Epicardial adipose tissue thickness is associated with increased COVID-19 severity and mortality

Roopa Mehta, Omar Yaxmehen Bello-Chavolla, Leonardo Mancillas-Adame, Marcela Rodriguez-Flores, Natalia Ramírez Pedraza, Bethsabel Rodríguez Encinas, Carolina Isabel Pérez Carrión, María Isabel Jasso Ávila, Jorge Carlos Valladares-García, Pablo Esteban Vanegas-Cedillo, Diana Hernández Juárez, Arsenio Vargas-Vázquez, Neftali Eduardo Antonio-Villa, Monica Chapa-Ibarguengoitia, Paloma Almeda-Valdés, Daniel Elias-Lopez, Arturo Galindo-Fraga, Alfonso Gulias-Herrero, Alfredo Ponce de Leon, José Sifuentes-Osornio, Carlos A. Aguilar-Salinas
2021 · doi:10.1101/2021.03.14.21253532
preprint OA: gold CC-BY-NC-ND-4.0
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Abstract

ABSTRACT BACKGROUND Increased adiposity and visceral obesity have been linked to adverse COVID-19 outcomes. The amount of epicardial adipose tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 adverse outcomes. METHODS We included 748 patients with COVID-19 attending a reference center in Mexico City. EAT thickness, sub-thoracic and extra-pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with COVID-19 mortality and severe COVID-19 (defined as mortality and need for invasive mechanical ventilation), according to the presence or absence of obesity. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with COVID-19 outcomes. RESULTS EAT thickness was associated with increased risk of COVID-19 mortality (HR 1.18, 95%CI 1.01-1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, fibrinogen, C-reactive protein, and 4C severity score, independent of obesity. EAT mediated 13.1% (95%CI 3.67-28.0%) and 5.1% (95%CI 0.19-14.0%) of the effect of age and 19.4% (95%CI 4.67-63.0%) and 12.8% (95%CI 0.03-46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction during COVID-19. CONCLUSION EAT is an independent risk factor for severe COVID-19 and mortality independent of obesity. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 outcomes.

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License: CC-BY-NC-ND-4.0