Epicardial Fat and Heart Failure in Type 2 Diabetes : Metabolism, Imaging and Novel Biomarkers-A Translational Perspective
Gil, Pedro (Universitat Autònoma de Barcelona. Departament de Medicina)
Rives Jimenez, Jose (Institut de Recerca Sant Pau)
Sanchez-Quesada, Jose Luis (Institut de Recerca Sant Pau)
Pérez Pérez, Antonio (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))

Date:	2025
Abstract:	Heart failure (HF) is a major cardiovascular complication in people with type 2 diabetes (T2D), where heart failure with preserved ejection fraction (HFpEF) is the most common presentation. Despite its high prevalence, HF in T2D often remains undiagnosed during its early stages due to nonspecific symptoms and the limitations of conventional diagnostic tools. Epicardial adipose tissue (EAT), a visceral fat depot surrounding the myocardium, has emerged as a mechanistic and clinically relevant contributor to myocardial dysfunction. In T2D, EAT expansion fosters a pro-inflammatory, fibrotic, and metabolically adverse milieu that may directly promote the onset and progression of HF. This perspective synthesizes current translational evidence on the role of EAT in the pathogenesis of HF among individuals with T2D. We highlight diagnostic challenges related to imaging-based quantification and the limited sensitivity of natriuretic peptide-based screening, while emphasizing the potential relevance of emerging biomarkers such as GDF-15, Galectin-3, sST2, LDL particle size, GGT, and soluble low-density lipoprotein receptor-related protein 1 (sLRP1) to enhance early detection and risk stratification. Additionally, therapeutic approaches-including lifestyle modification, SGLT2 inhibitors, and GLP-1 receptor agonists-are considered for their potential to modulate EAT volume and reduce cardiovascular risk. Advancing knowledge on EAT biology and its circulating biomarkers holds promise to refine HF risk stratification and support translational efforts toward precision cardiometabolic care.
Grants:	Instituto de Salud Carlos III PI20/00334
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	epicardial adipose tissue (EAT) ; Type 2 diabetes ; heart failure with preserved ejection fraction (HFpEF) ; Inflammatory biomarkers ; sLRP1 ; GDF15 ; Galectin-3 ; sST2 ; LDL particle size ; Cardiac imaging
Published in:	Journal of clinical medicine, Vol. 14, Num. 23 (November 2025) , ISSN 2077-0383

DOI: 10.3390/jcm14238413
PMID: 41375727

24 p, 1.3 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles