Author + information
- Received March 29, 2018
- Revision received June 1, 2018
- Accepted June 7, 2018
- Published online July 30, 2018.
- Mark J. Haykowsky, PhDa,
- Barbara J. Nicklas, PhDb,
- Peter H. Brubaker, PhDc,
- W. Gregory Hundley, MDd,
- Tina E. Brinkley, PhDb,
- Bharathi Upadhya, MDd,
- J. Thomas Becton, MSd,
- Michael D. Nelson, PhDa,
- Haiying Chen, PhDe and
- Dalane W. Kitzman, MDb,d,∗ ()
- aCollege of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
- bSection on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
- cDepartment of Exercise and Health Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
- dCardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
- eDepartment of Biostatistical Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
- ↵∗Address for correspondence:
Dr. Dalane W. Kitzman, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045.
Objectives This study sought to test the hypothesis that older obese patients with heart failure with preserved ejection fraction (HFpEF) have significantly greater abdominal, cardiac, and intermuscular fat than healthy, age-matched controls, out of proportion to total body fat, and that these abnormalities are associated with objective measurements of physical function.
Background Recent studies indicate that excess total body adipose tissue contributes to exercise intolerance in patients with HFpEF. However, the impact of the pattern of regional (abdominal, cardiac, intermuscular) adipose deposition on exercise intolerance in patients with HFpEF is unknown.
Methods We measured total body adiposity (using dual-energy x-ray absorptiometry) and regional adiposity (using cardiac magnetic resonance), peak oxygen uptake (Vo2), 6-min walk distance (6MWD), short physical performance battery (SPPB), and leg press power in 100 older obese patients with HFpEF and 61 healthy controls (HCs) and adjusted for age, sex, race, and body surface area.
Results Peak Vo2 (15.7 ± 0.4 ml/kg/min vs. 23.0 ± 0.6 ml/kg/min, respectively; p < 0.001), 6MWD (427 ± 7 m vs. 538 ± 10 m, respectively; p < 0.001), SPPB (10.3 ± 0.2 vs. 10.9 ± 0.2, respectively; p < 0.05), and leg power (117 ± 5 W vs. 152 ± 9 W, respectively; p = 0.004) were significantly lower in patients with HFpEF than HCs. Total fat mass, total percent fat, abdominal subcutaneous fat, intra-abdominal fat, and thigh intermuscular fat were significantly higher, whereas epicardial fat was significantly lower in patients with HFpEF than in HC. After we adjusted for total body fat, intra-abdominal fat remained significantly higher, while epicardial fat remained significantly lower in patients with HFpEF. Abdominal subcutaneous fat, thigh subcutaneous fat, and thigh intermuscular fat:skeletal muscle ratio were inversely associated, whereas epicardial fat was directly associated with peak Vo2, 6MWD, SPPB, and leg power. Using multiple stepwise regression, we found intra-abdominal fat was the strongest independent predictor of peak Vo2 and 6MWD.
Conclusions In metabolic obese HFpEF, the pattern of regional adipose deposition may have important adverse consequences beyond total body adiposity. Interventions targeting intra-abdominal and intermuscular fat could potentially improve exercise intolerance. (Exercise Intolerance in Elderly Patients With Diastolic Heart Failure [SECRET]; NCT00959660)
Supported by U.S. National Institutes of Health grants R01AG18917, R01AG045551, R01HL107257, P30-AG21331, and UL1TR001420 (Dr. Kitzman), R15NR016826 (Dr. Haykowsky), K01AG033652 (Dr. Brinkley), and R01HL093713 (Dr. Nicklas). Dr. Kitzman has consulted for Relypsa, Abbvie, GlaxoSmithKline, St. Luke′s Medical Center, DCRI, and Corvia Medical; has received grants from Novartis and St. Luke′s Medical Center; holds the Kermit G. Phillips II Chair in Cardiovascular Medicine of Wake Forest School of Medicine; and owns stock in Gilead Sciences. Dr. Haykowsky holds the Moritz Endowed Chair in Geriatrics in the College of Nursing and Health Innovation, University of Texas at Arlington. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 29, 2018.
- Revision received June 1, 2018.
- Accepted June 7, 2018.
- 2018 American College of Cardiology Foundation