Epicardial adipose tissue (EAT) relates to atrial fibrillation (AF), although reports note lower EAT volume in heart failure with reduced ejection fraction (HFrEF). A case-control study in BMC Cardiovascular Disorders analyzed radiomic and volumetric EAT differences in 120 patients, including 60 with HFrEF and 60 with HFrEF plus AF (HFrEF-AF).

Non-contrast chest CT quantified EAT volume (EATV) and EAT volume index (EATVI). PyRadiomics extracted radiomic features, and intraclass correlation coefficients confirmed reproducibility. The Boruta algorithm with five-fold cross-validation selected features. Logistic regression identified group differences in echocardiographic parameters. Network correlation analysis and Mantel tests evaluated associations with structural indices, including left ventricular end-diastolic diameter (LVEDD) and right atrial volume index (RAVI).

HFrEF-AF patients showed higher EATV (174.22 ± 67.51 mL vs 137.21 ± 58.03 mL; P=0.002) and EATVI (102.68 ± 39.56 mL/m² vs 80.60 ± 31.93 mL/m²; P=0.001). Five radiomic features differed between groups. In HFrEF, features such as original_shape_VoxelVolume and original_gldm_GrayLevelNonUniformity correlated with LVEDD (Mantel 0.01<P<0.05; r>0.05). In HFrEF-AF, these features correlated with RAVI (Mantel 0.01<P<0.05; r>0.05). The study concluded that HFrEF-AF displays elevated EATVI and distinct radiomic patterns, reflecting subgroup-specific structural remodeling.