Epicardial adiposity is associated with impaired cardiac energetics in immune-mediated inflammatory diseases.

Thursday, February 5, 2026

5:00 PM - 5:10 PM

Location: Asia IV and Hall 8 (3rd Floor)

Presenting Author(s)

Nicholas Jex, PhD

Cardiologist
University of Leeds
Leeds, England, United Kingdom

Primary Author(s)

AR

Alan Sujin Philip Rajiv Suresh Kumar, MB

Post-graduate student
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom

Co-Author(s)

CY

Chin Yit Soo, MD

Clinical Research Fellow
University of Leeds
Leeds, England, United Kingdom
LD

Laurence Duquenne, MD

Rheumatology registrar
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Leeds, England, United Kingdom
SS

Sana Sharrack, MB

Rheumatologist
University of Leeds, United Kingdom
HS

Helen-Jayne Sugden, MB

Rheumatologist
University of Leeds, United Kingdom
NB

Nicola Burnett

Research Co-ordinator
University of Leeds, United Kingdom
RJ

Rabeia Javid, BSc, MB

Cardiology Registrar
University of Leeds
Bradford, England, United Kingdom
LC

Lizette Cash, MRT

Operational Radiographer (Cross-Sectional)
Department of Biomedical Imaging Science, Leeds, United Kingdom & Advanced Imaging Centre, Leeds Teaching Hospitals NHS Trust, United Kingdom
Leeds, England, United Kingdom
Peter Kellman, PhD

Senior Scientist
National Institutes of Health
Bethesda, Maryland, United States
DB

David A. Broadbent, PhD

Principal Clinical Scientist (MRI Physics)
Leeds Institute of Cardiovascular and Metabolic Medicine, England, United Kingdom
LB

Lesley-Anne Bissell, PhD

Consultant Rheumatologist
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Leeds, England, United Kingdom
SK

Sindhoora Kotha, BSc, MB

Cardiology Clinical Research Fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom
Leeds, England, United Kingdom
EL

Eylem Levelt

Baker Heart and Diabetes Institute, Australia
TA

Thomas Anderton, MBChB

Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom
Leeds, England, United Kingdom
ML

May Lwin, MB

Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom
Leeds, England, United Kingdom
BC

Bradley Chambers, MBChB BSc MRCP

Cardiology Registrar
University of Leeds, England, United Kingdom
MA

Mehak Asad, MD, MPH

Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom
Leeds, England, United Kingdom
Maryum Farooq, MB

Research Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
Leeds, England, United Kingdom
CS

Ching-Hui Sia, MD

Dr
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
MA

Mohd Imree Azmi, MB

Consultant Radiologist
University of Leeds
Leeds, England, United Kingdom
MT

Masafumi Takafuji, MD, PhD

Assistant Professor
Mie University Hospital
Tsu, Mie, Japan
RT

Raluca Tomoaia, MD, PhD

Clinical Research Fellow
University of Leeds
Leeds, England, United Kingdom
LT

Lucy Thornton, MB

Rheumatology Registrar
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Leeds, England, United Kingdom
KM

Kulveer Mankia, PhD

Consultant Rheumatologist
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Leeds, England, United Kingdom
FD

Francesco Delgaldo, PhD

Professor of Rheumatology
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Leeds, England, United Kingdom
Sven Plein, MD, PhD

Professor of Cardiology
Leeds Institute of Cardiovascular and Metabolic Medicine
Leeds, England, United Kingdom

Background: Immune-mediated inflammatory diseases (IMIDs) are associated with increased risks of cardiovascular disease (CVD) and mortality mainly driven by systemic inflammation. Odds ratios for myocardial infarction are >2 in most IMIDs. Epicardial, subcutaneous and visceral adiposity are also linked to increased cardiovascular inflammation and disease. Whether adiposity impacts myocardial structure and function in patients with IMIDs is unknown.

Methods: Twenty-one patients with systemic sclerosis (SSc), 14 with positive anti-cyclic citrullinated peptide antibody (CCP+ve) at high risk of developing rheumatoid arthritis (RA), 14 with established RA, and 18 age, sex, and body mass index (BMI) matched healthy volunteers (HV) underwent Phosphorus-31 magnetic resonance spectroscopy (31P-MRS) and cardiac magnetic resonance (CMR) on a Siemens 3 Tesla PRISMA system (Erlangen, Germany).

In addition to volumes, a fat/water separated multi-echo GRE sequence was acquired, and fat images manually contoured in cvi42 (Calgary, Canada). Areas of epicardial adiposity tissue (EAT) were averaged over 10 long-axis slices from the level of the great vessels to the true cardiac apex. Areas of abdominal subcutaneous (SAT) and visceral (VAT) adiposity tissue were averaged over 5 contiguous axial slices centred at L2-L3 intervertebral disc level.

31P-MRS data were acquired with non-gated 3D acquisition weighted chemical shift imaging (CSI). Post processing analysis was performed with custom Matlab software (Mathworks, Natick, Mass).

Results: Bi-ventricular size, function, left ventricular (LV) mass index, left atrial (LA) volume and function were normal across all groups (Table-1).

SAT (cm2) was significantly increased in RA (RA: 272 [194-322], HV: 154 [116-221], p=0.0015). VAT (cm2) was significantly increased in anti-CCP+ve patients (CCP: 203 [176-338], HV: 127 [75-185], p=0.0248). EAT (cm2) was significantly increased in SSc (23 [17-29]), anti-CCP (40 [29-46]), and chronic RA (33 [22-42]) versus HV (19 [15-31], p=0.0008).

All three patient groups had reduced cardiac energetics with significantly reduced phosphocreatine-to-adenosine triphosphate (PCr/ATP) ratio (SSc: 1.8 [1.7-2.2], CCP: 1.8 [1.5-2], SSc: 1.8 [1.6-2.2], HV: 2.3 [2.2-2.5], p=0.0126).

EAT correlated negatively with PCr/ATP (r -0.33, p = 0.0178) and global longitudinal strain (r -0.38, p=0.0413). Both EAT and VAT correlated positively with male sex, age, BMI, body surface area (BSA), and HBA1c (all p< 0.05). VAT correlated with worse lipid profile (p< 0.05). SAT correlated positively with male sex, BMI, and BSA (all p< 0.05) without impact on cardiac functions.

Conclusion: We report for the first time that epicardial adiposity tissue is associated with subclinical reduction in myocardial energetics and global longitudinal strain in patients with IMIDs and CCP positive patients at-risk of RA. This underlines the importance of CVD risk factor modulation in this patient group, especially when EAT is increased.

Table 1 Clinical, CMR and 31 P MRS findings

Table 1 Clinical, CMR and 31 P MRS findings

Figure 1: Scatter plots of epicardial adiposity tissue (EAT), abdominal visceral adiposity tissue (VAT), and abdominal subcutaneous adiposity tissue (SAT), in healthy volunteers (HV), systemic sclerosis (SSc), CCP antibody positive at risk of RA (CCP), and established rheumatoid arthritis (RA).

Figure 2: Fat images (from multi-echo GRE sequence) showing a) contouring of epicardial adiposity tissue (EAT), and b) contouring of abdominal subcutaneous adiposity tissue (SAT). Note that abdominal visceral adiposity tissue (VAT) is also visible without contouring.

	HV (n=18)	SSc (n=21)	CCP+ve (n=14)	RA (n=14)	P value
Age, y	45 [31-63]	53 [38-63]	55 [51-66]	62 [47-67]	0.0707
Female, n (%)	14 (78)	13 (62)	8 (57)	11 (79)	0.4308
BMI, kg/m²	27 ± 5	25.5 ± 5.1	29.3 ± 4.3	27.3 ± 2.9	0.1157
Body surface area, m²	1.9 ± 0.2	1.8 ± 0.2	2.0 ± 0.2	1.9 ± 0.2	0.2629
Systolic BP, mmHg	124 [112-136]	114 [100-130]	125 [122-138]	127 [113-139]	0.2588
NT- Pro BNP, ng/L	61 [36-103]	86 [57-183]	77 [35-105]	105 [66-145]	0.3052
Troponin I, ng/L	3 [3-6]	4 [3-8]	3 [3-8]	5 [3-8]	0.7944
HbA1c, mmol/mol	35 [34-39]	34 [33-38]	38 [37-42]	38 [35-42]	0.0195
Total cholesterol, mmol/L	5.1 [4.3-6.3]	5.0 [4-5.7]	5.3 [4.3-6.3]	4.8 [4.3-5.7]	0.7247
HDL cholesterol, mmol/L	1.8 [1.3-2.1]	1.4 [1.1-1.9]	1.3 [1.1-1.7]	1.7 [1.3-2.1]	0.1250
LDL cholesterol, mmol/L	2.7 [2.2-3.5]	2.7 [2.1-3.0]	3.1 [2.3-4]	2.2 [2-3.2]	0.5076