Pericardial fat is associated with ventricular tachyarrhythmia and mortality in patients with systolic heart failure

•Pericardial fat is associated with long-term mortality in patients with systolic heart failure.•These associations are both independent of and stronger than more systemic measures of adiposity.•Measurements of pericardial fat by CMRI could reflect the prognosis of heart failure patients.

ObjectivePericardial fat (PF) has been hypothesized to exert local pathogenic effects on nearby cardiac structures above and beyond that of systemic adiposity which might be associated with the presence of arrhythmia or even worse outcomes. The aims of this study was to characterize the relationship between PF and the prognosis in patients with systolic heart failure (HF).MethodsThis is a retrospective cohort study of a cardiac magnetic resonance imaging (CMRI) database from 2004 to 2011. Fifty patients with systolic HF underwent CMRI examinations were included. We also enrolled twenty patients with HF as the control group. The cine imaging was analyzed to derive total PF volumes, left ventricular volumes and mass and left ventricular ejection fraction by using a previously validated technique. The outcomes, including ventricular tachycardia (VT), ventricular fibrillation (VF) and total mortality were obtained by reviewing medical records.ResultsAfter a median follow-up of 694 days, patients with VT/VF had significant larger indexed PF volumes than those without [36.3 (32.8-43.1) ml/m2 vs. 24.1 (20.2-27.6) ml/m2, p = 0.001]. The mortality group also had significant larger indexed PF volumes (PF/body surface area) than those without [31.3 (22.8-38.4) ml/m2 vs. 23.9 (19.8-27.3) ml/m2, p = 0.010]. Indexed PF volumes were associated with the development of VT/VF (Hazard ratio, 7.510; 95% C.I, 0.901-62.582, p = 0.062) and mortality (Hazard ratio, 3.998; 95% C.I, 1.077-14.845, p = 0.038) by Cox's regression analyses.ConclusionPF is associated with the development of VT/VF and long-term overall mortality in patients with systolic HF.