Epicardial Adipose Tissue Is an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension

Breanne E. McCarthy; Rui Feng; Drew A. Torigian; Yubing Tong; Jason S. Fritz; Jasleen K. Minhas; Jeremy A. Mazurek; K. Akaya Smith; Harold I. Palevsky; Steven C. Pugliese; Natalie Z. Homer; Margaret R. Maclean; Jayaram K. Udupa; Nadine Al-Naamani

doi:10.1016/j.chest.2024.11.020

Epicardial Adipose Tissue Is an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension

Breanne E. McCarthy, Rui Feng, Drew A. Torigian, Yubing Tong, Jason S. Fritz, Jasleen K. Minhas, Jeremy A. Mazurek, K. Akaya Smith, Harold I. Palevsky, Steven C. Pugliese, Natalie Z. Homer, Margaret R. Maclean, Jayaram K. Udupa, Nadine Al-Naamani

Research output: Contribution to journal › Article › peer-review

Abstract

Background
Increased epicardial adipose tissue (EAT) has adverse effects in cardiovascular
diseases, independent of body mass index (BMI). Estrogen levels may impact EAT
accumulation. Little is known about the predictors and potential impact of EAT in PAH.
Research Question
Is EAT associated with estrogen levels, disease severity, and mortality in PAH?
Study Design and Methods
We conducted a retrospective cohort study of patients with PAH enrolled in the Penn
Pulmonary Hypertension registry and used chest computed tomography (CT) scans to
quantify EAT. We also measured serum estrone and estradiol levels.
Results
221 patients were included in the analysis, with median follow-up of 88 months. Mean
age was 55.1 years, 74.7% were female, mean BMI was 27.20 kg/m2, and the most
common PAH etiology was connective tissue disease-associated PAH (43.0%)
followed by idiopathic PAH (35.3%). Median EAT volume was 52.1 mL/m2. Of the 102
patients with a follow-up chest CT, EAT increased over time in 74 (71.8%). High EAT
volume (HR 2.62, 95% CI 1.62-4.24, p<0.001) and greater accumulation of EAT over
time (HR 1.09, 95% CI 1.01 – 1.17, p=0.03) were both independently associated with
worse survival. Patients with high EAT volume had lower serum estrone (13.70 versus
30.60 pg/mL, p=0.009) and estradiol (6.05 versus 19.40 pg/mL, p=0.002) levels
compared to those with low EAT volume.
Interpretation
In patients with PAH, high EAT and a greater rate of accumulation of EAT volume were
independently associated with worse survival. Higher EAT volume was also associated
with lower estrogen levels. The association of EAT volume with survival was
independent of BMI and disease severity, suggesting that EAT may be a marker for a
unique PAH phenotype. Future research should investigate the role of EAT-modifying
therapies in PAH and consider incorporating EAT into PAH risk models.

Original language	English
Journal	Chest Journal
DOIs	https://doi.org/10.1016/j.chest.2024.11.020
Publication status	Published - 28 Nov 2024

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10.1016/j.chest.2024.11.020Licence: Creative Commons: Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND)

CHEST-D-24-01762_R2Accepted author manuscript, 5.85 MBLicence: Creative Commons: Attribution (CC-BY)

https://linkinghub.elsevier.com/retrieve/pii/S0012369224055922

Edinburgh Clinical Research Facility Mass Spectrometry Core in the QMRI
Homer, N. (Manager), Denham, S. (Other) & Simpson, J. (Other)
Centre for Cardiovascular Science
Facility/equipment: Facility

Cite this

McCarthy, B. E., Feng, R., Torigian, D. A., Tong, Y., Fritz, J. S., Minhas, J. K., Mazurek, J. A., Smith, K. A., Palevsky, H. I., Pugliese, S. C., Homer, N. Z., Maclean, M. R., Udupa, J. K., & Al-Naamani, N. (2024). Epicardial Adipose Tissue Is an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension. Chest Journal. https://doi.org/10.1016/j.chest.2024.11.020

@article{2ac9e58f4b214c5ca70d1a5784f495ea,

title = "Epicardial Adipose Tissue Is an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension",

abstract = "BackgroundIncreased epicardial adipose tissue (EAT) has adverse effects in cardiovasculardiseases, independent of body mass index (BMI). Estrogen levels may impact EATaccumulation. Little is known about the predictors and potential impact of EAT in PAH.Research QuestionIs EAT associated with estrogen levels, disease severity, and mortality in PAH?Study Design and MethodsWe conducted a retrospective cohort study of patients with PAH enrolled in the PennPulmonary Hypertension registry and used chest computed tomography (CT) scans toquantify EAT. We also measured serum estrone and estradiol levels.Results221 patients were included in the analysis, with median follow-up of 88 months. Meanage was 55.1 years, 74.7% were female, mean BMI was 27.20 kg/m2, and the mostcommon PAH etiology was connective tissue disease-associated PAH (43.0%)followed by idiopathic PAH (35.3%). Median EAT volume was 52.1 mL/m2. Of the 102patients with a follow-up chest CT, EAT increased over time in 74 (71.8%). High EATvolume (HR 2.62, 95% CI 1.62-4.24, p<0.001) and greater accumulation of EAT overtime (HR 1.09, 95% CI 1.01 – 1.17, p=0.03) were both independently associated withworse survival. Patients with high EAT volume had lower serum estrone (13.70 versus30.60 pg/mL, p=0.009) and estradiol (6.05 versus 19.40 pg/mL, p=0.002) levelscompared to those with low EAT volume.InterpretationIn patients with PAH, high EAT and a greater rate of accumulation of EAT volume wereindependently associated with worse survival. Higher EAT volume was also associatedwith lower estrogen levels. The association of EAT volume with survival wasindependent of BMI and disease severity, suggesting that EAT may be a marker for aunique PAH phenotype. Future research should investigate the role of EAT-modifyingtherapies in PAH and consider incorporating EAT into PAH risk models.",

author = "McCarthy, {Breanne E.} and Rui Feng and Torigian, {Drew A.} and Yubing Tong and Fritz, {Jason S.} and Minhas, {Jasleen K.} and Mazurek, {Jeremy A.} and Smith, {K. Akaya} and Palevsky, {Harold I.} and Pugliese, {Steven C.} and Homer, {Natalie Z.} and Maclean, {Margaret R.} and Udupa, {Jayaram K.} and Nadine Al-Naamani",

year = "2024",

month = nov,

day = "28",

doi = "10.1016/j.chest.2024.11.020",

language = "English",

journal = "Chest Journal",

issn = "0012-3692",

publisher = "Elsevier",

}

TY - JOUR

T1 - Epicardial Adipose Tissue Is an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension

AU - McCarthy, Breanne E.

AU - Feng, Rui

AU - Torigian, Drew A.

AU - Tong, Yubing

AU - Fritz, Jason S.

AU - Minhas, Jasleen K.

AU - Mazurek, Jeremy A.

AU - Smith, K. Akaya

AU - Palevsky, Harold I.

AU - Pugliese, Steven C.

AU - Homer, Natalie Z.

AU - Maclean, Margaret R.

AU - Udupa, Jayaram K.

AU - Al-Naamani, Nadine

PY - 2024/11/28

Y1 - 2024/11/28

N2 - BackgroundIncreased epicardial adipose tissue (EAT) has adverse effects in cardiovasculardiseases, independent of body mass index (BMI). Estrogen levels may impact EATaccumulation. Little is known about the predictors and potential impact of EAT in PAH.Research QuestionIs EAT associated with estrogen levels, disease severity, and mortality in PAH?Study Design and MethodsWe conducted a retrospective cohort study of patients with PAH enrolled in the PennPulmonary Hypertension registry and used chest computed tomography (CT) scans toquantify EAT. We also measured serum estrone and estradiol levels.Results221 patients were included in the analysis, with median follow-up of 88 months. Meanage was 55.1 years, 74.7% were female, mean BMI was 27.20 kg/m2, and the mostcommon PAH etiology was connective tissue disease-associated PAH (43.0%)followed by idiopathic PAH (35.3%). Median EAT volume was 52.1 mL/m2. Of the 102patients with a follow-up chest CT, EAT increased over time in 74 (71.8%). High EATvolume (HR 2.62, 95% CI 1.62-4.24, p<0.001) and greater accumulation of EAT overtime (HR 1.09, 95% CI 1.01 – 1.17, p=0.03) were both independently associated withworse survival. Patients with high EAT volume had lower serum estrone (13.70 versus30.60 pg/mL, p=0.009) and estradiol (6.05 versus 19.40 pg/mL, p=0.002) levelscompared to those with low EAT volume.InterpretationIn patients with PAH, high EAT and a greater rate of accumulation of EAT volume wereindependently associated with worse survival. Higher EAT volume was also associatedwith lower estrogen levels. The association of EAT volume with survival wasindependent of BMI and disease severity, suggesting that EAT may be a marker for aunique PAH phenotype. Future research should investigate the role of EAT-modifyingtherapies in PAH and consider incorporating EAT into PAH risk models.

AB - BackgroundIncreased epicardial adipose tissue (EAT) has adverse effects in cardiovasculardiseases, independent of body mass index (BMI). Estrogen levels may impact EATaccumulation. Little is known about the predictors and potential impact of EAT in PAH.Research QuestionIs EAT associated with estrogen levels, disease severity, and mortality in PAH?Study Design and MethodsWe conducted a retrospective cohort study of patients with PAH enrolled in the PennPulmonary Hypertension registry and used chest computed tomography (CT) scans toquantify EAT. We also measured serum estrone and estradiol levels.Results221 patients were included in the analysis, with median follow-up of 88 months. Meanage was 55.1 years, 74.7% were female, mean BMI was 27.20 kg/m2, and the mostcommon PAH etiology was connective tissue disease-associated PAH (43.0%)followed by idiopathic PAH (35.3%). Median EAT volume was 52.1 mL/m2. Of the 102patients with a follow-up chest CT, EAT increased over time in 74 (71.8%). High EATvolume (HR 2.62, 95% CI 1.62-4.24, p<0.001) and greater accumulation of EAT overtime (HR 1.09, 95% CI 1.01 – 1.17, p=0.03) were both independently associated withworse survival. Patients with high EAT volume had lower serum estrone (13.70 versus30.60 pg/mL, p=0.009) and estradiol (6.05 versus 19.40 pg/mL, p=0.002) levelscompared to those with low EAT volume.InterpretationIn patients with PAH, high EAT and a greater rate of accumulation of EAT volume wereindependently associated with worse survival. Higher EAT volume was also associatedwith lower estrogen levels. The association of EAT volume with survival wasindependent of BMI and disease severity, suggesting that EAT may be a marker for aunique PAH phenotype. Future research should investigate the role of EAT-modifyingtherapies in PAH and consider incorporating EAT into PAH risk models.

U2 - 10.1016/j.chest.2024.11.020

DO - 10.1016/j.chest.2024.11.020

M3 - Article

SN - 0012-3692

JO - Chest Journal

JF - Chest Journal

ER -

Epicardial Adipose Tissue Is an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension

Abstract

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Edinburgh Clinical Research Facility Mass Spectrometry Core in the QMRI

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