (%)	0.147	0.210	0.238	0.041
Obesity degree (%)	0.093	0.426	0.298	0.009
SBP (mmHg)	0.245	0.016	0.144	0.162
DBP (mmHg)	0.241	0.018	0.178	0.082
CRP (mg/L)	0.306	0.019	0.116	0.382
FBG (mmol/L)	0.344	0.001	0.363	<0.001
HbA1C (%)	0.143	0.171	0.372	<0.001
TC (mmol/L)	0.123	0.238	0.180	0.083
TG (mmol/L)	0.169	0.106	0.422	<0.001
LDL (mmol/L)	0.031	0.778	0.109	0.320

Abbreviations: baPWV, brachial-ankle pulse wave velocity; EAT, epicardial adipose tissue; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; CRP, c-reactive protein; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; TC, total cholesterol; TG, triglyceride; LDL, low-density lipoprotein.

Table 3 Multivariate Linear Regression Analysis for the Effect of Epicardial Fat Thickness on the Absolute Value of baPWV

	β	95% CI	P value
Model 1
EAT (mm)	0.292	0.109 to 0.474	0.002
Age (years)	0.274	0.092 to 0.456	0.004
Gender (n)	−0.094	−0.274 to 0.086	0.302
Model 2
EAT (mm)	0.255	0.030 to 0.472	0.026
Hypertension (n)	0.110	−0.102 to 0.320	0.307
CAD (n)	0.129	−0.084 to 0.341	0.233
Model 3
EAT (mm)	0.315	0.123 to 0.499	0.001
Heart rate (bmp)	0.193	−0.001 to 0.376	0.052
SBP (mmHg)	0.158	−0.067 to 0.380	0.168
DBP (mmHg)	0.015	−0.220 to 0.250	0.898
Model 4
EAT (mm)	0.361	0.138 to 0.707	0.004
Waist circumference (cm)	−0.221	−0.554 to 0.100	0.171
Visceral fat area (cm^2)	0.379	0.078 to 0.676	0.014
Model 5
EAT (mm)	0.321	0.069 to 0.580	0.014
CRP (mg/L)	0.239	−0.023 to 0.459	0.076
FBG (mmol/L)	0.060	−0.178 to 0.279	0.659
Model 6
EAT (mm)	0.256	0.067 to 0.449	0.009
Age (years)	0.188	−0.018 to 0.391	0.073
Visceral fat area (cm^2)	0.229	0.016 to 0.446	0.036

Notes: Model 1 was adjusted for EAT, age, gender. Model 2 was adjusted for EAT, hypertension, CAD. Model 3 was adjusted for EAT, heart rate, SBP, DBP. Model 4 was adjusted for EAT, waist circumference, visceral fat area. Model 5 was adjusted for EAT, CRP, FBG. Model 6 was adjusted for EAT, age, visceral fat area.

Abbreviations: EAT, epicardial adipose tissue; CAD, coronary artery disease; SBP, systolic blood pressure; DBP, diastolic blood pressure; CRP, C-reactive protein; FBG, fasting blood glucose.