Targeting epicardial adipose tissue: A potential therapeutic strategy for heart failure with preserved ejection fraction with type 2 diabetes mellitus

Table 2 Relationship between increased epicardial adipose tissue and clinical characteristics of heart failure with preserved ejection fraction

Ref.	Participants, n	Imaging method	Relationship between increased EAT and clinical characteristics of HFpEF
			Pathological changes	Clinical manifestations	Prognosis
van Woerden et al[48], 2018	64 HF patients with LVEF > 40%	CMR	Myocardial injury: increased creatine kinase-MB and TnT	Decreased quality of life (KCCQ score)
Wang et al[49], 2022	53 HF patients with LVEF > 50%	CMR	Inflammation: increased CRP; LV hypertrophy: increased LVmass index; LV diastolic dysfunction: increased E/e' and tricuspid regurgitation velocity
Venkateshvaran et al[50], 2022	182 HF patients with LVEF > 50%	Echo	Inflammation; endothelial dysfunction; LV hypertrophy: increased LV septal wall thickness; LV diastolic dysfunction: increased E peak deceleration time	Decreased quality of life (KCCQ score)
Koepp et al[51], 2020	169 HF patients with LVEF > 50%	Echo	Increased cardiac filling pressures, pulmonary hypertension, and pericardial restraint	Decreased exercise capacity (VO2, AVO2 diff)
Haykowsky et al[52], 2018	100 HF patients with LVEF > 50%	CMR		Decreased exercise capacity (VO2, 6-min walk test, leg power)
Gorter et al[53], 2020	75 HF patients with LVEF > 45%	Echo		Decreased exercise capacity (VO2)
Pugliese et al[54], 2021	188 HF patients with LVEF > 50%	Echo	Myocardial injury: increased TnT; inflammation: increased CRP	Decreased exercise capacity (peak VO2 and AVO2 diff)	Increased risk of the composite endpoint of HF hospitalization and cardiovascular deaths
van Woerden et al[55], 2022	105 HF patients with LVEF > 40%	CMR			Increased risk of HF hospitalization, all-cause death, and the composite endpoint

AVO₂ diff: Non-invasive arterial-venous oxygen content difference; CMR: Cardiac magnetic resonance; CRP: C-reactive protein; EAT: Epicardial adipose tissue; Echo: Echocardiography; E/e': Peak velocity during early diastole/early diastolic mitral annular velocity; HF: Heart failure; HFpEF: Heart failure with preserved ejection fraction; KCCQ: Kansas City cardiomyopathy questionnaire; LV: Left ventricular; LVEF: Left ventricular ejection fraction; MB: Myocardial band; TnT: Troponin T; VO₂: Peak oxygen consumption.