Hemodynamic and Functional Impact of Epicardial Adipose Tissue in Heart Failure With Preserved Ejection Fraction
Autor: | Yogesh N.V. Reddy, Katlyn E. Koepp, Masaru Obokata, Thomas P. Olson, Barry A. Borlaug |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Cardiac fibrosis business.industry digestive oral and skin physiology Hemodynamics 030204 cardiovascular system & hematology medicine.disease Pulmonary hypertension Article Pathophysiology 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Heart failure medicine.artery Internal medicine Pulmonary artery medicine Cardiology Pericardium 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Heart failure with preserved ejection fraction |
Zdroj: | JACC Heart Fail |
ISSN: | 2213-1779 |
DOI: | 10.1016/j.jchf.2020.04.016 |
Popis: | Objectives This study determined the impact of excess epicardial adipose tissue (EAT) in patients with the obese phenotype of heart failure with preserved ejection fraction (HFpEF). Background Patients with HFpEF and an elevated body mass index differ from nonobese patients, but beyond generalized obesity, fat distribution may be more important. Increases in EAT are associated with excess visceral adiposity, inflammation, and cardiac fibrosis, and EAT has been speculated to play an important role in the pathophysiology of HFpEF, but no study has directly evaluated this question. Methods Patients with HFpEF and obesity (n = 169) underwent invasive hemodynamic exercise testing with expired gas analysis and echocardiography. Increased EAT was defined by echocardiography (EAT thickness ≥9 mm). Results Compared with obese patients without increased EAT (HFpEFEAT−, n = 92), obese patients with HFpEF with increased EAT (HFpEFEAT+; n = 77) displayed a higher left ventricular eccentricity index, indicating increased pericardial restraint, but similar resting biventricular structure and function. In contrast, hemodynamics were more abnormal in patients with HFpEFEAT+, with higher right atrial, pulmonary artery, and pulmonary capillary wedge pressures at rest and during exercise compared with those of patients with HFpEFEAT−. Peak oxygen consumption (VO2) was reduced in both groups but was 20% lower in patients with HFpEFEAT+ (p Conclusions Among patients with the obese phenotype of HFpEF, the presence of increased EAT is associated with more profound hemodynamic derangements at rest and exercise, including greater elevation in cardiac filling pressures, more severe pulmonary hypertension, and greater pericardial restraint, culminating in poorer exercise capacity. Further study is needed to understand the biology and treatment of excessive EAT in patients with HFpEF. |
Databáze: | OpenAIRE |
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