Epicardial Fat Volume, Cardiac Function, and Incident Heart Failure: The Rotterdam Study

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BACKGROUND: Larger epicardial fat volume (EFV) has been associated with increased risks of cardiovascular disease and atrial fibrillation. Yet, evidence on the association of EFV with cardiac function and incident heart failure (HF) remains scarce. METHODS AND RESULTS: We included 2103 participants (mean age, 68 years; 54.4% women) from the prospective population-based RS (Rotterdam Study) with computed tomography– based EFV and repeated echocardiography-based assessment of left ventricular (LV) systolic and diastolic function. Linear mixed effects and Cox-proportional hazard regression models, adjusted for cardiovascular risk factors, were used to assess the associations of EFV with repeated measurements of echo-cardiographic parameters and with incident HF. During a median follow-up of 9.7 years, 124 HF events occurred (incidence rate, 6.37 per 1000 person-years). For LV systolic function, 1-SD larger EFV was associated with 0.76 (95% CI, 0.54– 0.98) mm larger LV end-diastolic dimension, 0.66 (95% CI, 0.47– 0.85) mm larger LV end-systolic dimension, and 0.56% (95% CI, −0.86% to −0.27%) lower LV ejection fraction. Interactions between EFV and time were small. For LV diastolic function, 1-SD larger EFV was associated with 1.02 (95% CI, 0.78–1.27) mm larger left atrial diameter. Larger EFV was also associated with incident HF (hazard ratio per 1-SD increase in EFV, 1.34 [95% CI, 1.07–1.68] per 1-SD larger EFV). CONCLUSIONS: We report an independent association between EFV with new-onset HF in the general population. EFV seems to exert its influence on HF through different pathways contributing to deteriorations in systolic function and larger left atrial size in part, likely through mechanical restraint and hypertrophy.

Original languageEnglish
Article numbere026197
JournalJournal of the American Heart Association
Issue number1
Publication statusPublished - 3 Jan 2023

Bibliographical note

Funding Information:
The RS (Rotterdam Study) is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development, the Research Institute for Diseases in the Elderly, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission, and the Municipality of Rotterdam. This study is further supported by the Senior Scientist Grant from the Dutch Heart Foundation (03-004-2021-T050).

Publisher Copyright:
© 2022 The Authors.


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