Epicardial adipose tissue native T1 and LVEF improvement across BMI categories in HFrEF: an exploratory CMR study
4 affiliations
- 1Department of Cardiology, The First Affiliated Hospital of Ningbo University
- 2Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, The First Affiliated Hospital of Ningbo University
- 3Department of Medical Imaging, The First Affiliated Hospital of Ningbo University
- 4Department of Traditional Chinese Internal Medicine, The First Affiliated Hospital of Ningbo University
Abstract
Objective: To explore whether the association between regional epicardial adipose tissue (EAT) native T1 and improvement in left ventricular ejection fraction (LVEF) differs according to body mass index (BMI) category in patients with heart failure with reduced ejection fraction (HFrEF).
Methods: This single-center retrospective exploratory study included 119 patients with clinically diagnosed HFrEF and a baseline cardiovascular magnetic resonance (CMR) LVEF < 40%. Improvement was defined as ≥10 percentage points higher follow-up than baseline echocardiographic LVEF, using the last eligible examination at 3–18 months. BMI was categorized using a cutoff of 24 kg / m ² . Four BMI–EAT native T1 categories based on the cohort median T1 were used only descriptively. The primary logistic model included a BMI category × standardized continuous EAT native T1 interaction, adjusting for age, sex, baseline echocardiographic LVEF, EAT volume index (EATVi), and the CMR-to-baseline echocardiography interval. BMI-specific effects came from the same model; sensitivity analyses used Firth regression and alternative follow-up, exposure, and outcome specifications.
Results: Overall, 53 patients met the criterion for LVEF improvement, including 16 of 52 patients (30.8%) with BMI < 24 kg / m ² and 37 of 67 (55.2%) with BMI ≥ 24 kg / m ² . The interaction term yielded an odds ratio of 0.396 (95% CI, 0.161–0.975; Wald P = 0.044), and inclusion of the interaction improved model fit (LR P = 0.037). For each 1-SD higher EAT native T1, the BMI-specific ORs were 1.407 (95% CI, 0.776–2.551; P = 0.261) for BMI < 24 kg / m ² and 0.557 (95% CI, 0.284–1.092; P = 0.088) for BMI ≥ 24 kg/m ² . Separate sensitivity analyses excluding patients with recorded follow-up CRT/CRT-D or jointly adjusting for baseline AF diagnosis and continuous eGFR, including Firth estimation of the joint model, yielded interaction point estimates close to the primary estimate, with CIs including 1. Uncertainty remained in the approximately 6-month window and continuous Δ LVEF analyses.
Conclusion: The association between regional EAT native T1 and LVEF improvement may vary according to BMI category in HFrEF. However, the BMI-specific associations were imprecisely estimated and sensitivity analyses showed variable precision. These findings are hypothesis generating and require independent confirmation in larger prospective cohorts using standardized imaging methods.
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BibTeX
@article{guo2026epicardial,
title = {{Epicardial adipose tissue native T1 and LVEF improvement across BMI categories in HFrEF: an exploratory CMR study}},
author = {Haotian Guo and Jingfeng Huang and Qinglin Yu and Jiaying Xie and Weiping Du and Yudie Song and Cui Li and Xiaomin Chen and Jia Su},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = nov,
doi = {10.3389/fcvm.2026.1949156},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1949156/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Epicardial adipose tissue native T1 and LVEF improvement across BMI categories in HFrEF: an exploratory CMR study
AU - Haotian Guo
AU - Jingfeng Huang
AU - Qinglin Yu
AU - Jiaying Xie
AU - Weiping Du
AU - Yudie Song
AU - Cui Li
AU - Xiaomin Chen
AU - Jia Su
PY - 2026
DA - 2026/11/09
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1949156
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1949156/full
AB - Objective: To explore whether the association between regional epicardial adipose tissue (EAT) native T1 and improvement in left ventricular ejection fraction (LVEF) differs according to body mass index (BMI) category in patients with heart failure with reduced ejection fraction (HFrEF). Methods: This single-center retrospective exploratory study included 119 patients with clinically diagnosed HFrEF and a baseline cardiovascular magnetic resonance (CMR) LVEF < 40%. Improvement was defined as ≥10 percentage points higher follow-up than baseline echocardiographic LVEF, using the last eligible examination at 3–18 months. BMI was categorized using a cutoff of 24 kg / m ² . Four BMI–EAT native T1 categories based on the cohort median T1 were used only descriptively. The primary logistic model included a BMI category × standardized continuous EAT native T1 interaction, adjusting for age, sex, baseline echocardiographic LVEF, EAT volume index (EATVi), and the CMR-to-baseline echocardiography interval. BMI-specific effects came from the same model; sensitivity analyses used Firth regression and alternative follow-up, exposure, and outcome specifications. Results: Overall, 53 patients met the criterion for LVEF improvement, including 16 of 52 patients (30.8%) with BMI < 24 kg / m ² and 37 of 67 (55.2%) with BMI ≥ 24 kg / m ² . The interaction term yielded an odds ratio of 0.396 (95% CI, 0.161–0.975; Wald P = 0.044), and inclusion of the interaction improved model fit (LR P = 0.037). For each 1-SD higher EAT native T1, the BMI-specific ORs were 1.407 (95% CI, 0.776–2.551; P = 0.261) for BMI < 24 kg / m ² and 0.557 (95% CI, 0.284–1.092; P = 0.088) for BMI ≥ 24 kg/m ² . Separate sensitivity analyses excluding patients with recorded follow-up CRT/CRT-D or jointly adjusting for baseline AF diagnosis and continuous eGFR, including Firth estimation of the joint model, yielded interaction point estimates close to the primary estimate, with CIs including 1. Uncertainty remained in the approximately 6-month window and continuous Δ LVEF analyses. Conclusion: The association between regional EAT native T1 and LVEF improvement may vary according to BMI category in HFrEF. However, the BMI-specific associations were imprecisely estimated and sensitivity analyses showed variable precision. These findings are hypothesis generating and require independent confirmation in larger prospective cohorts using standardized imaging methods.
SN - 2297-055X
ER -