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EAT volumes were depicted from CMR short-axis stacks. First, the impact of increased EAT above the median was investigated. Second, the association of ventricular and atrial EAT with myocardial deformation at rest and during exercise stress was analysed in a multivariable regression analysis. Patients with high EAT had higher HFA-PEFF and H2FPEFF scores as well as N-terminal prohormone of brain natriuretic peptide levels (all P &amp;lt; 0.048). They were diagnosed with manifest heart failure with preserved ejection fraction (HFpEF) more frequently (low EAT: 37% vs. high EAT: 64%; P = 0.029) and had signs of adverse remodelling indicated by higher T1 times (P &amp;lt; 0.001). No differences in biventricular volumetry and left ventricular mass (all P &amp;gt; 0.074) were observed. Patients with high EAT had impaired atrial strain at rest and during exercise stress, and impaired ventricular strain during exercise stress. Regionally increased EAT was independently associated with functional impairment of the adjacent chambers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with diastolic dysfunction and increased EAT show more pronounced signs of diastolic functional failure and adverse structural remodelling. Despite similar morphological characteristics, patients with high EAT show significant cardiac functional impairment, in particular in the atria. Our results indicate that regionally increased EAT directly induces atrial functional failure, which represents a distinct pathophysiological feature in HFpEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14744","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T23:52:25Z","timestamp":1710373945000},"page":"2013-2022","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Impact of Epicardial Adipose Tissue on Cardiac Function and Morphology in Patients with Diastolic Dysfunction"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5589-8792","authenticated-orcid":false,"given":"Alexander","family":"Schulz","sequence":"first","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg August University of G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f6ren J.","family":"Backhaus","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic , Bad Nauheim ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torben","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg August University of G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Evertz","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg August University of G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby","family":"Kutty","sequence":"additional","affiliation":[{"name":"Taussig Heart Center, Johns Hopkins Hospital and School of Medicine , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes T.","family":"Kowallick","sequence":"additional","affiliation":[{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]},{"name":"Institute for Diagnostic and Interventional Radiology, University Medical Center G\u00f6ttingen, Georg August University of G\u00f6ttingen , G\u00f6ttingen 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