Abstract
BackgroundEpicardial adipose tissue (EAT) has been implicated in the pathophysiology of heart failure (HF) with left ventricular ejection fraction (LVEF) >40%, but whether this is due to a regional or global effect of EAT remains unclear.HypothesisRegional EAT is associated with alterations in local cardiac structure and function.MethodsPatients with HF and LVEF >40% were studied. Cardiac Magnetic Resonance imaging was used to localize EAT surrounding the right ventricle (RV) and LV separately, using anterior‐ and posterior interventricular grooves as boundaries. Atrial‐ and ventricular EAT were differentiated using the mitral‐valve position. All EAT depots were related to the adjacent myocardial structure.Results102 consecutive HF patients were enrolled. The majority of EAT was present around the RV (42% of total EAT, p < .001). RV‐EAT showed a strong association with increased RV mass (β = 0.60, p < .001) and remained associated with RV mass after adjusting for total EAT, sex, N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP), renal function and blood glucose. LV‐EAT showed a similar association with LV mass in univariable analysis, albeit less pronounced (β = 0.24, p = .02). Atrial EAT was increased in patients with atrial fibrillation compared to those without atrial fibrillation (30 vs. 26 ml/m2, p = .04), whereas ventricular EAT was similar (74 vs. 75 ml/m2, p = .9).ConclusionsRegional EAT is strongly associated with local cardiac structure and function in HF patients with LVEF >40%. These data support the hypothesis that regional EAT is involved in the pathophysiology of HF with LVEF >40%.
Highlights
Epicardial adipose tissue (EAT) has been implicated in the pathophysiology of heart failure (HF) with left ventricular ejection fraction (LVEF) >40%, but whether this is due to a regional or global effect of EAT remains unclear
These data are novel, and to our knowledge this is the first study to separately quantify EAT volumes around the LV, right ventricle (RV) and atria in HFmrEF/HFpEF patients and show that local EAT is involved in the pathophysiology of HFmrEF and HFpEF
Our finding that local EAT is associated with changes in the adjacent myocardial structure, independent of global measures of adiposity, is in line with the study by Nalliah et al none of the LV function and structure indices were associated with RV-EAT and vice versa, suggesting that local, rather than global EAT is related to myocardial structure
Summary
Heart failure (HF) with a left ventricular ejection fraction (LVEF) >40% (i.e. HF with mid-range EF [HFmrEF] and preserved EF [HFpEF]) is an emerging heart disease with poor prognosis for which currently no evidence based therapies exists.[1,2,3,4] Epicardial adipose tissue (EAT) is increasingly recognized as a potential culprit in the pathophysiology of HF patients with LVEF >40%.5–7. EAT is a layer of visceral fat that is in direct contact with the heart that has the potential to influence myocardial structure and function. Experimental and clinical studies have shown that local EAT can affect the electrophysiological properties of the atrial myocardium, resulting in slowed conduction and fractionated electrograms.[8,9] This is at least partially due to myocardial infiltration of EAT, which disrupts myocardial ultrastructure and promotes fibrosis.[9] In contrast, the accumulation of EAT has been associated with increased cardiac filling pressures suggesting that it increases the mechanical load on the myocardium.[6,7,10]. We investigated the relationship between local EAT accumulation and adjacent local myocardial structure and function using cardiac magnetic resonance (CMR) imaging in patients with HFmrEF and HFpEF
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