Epicardial adipose tissue (EAT) may contribute to functional impairment in heart failure with preserved ejection fraction (HFpEF) beyond overall body mass. Findings presented at the European Society of Cardiology Conference 2025 examined the relationship between EAT, functional status, and invasive exercise hemodynamics in 566 HFpEF patients.

Participants had a mean age of 72 years, 62% were women, and average body mass index was 33 kg/m². Mean EAT thickness was 6.0 mm, ranging from 1.7 to 17.2 mm. Patients in the highest EAT tertile walked shorter distances in the 6-minute walk test (287 m) compared to the first (320 m) and second tertiles (315 m; p=0.01). Similarly, Kansas City Cardiomyopathy Questionnaire scores were lower in the highest tertile (41 vs. 51 and 45; p=0.003), with this association independent of body mass index.

At peak exercise, higher EAT was associated with elevated pulmonary capillary wedge pressure (36 mmHg vs. 34 mmHg; p=0.009) and increased PCWP to right atrial pressure gradient (18 vs. 16 mmHg; p=0.002). Resting hemodynamics did not differ across tertiles.

These findings highlight that excess epicardial fat negatively impacts exercise capacity and hemodynamics, suggesting a key role in HFpEF pathophysiology.