Epicardial Fat in Heart Failure with Preserved Ejection Fraction: Bad Actor or Just Lying Around?

Author:

Oduah Mary-Tiffany1ORCID,Sundaram Varun2,Reddy Yogesh NV1ORCID

Affiliation:

1. Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, US

2. Division of Cardiovascular Diseases, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, US

Abstract

Heart failure with preserved ejection fraction (HFpEF) is increasingly recognised to be strongly associated with obesity and abnormalities in fat distribution. Epicardial fat has been associated with abnormal haemodynamics in HFpEF, with potential for direct mechanical effects on the heart causing constriction-like physiology and local myocardial remodelling effects from secretion of inflammatory and profibrotic mediators. However, patients with epicardial fat generally have more systemic and visceral adipose tissue making determination of causality between epicardial fat and HFpEF complex. In this review, we will summarise the evidence for epicardial fat being either directly causal in HFpEF pathogenesis or merely being a correlate of worse systemic inflammatory and generalised adiposity. We will also discuss therapies that directly target epicardial fat and may have potential for treating HFpEF and elucidating the independent role of epicardial fat in its pathogenesis.

Publisher

Radcliffe Media Media Ltd

Subject

Cardiology and Cardiovascular Medicine

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