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Association of epicardial and intramyocardial fat with ventricular arrhythmias

Maryam Mojarrad Sani1, Eric Sung2, Marc Engels1

  • 1Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.

Heart Rhythm
|August 28, 2023
PubMed

Insights

Myocardial fat volume and distribution are linked to ventricular arrhythmias (VA) in cardiomyopathy patients. The association differs between ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) patients, highlighting substrate-specific risks.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Myocardial fibrosis increases ventricular arrhythmia (VA) risk in ischemic (ICM) and nonischemic (NICM) cardiomyopathy.
  • Myocardial fat accumulation is increasingly recognized as a contributor to ventricular arrhythmogenesis.
  • The specific roles of epicardial adipose tissue and intramyocardial fat in VA remain unclear.

Purpose of the Study:

  • To evaluate the association between contrast-enhanced computed tomography (CE-CT) derived left ventricular (LV) tissue heterogeneity, epicardial adipose tissue volume, and intramyocardial fat volume with VA risk.
  • To differentiate these associations in patients with ICM versus NICM.

Main Methods:

  • Utilized data from the PROSE-ICD registry, including patients who underwent CE-CT.
  • Quantified intramyocardial fat volume (-180 to -5 HU), epicardial adipose tissue volume (-200 to -50 HU), and LV tissue heterogeneity.
  • Assessed the primary endpoint of appropriate implantable cardioverter-defibrillator (ICD) shocks or sudden arrhythmic death.

Main Results:

  • LV tissue heterogeneity correlated with VA risk (OR 1.10, P = .01), particularly in the ICM cohort.
  • In NICM patients, both epicardial adipose tissue (OR 1.11, P = .01) and intramyocardial fat volume (OR 1.21, P = .01) were associated with VA.
  • These fat-related associations were not significant in the ICM cohort (P > .19 for both).

Conclusions:

  • Increased fat distribution heterogeneity is linked to VA in ICM patients.
  • In NICM patients, greater intramyocardial and epicardial fat volumes predict higher VA risk.
  • The contribution of cardiac fat to VA appears dependent on the underlying cardiomyopathy substrate.
Abstract

Keywords:
Contrast-enhanced computed tomographyEpicardial fatIntramyocardial fatIschemic cardiomyopathyLeft ventricular tissue heterogeneityNonischemic cardiomyopathyVentricular arrhythmia

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