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

• Published in: International Journal of Obesity Vol. 46; no. 4; pp. 866 - 873
• Main Authors: Mehta, Roopa, Bello-Chavolla, Omar Yaxmehen, Mancillas-Adame, Leonardo, Rodriguez-Flores, Marcela, Pedraza, Natalia Ramírez, Encinas, Bethsabel Rodríguez, Carrión, Carolina Isabel Pérez, Ávila, María Isabel Jasso, Valladares-García, Jorge Carlos, Vanegas-Cedillo, Pablo Esteban, Juárez, Diana Hernández, Vargas-Vázquez, Arsenio, Antonio-Villa, Neftali Eduardo, Chapa-Ibarguengoitia, Monica, Almeda-Valdés, Paloma, Elias-Lopez, Daniel, Galindo-Fraga, Arturo, Gulias-Herrero, Alfonso, de Leon, Alfredo Ponce, Sifuentes-Osornio, José, Aguilar-Salinas, Carlos A.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-04-2022; Nature Publishing Group
• Subjects: 692/163/2743/393; 692/308/174; Adipose tissue; Adipose Tissue - diagnostic imaging; Adipose Tissue - metabolism; Adiposity; Adult; Age; Age factors; Body fat; Body Mass Index; Body size; C-reactive protein; Calcium-binding protein; Computed tomography; Coronaviruses; COVID-19; Dimers; Epidemiology; Fibrinogen; Health Promotion and Disease Prevention; Heart; Humans; Internal Medicine; Intubation; Mechanical ventilation; Medicine; Medicine & Public Health; Metabolic Diseases; Mortality; Myocardial infarction; Obesity; Pericardium - diagnostic imaging; Pericardium - metabolism; Public Health; Risk analysis; Risk factors; Thickness; Thorax; Troponin; Young Adult
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/s41366-021-01050-7

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 4 C 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.