Decrease In Epicardial Adipose Tissue Volume Predicts Mortality In Covid-19: A New Biomarker

INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has been associated with cardiovascular complications, including increased epicardial adipose tissue (EAT) volume. Previous studies have shown a correlation between COVID-19 severity and EAT volume; however, none have investigated dynamic changes in EAT over time and their relationship with mortality. To evaluate the association between changes in EAT volume and prognosis in patients with COVID-19 and to explore the role of EAT in disease pathophysiology by correlating its volume changes with laboratory markers.
METHODS: This retrospective study included 134 patients with COVID-19 who underwent two non-contrast thoracic CT scans during hospitalization. EAT volume was quantified using dedicated segmentation software, and results were compared between survivors and non-survivors. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive performance of EAT volume change and laboratory biomarkers for mortality.
RESULTS: Among 134 patients, 64 (47.7%) died. D-dimer, IL-6, cTnI, and ferritin levels were significantly higher in non-survivors (p < 0.05). The reduction in EAT volume was significantly greater in non-survivors than in survivors (p = 0.001). ROC analysis identified an optimal cut-off value of −3.78% for EAT volume decrease in predicting mortality. Both EAT volume change (AUC = 0.867) and cardiac troponin I (AUC = 0.921) showed the strongest predictive performance for mortality.
DISCUSSION AND CONCLUSION: A decrease in EAT volume of ≥3.78% is a strong predictor of mortality in COVID-19. EAT volume change may serve as a novel imaging biomarker reflecting the inflammatory and cardiovascular effects of the disease.

Keywords: COVID-19, epicardial adipose tissue, mortality, biomarkers, computed tomography, inflammation