Thick but safe: revisiting the role of epicardial adipose tissue in chemotherapy-induced cardiac dysfunction

Abstract Background Epicardial adipose tissue (EAT) is increasingly recognized as a cardiometabolic risk factor, known to promote oxidative stress, contractile dysfunction, and myocardial fibrosis through its paracrine and endocrine activity. These mechanisms are also implicated in chemotherapy-related cardiac dysfunction (CTRCD), suggesting a potential link. Conversely, EAT may exert cardioprotective effects under physiological conditions by secreting beneficial adipokines and providing metabolic support to the myocardium. Given this dual role, the influence of EAT on CTRCD susceptibility remains unclear. Purpose To investigate whether baseline EAT thickness is associated with the development of CTRCD in breast cancer patients and to evaluate longitudinal changes in EAT during chemotherapy. Methods A total of 131 consecutive breast cancer patients (mean age 51.0 ± 9.3 years) who received chemotherapy were included. Baseline echocardiography was performed within 1 day before chemotherapy and repeated at 3, 6, and 12 months thereafter. CTRCD was defined as a ≥5% decline in LVEF to