Evolutional change in epicardial fat and its correlation with myocardial diffuse fibrosis in heart failure patients

Wu, Cho Kai; Tsai, Hao Yuan; Su, Mao‐Yuan; Wu, Yi Fan; Hwang, Juey‐Jen; Lin, Jiunn Lee; Lin, Lian Yu; Chen, Jien Jiun

doi:10.1016/j.jacl.2017.08.018

Cited by 78 publications

(55 citation statements)

References 37 publications

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“…On the other hand, epicardial fat correlated with some LV diastolic parameters in male subgroups, including LAVI (r = 0.278, P = 0.008) and LVPFR (r = −0.370, P < 0.001), but not in HFpEF women (online supplementary Figure ). This finding was consistent with our previous study …”

Section: Resultssupporting

confidence: 94%

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Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

Lee

Hsu

et al. 2019

European J of Heart Fail

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Aims It has been proposed that an increase of myocardial adiposity is related to left ventricular (LV) diastolic dysfunction. The specific roles of myocardial steatosis including epicardial fat and intramyocardial fat for diastolic function are unknown in those patients suffering heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF). This study aims to determine the complex relationship between myocardial adiposity in patients with HFrEF or HFpEF. Methods and results Using cardiac magnetic resonance imaging (CMRI), myocardial steatosis was measured in 305 subjects (34 patients with HFrEF, 163 with HFpEF, and 108 non‐HF controls). We also evaluated cardiac structure and diastolic and systolic function by echocardiography and CMRI. Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non‐HF controls [intramyocardial fat content (%), 1.56 (1.26, 1.89) vs. 0.75 (0.50, 0.87) and 1.0 (0.79, 1.15), P < 0.05]. Intramyocardial fat amount (%) was higher in HFpEF women than in men [1.91% (1.17%, 2.32%) vs. 1.22 (0.87%, 2.02%), P = 0.01]. When estimated by CMRI (left ventricular peak filling rate), echocardiographic E/e′ level, or left atrial volume index, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients, and this was independent of age, co‐morbidities, body mass index, gender, and myocardial fibrosis (standardized coefficient: β = −0.34, P = 0.03; β = 0.29, P = 0.025; and β = 0.25, P = 0.02, respectively). Conclusions Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non‐HF controls. Independent of risk factors or gender, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients.

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Section: Resultssupporting

confidence: 94%

“…However, due to the difficulty of accurately measuring myocardial adiposity, very few studies have investigated this further. Recently, we demonstrated that the amount of epicardial fat was associated with cardiac fibrosis and diastolic function, as revealed by the findings of cardiac magnetic resonance imaging (CMRI) …”

Section: Introductionmentioning

confidence: 99%

Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

Lee

Hsu

et al. 2019

European J of Heart Fail

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“…When fat cells become dysfunctional, they may start to release pro‐inflammatory adipokines into the bloodstream, possibly leading to a chronic systemic inflammatory state associated with arterial stiffness, endothelial dysfunction of arterioles, and fibrosis, which are all implicated in the development of HF with LVEF >40% . One can postulate this same mechanism may hold true for epicardial fat.…”

Section: Discussionmentioning

confidence: 99%

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

Woerden

Gorter

Westenbrink

et al. 2018

European J of Heart Fail

207

180

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Aims Adipose tissue and inflammation may play a role in the pathophysiology of patients with heart failure (HF) with mildly reduced or preserved ejection fraction. We therefore investigated epicardial fat in patients with HF with preserved (HFpEF) and mid‐range ejection fraction (HFmrEF), and related this to co‐morbidities, plasma biomarkers and cardiac structure. Methods and results A total of 64 HF patients with left ventricular ejection fraction >40% and 20 controls underwent routine cardiac magnetic resonance examination. Epicardial fat volume was quantified on short‐axis cine stacks covering the entire epicardium and was related to clinical correlates, biomarkers associated with inflammation and myocardial injury, and cardiac function and contractility on cardiac magnetic resonance. HF patients and controls were of comparable age, sex and body mass index. Total epicardial fat volume was significantly higher in HF patients compared to controls (107 mL/m 2 vs. 77 mL/m 2 , P <0.0001). HF patients with atrial fibrillation and/or type 2 diabetes mellitus had more epicardial fat than HF patients without these co‐morbidities (116 vs. 100 mL/m 2 , P =0.03, and 120 vs. 97 mL/m 2 , P =0.001, respectively). Creatine kinase‐MB, troponin T and glycated haemoglobin in patients with HF were positively correlated with epicardial fat volume (R =0.37, P =0.006; R =0.35, P =0.01; and R =0.42, P =0.002, respectively). Conclusion Heart failure patients had more epicardial fat compared to controls, despite similar body mass index. Epicardial fat volume was associated with the presence of atrial fibrillation and type 2 diabetes mellitus and with biomarkers related to myocardial injury. The clinical implications of these findings are unclear, but warrant further investigation.

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“…A recent meta‐analysis of studies using relatively simple indicators of diastolic dysfunction, mitral valve E/A ratio or E/e′, showed a significant correlation between the amount of epicardial fat and diastolic dysfunction (Figure ). Individuals with HFpEF have a greater amount of epicardial fat compared with left ventricular mass than individuals without HFpEF . The amount of epicardial fat is increased in obesity and the MetS .…”

Section: Epicardial Fatmentioning

confidence: 98%

Hypoxia‐inducible factor 1‐alpha (HIF‐1α) as a factor mediating the relationship between obesity and heart failure with preserved ejection fraction

Warbrick

Rabkin

2019

Obesity Reviews

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Summary Heart failure with preserved ejection fraction (HFpEF), a common condition with an increased mortality, is strongly associated with obesity and the metabolic syndrome. The latter two conditions are associated with increased epicardial fat that can extend into the heart. This review advances the proposition that hypoxia‐inhibitory factor‐1α (HIF‐1α) maybe a key factor producing HFpEF. HIF‐1α, a highly conserved transcription factor that plays a key role in tissue response to hypoxia, is increased in adipose tissue in obesity. Increased HIF‐1α expression leads to expression of a potent profibrotic transcriptional programme involving collagen I, III, IV, TIMP, and lysyl oxidase. The net effect is the formation of collagen fibres leading to fibrosis. HIF‐1α is also responsible for recruiting M1 macrophages that mediate obesity‐associated inflammation, releasing IL‐6, MCP‐1, TNF‐α, and IL‐1β with increased expression of thrombospondin, pro α2 (I) collagen, transforming growth factor β, NADPH oxidase, and connective tissue growth factor. These factors can accelerate cardiac fibrosis and impair cardiac diastolic function. Inhibition of HIF‐1α expression in adipose tissue of mice fed a high‐fat diet suppressed fibrosis and reduces inflammation in adipose tissue. Delineation of the role played by HIF‐1α in obesity‐associated HFpEF may lead to new potential therapies.

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Evolutional change in epicardial fat and its correlation with myocardial diffuse fibrosis in heart failure patients

Cited by 78 publications

References 37 publications

Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

Myocardial adipose deposition and the development of heart failure with preserved ejection fraction

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

Hypoxia‐inducible factor 1‐alpha (HIF‐1α) as a factor mediating the relationship between obesity and heart failure with preserved ejection fraction

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