Connecting Epicardial Adipose Tissue and Heart Failure with Preserved Ejection Fraction: Mechanisms, Management and Modern Perspectives

Overview

Journal Eur J Heart Fail

Publisher Wiley

Specialty Cardiology & Vascular Diseases

Date 2022 Nov 17

PMID 36394512

Authors

Gijs van Woerden

Dirk J Van Veldhuisen

B Daan Westenbrink

Rudolf A de Boer

Michiel Rienstra

Thomas M Gorter

Affiliations

Soon will be listed here.

Abstract

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.

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