Heart Failure With Preserved Ejection Fraction and Adipose Tissue: A Story of Two Tales

Background Visceral adipose tissue (VAT) is associated with incident heart failure (HF) and HF with preserved ejection fraction, yet it is unknown how pericardial and abdominal adiposity affect HF and mortality risks in Black individuals. We examined the associations of pericardial adipose tissue (PAT), VAT, and subcutaneous adipose tissue (SAT) with incident HF hospitalization and all‐cause mortality in a large community cohort of Black participants. Methods and Results Among the 2882 Jackson Heart Study Exam 2 participants without prevalent HF who underwent body computed tomography, we used Cox proportional hazards models to examine associations between computed tomography–derived regional adiposity and incident HF hospitalization and all‐cause mortality. Fully adjusted models included demographics and cardiovascular disease risk factors. Median follow‐up was 10.6 years among participants with available VAT (n=2844), SAT (n=2843), and PAT (n=1386). Fully adjusted hazard ratios (95% CIs) of distinct computed tomography–derived adiposity measures (PAT per 10 cm 3 , VAT or SAT per 100 cm 3 ) were as follows: for incident HF, PAT 1.08 (95% CI, 1.02–1.14) and VAT 1.04 (95% CI, 1.01–1.08); for HF with preserved ejection fraction, PAT 1.13 (95% CI, 1.04–1.21) and VAT 1.07 (95% CI, 1.01–1.13); for mortality, PAT 1.07 (95% CI, 1.03–1.12) and VAT 1.01 (95% CI, 0.98–1.04). SAT was not associated with either outcome. Conclusions High PAT and VAT, but not SAT, were associated with incident HF and HF with preserved ejection fraction, and only PAT was associated with mortality in the fully adjusted models in a longitudinal community cohort of Black participants. Future studies may help understand whether changes in regional adiposity improves HF, particularly HF with preserved ejection fraction, risk predictions. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00005485.

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INCREASED EPICARDIAL ADIPOSE TISSUE (EAT) IS ASSOCIATED WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF)

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2017.07.149 ◽

2017 ◽

Vol 33 (10) ◽

pp. S73

Author(s):

E. Saliba

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Ejection Fraction ◽

Epicardial Adipose Tissue ◽

Preserved Ejection Fraction

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Commentary: Heart Failure with Preserved Ejection Fraction Induces Beiging in Adipose Tissue

Frontiers in Physiology ◽

10.3389/fphys.2016.00085 ◽

2016 ◽

Vol 7 ◽

Author(s):

Salvatore Chirumbolo

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Ejection Fraction ◽

Preserved Ejection Fraction

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Epicardial Adipose Tissue and Outcome in Heart Failure With Mid-Range and Preserved Ejection Fraction

Circulation Heart Failure ◽

10.1161/circheartfailure.121.009238 ◽

2021 ◽

Author(s):

Gijs van Woerden ◽

Dirk J. van Veldhuisen ◽

Olivier C. Manintveld ◽

Vanessa P.M. van Empel ◽

Tineke P. Willems ◽

...

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Epicardial Adipose Tissue ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

All Cause Mortality

Background: Epicardial adipose tissue (EAT) accumulation is thought to play a role in the pathophysiology of heart failure (HF) with mid-range and preserved ejection fraction, but its effect on outcome is unknown. We evaluated the prognostic value of EAT volume measured with cardiac magnetic resonance in patients with HF with mid-range ejection fraction and HF with preserved ejection fraction. Methods: Patients enrolled in a prospective multicenter study that investigated the value of implantable loop-recorders in HF with mid-range ejection fraction and HF with preserved ejection fraction were analyzed. EAT volume was quantified with cardiac magnetic resonance. Main outcome was the composite of all-cause mortality and first HF hospitalizations. Hazard ratios (HR) and 95% CI are described per SD increase in EAT. Results: We studied 105 patients (mean age 72±8 years, 50% women, and mean left ventricular ejection fraction 53±8%). During median follow-up of 24 (17–25) months, 31 patients (30%) died or were hospitalized for HF. In univariable analysis, EAT was significantly associated with a higher risk of the composite outcome (HR, 1.76 [95% CI, 1.24–2.50], P =0.001), and EAT remained associated with outcome after adjustment for age, sex, and body mass index (HR, 1.61 [95% CI, 1.13–2.31], P =0.009), and after adjustment for New York Heart Association functional class and N-terminal of pro-brain natriuretic peptide (HR, 1.53 [95% CI, 1.04–2.24], P =0.03). Furthermore, EAT was associated with all-cause mortality alone (HR, 2.06 [95% CI, 1.26–3.37], P =0.004) and HF hospitalizations alone (HR, 1.54 [95% CI, 1.04–2.30], P =0.03). Conclusions: EAT accumulation is associated with adverse prognosis in patients with HF with mid-range ejection fraction and HF with preserved ejection fraction. This finding supports the importance of EAT in these patients with HF. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01989299.

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Epicardial Adipose Tissue in Heart Failure With Preserved Ejection Fraction

JACC Heart Failure ◽

10.1016/j.jchf.2020.08.006 ◽

2020 ◽

Vol 8 (11) ◽

pp. 956

Author(s):

Massimo Leggio

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Ejection Fraction ◽

Epicardial Adipose Tissue ◽

Preserved Ejection Fraction

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Impact of Epicardial Adipose Tissue in Heart Failure with Preserved Ejection Fraction

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2018.07.018 ◽

2018 ◽

Vol 24 (8) ◽

pp. S4 ◽

Cited By ~ 1

Author(s):

Katlyn E. Koepp ◽

Masaru Obokata ◽

Yogesh N. Reddy ◽

Thomas P. Olson ◽

Barry A. Borlaug

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Ejection Fraction ◽

Epicardial Adipose Tissue ◽

Preserved Ejection Fraction

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Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehaa823 ◽

2020 ◽

Cited By ~ 1

Author(s):

Hidemi Sorimachi ◽

Masaru Obokata ◽

Naoki Takahashi ◽

Yogesh N V Reddy ◽

Christopher C Jain ◽

...

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Ejection Fraction ◽

Visceral Adipose Tissue ◽

Preserved Ejection Fraction ◽

Similar Extent ◽

Pulmonary Capillary ◽

Tissue Area ◽

Visceral Adipose ◽

Wedge Pressure

Abstract Aims Central obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF), particularly in women, but the mechanisms remain unclear. We hypothesized that sex-specific differences in visceral adipose tissue (VAT) content would differentially relate to haemodynamic severity of HFpEF in women and men. Methods and results Abdominal computed tomography (CT) and invasive haemodynamic exercise testing were performed in 105 subjects with HFpEF (63 women) and 105 age-, sex-, and body mass index-matched controls. Visceral adipose tissue area was quantified by CT. As compared with control women, VAT area was 34% higher in women with HFpEF (186 ± 112 vs. 139 ± 72 cm2, P = 0.006), while VAT area was not significantly different in men with or without HFpEF (294 ± 158 vs. 252 ± 92 cm2, P = 0.1). During exercise, pulmonary capillary wedge pressure (PCWP) increased markedly and to similar extent in both men and women with HFpEF. Women with increased VAT area displayed 33% higher PCWP during exercise compared with women with normal VAT area (28 ± 10 vs. 21 ± 10 mmHg, P = 0.001), whereas exercise PCWP was similar in men with or without excess VAT (24 ± 9 vs. 25 ± 6, P = 0.89). In women, each 100 cm2 increase in VAT area was associated with a 4.0 mmHg higher PCWP (95% CI 2.1, 6.0 mmHg; P < 0.0001), but there was no such relationship in men (interaction P = 0.009). Conclusions These data suggest that accumulation of excess VAT plays a distinct and important role in the pathophysiology of HFpEF preferentially in women. Further research is needed to better understand the mechanisms and treatment implications for visceral fat in HFpEF.

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