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• Clinical Articles •
Predictive value of normalized epicardial adipose tissue volume for left ventricular reverse remodeling in dilated cardiomyopathy based on CMR
WANG Xinran  XU Wen  ZHANG Chao  KE Jie  CHENG Liang  WU Chen  YAO Yuheng  ZHOU Yunfeng 

Cite this article as WANG X R, XU W, ZHANG C, et al. Predictive value of normalized epicardial adipose tissue volume for left ventricular reverse remodeling in dilated cardiomyopathy based on CMR[J]. Chin J Magn Reson Imaging, 2026, 17(8): 80-87, 205. DOI:10.12015/issn.1674-8034.2026.08.008.


[Abstract] Objective To investigate the predictive value of epicardial adipose tissue (EAT) parameters derived from cardiac magnetic resonance (CMR) for left ventricular reverse remodeling (LVRR) in patients with dilated cardiomyopathy (DCM).Materials and Methods A total of 73 patients with DCM treated at Yijishan Hospital of Wannan Medical University from May 2023 to July 2025 were retrospectively enrolled. Clinical data, echocardiographic parameters, and CMR-derived parameters including cardiac functional parameters, EAT thickness, epicardial adipose tissue volume (EATV), and late gadolinium enhancement (LGE) percentage (LEG%) were collected. All patients received guideline-directed medical therapy and were followed up by echocardiography for 12 months. Patients were divided into the LVRR and non-LVRR groups according to the occurrence of LVRR. Baseline clinical and CMR data were compared between the two groups. Variables with statistically significant differences in univariate analysis (P < 0.05), except for normalized EATV and LGE extent LGE%, were entered into stepwise logistic regression to construct the baseline model (Model 1). Normalized EATV and LGE% were then separately added to Model 1 to construct Model 2 and Model 3, respectively. Finally, both normalized EATV and LGE% were added to construct the combined model. The area under the receiver operating characteristic curve (AUC) was calculated for each model, and predictive performance was compared using the DeLong test. Spearman correlation analysis and mediation analysis were used to explore the relationship between EAT indices and LGE%.Results At baseline, the LVRR group had a higher proportion of women and a higher body mass index, whereas left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume (LVESV), right ventricular free wall (RVFW) thickness, EATV, normalized EATV, and LGE% were all significantly lower than those in the non-LVRR group (all P < 0.05). After adjustment for potential confounders, stepwise multivariate logistic regression analysis identified female sex (P = 0.019), normalized EATV (P = 0.010), and LGE% (P = 0.023) as independent predictors of LVRR. The AUCs of Model 1, Model 2, Model 3, and the combined model for predicting LVRR were 0.765, 0.857, 0.856, and 0.891, respectively. DeLong test showed that Model 2 (P = 0.028), Model 3 (P = 0.043), and the combined model (P = 0.018) all demonstrated significantly better predictive performance than Model 1, whereas no significant differences were observed among Model 2, Model 3, and the combined model (all P > 0.05). Correlation analysis showed that EATV and normalized EATV were significantly positively correlated with LGE% (r = 0.613 and 0.624, respectively; both P < 0.001). Mediation analysis demonstrated that LGE% partially mediated the association between normalized EATV and LVRR, with a mediation proportion of 39.10% (P = 0.030).Conclusions Normalized EATV is an independent predictor for LVRR in patients with DCM, and its effect is partially mediated by promoting myocardial fibrosis. Quantitative EAT parameters and LGE% obtained from one-stop CMR imaging may serve as objective imaging markers for treatment response and prognostic stratification in patients with DCM.
[Keywords] dilated cardiomyopathy；epicardial adipose tissue；late gadolinium enhancement；left ventricular reverse remodeling；cardiac magnetic resonance

WANG Xinran   XU Wen   ZHANG Chao   KE Jie   CHENG Liang   WU Chen   YAO Yuheng   ZHOU Yunfeng*  

Department of Radiology, the First Affiliated Hospital (Yijishan hospital) of Wannan Medical University, Wuhu 241001, China

Corresponding author: ZHOU Y F, E-mail: zhouyunfeng808@163.com

Conflicts of interest   None.

Received  2026-04-14
Accepted  2026-07-14
DOI: 10.12015/issn.1674-8034.2026.08.008
Cite this article as WANG X R, XU W, ZHANG C, et al. Predictive value of normalized epicardial adipose tissue volume for left ventricular reverse remodeling in dilated cardiomyopathy based on CMR[J]. Chin J Magn Reson Imaging, 2026, 17(8): 80-87, 205. DOI:10.12015/issn.1674-8034.2026.08.008.

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