Osman Mohamed Areij Awad, Bashir Omer Sahla Shurahbeel, Mukhtar Musab, Mohmmed Tagwa, Hussein Mohamed Wadah Mohamed, Mohamed Hassan Miska Haroun, Mohammed Hassan Ibrahim
Cardiology, Sudan Heart Center, Khartoum, SDN.
Cardiology, Sheikh Khalifa Specialty Hospital, Ras Al-Khaimah, ARE.
Cureus. 2025 May 15;17(5):e84184. doi: 10.7759/cureus.84184. eCollection 2025 May.
Heart failure (HF) remains a global health challenge, necessitating improved risk stratification tools. This systematic review evaluates the combined role of epicardial fat thickness (EFT) and B-type natriuretic peptide (BNP)/N-terminal pro B-type natriuretic peptide (NT-proBNP) in HF risk stratification, examining their pathophysiological interplay and clinical utility across diverse populations, including a wide age range, various comorbidities (e.g., obesity, diabetes, and systemic sclerosis), and geographic regions. EFT, a measurable marker of epicardial adipose tissue (EAT) located between the myocardium and visceral pericardium, was evaluated alongside BNP/NT-proBNP, established biomarkers of cardiac stress. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, 12 case-control studies were included after screening 192 records from PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library. Studies assessed EFT and BNP/NT-proBNP in HF or at-risk populations. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS). EFT consistently correlated with elevated BNP/NT-proBNP, though patterns differed by HF phenotype. In HF with reduced ejection fraction (HFrEF), NT-proBNP associated more strongly with muscle loss than adiposity, while in HF with preserved ejection fraction (HFpEF), EFT was linked to metabolic comorbidities and inflammatory markers. Paradoxically, lower EFT predicted worse outcomes in nonischemic cardiomyopathy (NICMP), potentially reflecting disease-related fat depletion or cachexia; this finding underscores the need for phenotype-specific interpretation of EFT in risk stratification. Mechanistically, EAT contributed to myocardial remodeling via adipokine secretion and inflammatory signaling. Four studies had a low risk of bias (NOS ≥ 8), while one showed a high risk. The combined assessment of EFT and BNP/NT-proBNP offers complementary prognostic insights, EFT capturing subclinical inflammation and adiposity-related remodeling, while BNP/NT-proBNP reflects myocyte stress, potentially guiding personalized treatment decisions, including closer monitoring of HFpEF patients with elevated EFT and early nutritional or anti-inflammatory interventions in those with muscle loss and elevated NT-proBNP. Inclusion criteria encompassed adult populations with HF or related conditions, with exclusion of reviews, case reports, and non-English articles, supporting the methodological rigor of this synthesis. Standardized EFT measurement and targeted EAT-modulating therapies warrant further investigation.
心力衰竭（HF）仍然是一项全球性的健康挑战，因此需要改进风险分层工具。本系统评价评估了心外膜脂肪厚度（EFT）和B型利钠肽（BNP）/N末端B型利钠肽原（NT-proBNP）在HF风险分层中的联合作用，研究了它们在不同人群中的病理生理相互作用和临床应用，这些人群包括广泛的年龄范围、各种合并症（如肥胖、糖尿病和系统性硬化症）以及不同的地理区域。EFT是位于心肌和脏层心包之间的心外膜脂肪组织（EAT）的一个可测量指标，与已确立的心脏应激生物标志物BNP/NT-proBNP一起进行了评估。按照《系统评价和Meta分析的首选报告项目2020》指南，在对来自PubMed/MEDLINE、Embase、Scopus、科学网和Cochrane图书馆的192条记录进行筛选后，纳入了12项病例对照研究。这些研究评估了HF患者或有风险人群中的EFT和BNP/NT-proBNP。使用纽卡斯尔-渥太华量表（NOS）评估方法学质量。EFT一直与升高的BNP/NT-proBNP相关，尽管其模式因HF表型而异。在射血分数降低的HF（HFrEF）中，NT-proBNP与肌肉减少的关联比与肥胖的关联更强，而在射血分数保留的HF（HFpEF）中，EFT与代谢合并症和炎症标志物有关。矛盾的是，较低的EFT预示着非缺血性心肌病（NICMP）的预后更差，这可能反映了疾病相关的脂肪消耗或恶病质；这一发现强调了在风险分层中对EFT进行表型特异性解读的必要性。从机制上讲，EAT通过脂肪因子分泌和炎症信号传导促进心肌重塑。四项研究的偏倚风险较低（NOS≥8），而一项研究显示偏倚风险较高。EFT和BNP/NT-proBNP的联合评估提供了互补的预后见解，EFT反映亚临床炎症和肥胖相关的重塑，而BNP/NT-proBNP反映心肌细胞应激，这可能指导个性化治疗决策，包括对EFT升高的HFpEF患者进行更密切的监测，以及对肌肉减少且NT-proBNP升高的患者进行早期营养或抗炎干预。纳入标准包括患有HF或相关疾病的成年人群，排除综述、病例报告和非英文文章，这支持了本综述的方法学严谨性。标准化的EFT测量和针对性的EAT调节疗法值得进一步研究。
