Connecting epicardial adipose tissue and heart failure with preserved ejection fraction: mechanisms, management and modern perspectives

Obesity is very common in patients with heart failure with preserved ejection fraction (HFpEF) and it has been suggested that obesity plays an important role in the pathophysiology of this disease. While body mass index defines the presence of obesity, this measure provides limited information on vi...

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Bibliographic Details
Published in:European journal of heart failure 2022-12, Vol.24 (12), p.2238-2250
Main Authors: Woerden, Gijs, Veldhuisen, Dirk J., Westenbrink, B. Daan, Boer, Rudolf A., Rienstra, Michiel, Gorter, Thomas M.
Format: Article
Language:English
Subjects:
Adipose Tissue
Epicardial adipose tissue
Heart Failure
HFpEF
Humans
Inflammation
Obesity
Pathophysiology
Pericardium
Review
Stroke Volume - physiology
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Summary:Obesity is very common in patients with heart failure with preserved ejection fraction (HFpEF) and it has been suggested that obesity plays an important role in the pathophysiology of this disease. While body mass index defines the presence of obesity, this measure provides limited information on visceral adiposity, which is probably more relevant in the pathophysiology of HFpEF. Epicardial adipose tissue is the visceral fat situated directly adjacent to the heart and recent data demonstrate that accumulation of epicardial adipose tissue is associated with the onset, symptomatology and outcome of HFpEF. However, the mechanisms by which epicardial adipose tissue may be involved in HFpEF remain unclear. It is also questioned whether epicardial adipose tissue may be a specific target for therapy for this disease. In the present review, we describe the physiology of epicardial adipose tissue and the pathophysiological transformation of epicardial adipose tissue in response to chronic inflammatory diseases, and we postulate conceptual mechanisms on how epicardial adipose tissue may be involved in HFpEF pathophysiology. Lastly, we outline potential treatment strategies, knowledge gaps and directions for further research.
ISSN:1388-9842
1879-0844
DOI:10.1002/ejhf.2741