Obesity accompanying COVID-19: the role of epicardial fat.

With interest we read the study by Simonnet A et al. (1) in which important novel evidence is addressed that obesity is highly frequent among critically ill patients with severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) infection. Although clinically very relevant, it remains difficult to elucidate the mechanisms by which SARS-Cov-2 severity is increased in the context of obesity. As reported by Katz JN et al. (2), 28% of hospitalised patients with coronavirus disease 2019 (COVID-19) presented cardiac complications including myocarditis, arrhythmias, heart failure (HF) and sudden death. Considering that myocardial response in COVID-19 is closely associated with in-hospital mortality, local biological effects on myocardial tissue from epicardial adipose tissue (EAT) is warrant further discussion.