Purpose. Epicardial adipose tissue (EAT) is thought to play an important role in the development and progression of cardiovascular diseases. However, the diagnostic and prognostic role of EAT measurement in patients with atrial fibrillation (AF) and heart failure (HF) coexistence is still unclear. The aim of the present study was to investigate the volume and distribution of EAT and their correlation with level of B-type natriuretic peptide (BNP) as well-established HF biomarker.

Material and methods. 69 patients with symptomatic HF and AF underwent cardiac computed tomography (CT) before catheter ablation (CA). The BNP levels, total and peri-atrial EAT volumes were evaluated. The study cohort was divided into two groups according to the BNP level: BNP≥105 pg/ml, n = 37 («AF with HF») and BNP<105 pg/ml, n=32 («AF without HF»).

Results. The median peri-atrial EAT volume was higher in the «AF with HF» group compared with «AF without HF» group (52.1 [40;59] ml vs 45.6 [35;56] ml, respectively). Twenty-one (57%) out of 37 patients with BNP ≥105 pg/ml had HF with preserved ejection fraction (HFpEF). In this cohort, total and peri-atrial EAT was associated with BNP ≥105 pg/ml (coefficient 0.33 [95% CI, 0.08 to 0.57], p = 0.011 and 0.16 [95% CI, 0.09 to 0.22], p < 0.001).

Conclusions. Cardiac CT for EAT assessment may be useful as an additional diagnostic tool of HFpEF in patients with AF. In patients with AF and HFpEF the EAT volume is associated with an increase of BNP level.