ReviewCureus2025
The Role of Epicardial Fat Thickness and B-type Natriuretic Peptide (BNP)/N-terminal Pro B-type Natriuretic Peptide (NT-proBNP) in Heart Failure Risk Stratification: A Systematic Review.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Cardiometabolic associations of SGLT-2 inhibitors on epicardial adiposity and left ventricular function in type 2 diabetes mellitus with coronary artery disease: insights from Malaysian EpiCAD study.Scientific reports · 2026Article
- The relationship between epicardial adipose tissue and mortality in systemic sclerosis patients: 10-year follow-up results.Frontiers in cardiovascular medicine · 2026Article
- Beyond BMI: Rethinking Obesity Metrics and Cardiovascular Risk in the Era of Precision Medicine.Diagnostics (Basel, Switzerland) · 2025Review
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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