Physicians' Academy for Cardiovascular Education

Epicardial fat in HFmrEF and HFpEF patients

Epicardial fat in heart failure patients with mid-range and preserved ejection fraction

News - Dec. 3, 2018

Introduction and methods

No therapies with proven benefit in reducing morbidity and mortality are available for heart failure with left ventricular ejection fraction (LVEF) >40%, possibly because of heterogeneous presentation of the condition [1]. Many of the patients in this category are obese, and increasing evidence suggests that adipose tissue and the associated inflammation may play a role in the pathophysiology of HF [2,3].

In obese patients, epicardial fat excretes several pro-inflammatory chemokines and cytokines, collectively called adipokines [4]. Epicardial fat volume has been related to several systemic diseases, such as the metabolic syndrome and obesity, which both induce a systemic pro-inflammatory state [5-7]. It is conceivable that epicardial fat has local inflammatory and mechanical effects on the myocardium and the coronary arteries.

This study therefore investigated the extent and location of epicardial fat volume using Cardiac Magnetic Resonance (CMR). Both patients with LVEF 40-50% (HF with mid-range EF, HFmrEF) and with LVEF >50% (HF with preserved EF, HFpEF) were enrolled. Patients enrolled were symptomatic (NYHA class ≥II), had LVEF >40% on echocardiography, and had NT-proBNP >125 ng/L and echocardiographic evidence of LV diastolic dysfunction and/or left ventricular hypertrophy. 64 HF patients with LVEF >40% and 20 controls were enrolled.

Main results


These data demonstrate that HF patients with LVEF >40% had more epicardial fat than non-HF controls, even though they had similar BMI. Higher epicardial fat volume was seen in patients with T2DM and in patients with atrial fibrillation. Further research may focus on the potential cause-effect relationship between epicardial fat, co-morbidities and myocardial damage in HF.


Show references

Find this article online at Eur J Heart Fail

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