Author + information
- Received May 8, 2020
- Revision received June 1, 2020
- Accepted June 2, 2020
- Published online July 27, 2020.
- Thomas M. Gorter, MD, PhD∗ (, )
- Gijs van Woerden, MD,
- Michiel Rienstra, MD, PhD,
- Michael G. Dickinson, MD, PhD,
- Yoran M. Hummel, PhD,
- Adriaan A. Voors, MD, PhD,
- Elke S. Hoendermis, MD, PhD and
- Dirk J. van Veldhuisen, MD, PhD
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- ↵∗Address for correspondence:
Dr. Thomas M. Gorter, Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
Objectives This study examined associations between epicardial adipose tissue (EAT), invasive hemodynamics, and exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF).
Background EAT is increased in patients with HFpEF and may play a role in the pathophysiology of this disorder.
Methods Patients with heart failure and a left ventricular ejection fraction >45% who underwent right and left heart catheterization with simultaneous echocardiography were included. Pulmonary capillary wedge pressure (PCWP), left ventricular end-diastolic pressure (LVEDP), right ventricular end-diastolic pressure (RVEDP), and pulmonary vascular resistance (PVR) were invasively measured. Obesity was defined as body mass index (BMI) ≥30 kg/m2. EAT thickness alongside the right ventricle was measured on echocardiographic long- and short-axis views. Cardiopulmonary exercise testing was performed to obtain maximal oxygen uptake (VO2-max).
Results This study examined 75 patients, mean age 74 ± 9 years; 68% were women, mean BMI was 29 ± 6 kg/m2, and 36% were obese. Higher BMI was strongly associated with increased EAT (r = 0.74; p < 0.001). Increased EAT was associated with higher RVEDP, independent of PVR (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.02 to 1.34; p = 0.03), but not independent of obesity (p = 0.10). Increased EAT and higher RVEDP were both associated with lower VO2-max (r = −0.43; p < 0.001 and r = −0.43; p = 0.001, respectively). Increased EAT remained associated with lower VO2-max after adjustment for PVR (OR: 0.64; 95% CI: 0.49 to 0.84; p = 0.002) and obesity (OR: 0.69; 95% CI: 0.53 to 0.92; p = 0.01). EAT thickness was not associated with left-sided filling pressures (i.e., PCWP and LVEDP).
Conclusions In HFpEF, obesity and increased EAT were associated with higher right-sided filling pressures and with reduced exercise capacity.
Dr. Voors has received consultancy fees and/or research grants from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Myokardia, Novartis, NovoNordisk, and Roche Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received May 8, 2020.
- Revision received June 1, 2020.
- Accepted June 2, 2020.
- 2020 American College of Cardiology Foundation
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