Epicardial Adipose Tissue in Duchenne Muscular Dystrophy Cardiomyopathy

Duchenne muscular dystrophy (DMD) has unique characteristics when compared with other forms of non-DMD dilated cardiomyopathy. We sought to describe epicardial adipose tissue (EAT), the fat layer surrounding the myocardium, and investigate its relationship to longitudinal cardiac changes in DMD.

This single-center, retrospective, cohort study included all DMD patients with ≥5 cardiac magnetic resonance studies between 2015 and 2022. EAT thickness was measured in the right atrioventricular groove during end diastole. Adiposity data were obtained from dual-energy x-ray absorptiometry scans. Linear mixed-effects regression was used for statistical modeling.

A total of 117 patients were included with 590 cardiac magnetic resonance studies, 333 dual-energy X-ray absorptiometry, and 255 NT-proBNP (N-terminal pro-B-type natriuretic peptide) values. The median age at first cardiac magnetic resonance was 13.1 years and at any cardiac magnetic resonance study was 15.9 years. The median EAT thickness was 15.5±4 mm. EAT thickness was positively associated with age (P<0.001) and measures of general adiposity (P<0.01). Increased EAT was positively associated with NT-proBNP and negatively associated with left ventricular volume and left ventricular mass indexed for body surface area (P<0.05). There was no association with left ventricular ejection fraction (P=0.98) or for left ventricular volume (P=0.61) or mass (P=0.52) when indexed for height.

DMD is associated with early, appreciable EAT, which increases over the life span and is positively related to measures of general adiposity. Increased EAT is associated with higher levels of NT-proBNP without a change in systolic function, suggesting it may contribute to diastolic dysfunction in DMD.