Right atrioventricular groove epicardial fat tissue thickness is associated with right ventricular dysfunction in patients with acute pulmonary embolism.

Right ventricular dysfunction (RVD) is a critical determinant of prognosis in acute pulmonary embolism (APE). Epicardial fat tissue (EFT), a metabolically active visceral fat depot, has been implicated in inflammation and thrombosis. However, the association between region-specific EFT thickness and RVD in APE remains unclear. This study aimed to evaluate the relationship between right atrioventricular groove EFT thickness and RVD in patients with low-to-intermediate-risk APE. In this cross-sectional study, 184 patients with low-to-intermediate-risk APE who underwent computed tomography pulmonary angiography (CTPA) were analyzed. Right atrioventricular groove EFT thickness was measured from axial tomographic images. RVD was defined as a right-to-left ventricular diameter ratio ≥ 0.9. Logistic regression analyses were used to identify independent predictors of RVD. Patients with RVD were significantly older and had higher serum troponin levels and systolic pulmonary artery pressure (sPAP). Right atrioventricular groove EFT thickness was significantly greater in patients with RVD (p < 0.001). In multivariate analysis, right atrioventricular groove EFT thickness (OR: 1.199, 95% CI: 1.024-1.404, p = 0.024) and troponin level were independently associated with RVD. A cut-off value of 16.05 mm for EFT thickness predicted RVD with 69.1% sensitivity and 65.7% specificity (AUC: 0.717, p = 0.001). Increased right atrioventricular groove EFT thickness is independently associated with RVD in patients with APE. This novel marker may contribute to non-invasive risk stratification and early identification of right heart dysfunction in APE.