Fighting HFpEF in women: taking aim at belly fat

Withaar, Coenraad; Meems, L. M. G.; Boer, Rudolf A. de

doi:10.1093/eurheartj/ehaa952

Cited by 8 publications

(6 citation statements)

References 45 publications

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“…14 Besides a potential mechanistic effect of increased fat mass, we have previously suggested that these sex-specific observations could be a result of sex-specific properties of the fat tissue itself. 15 Interestingly, in this study, no sex effect was observed and circulatory congestion was underestimated in men and women to a similar extent. Although this interesting finding warrants further research, it suggests that once individuals become very obese, sex-specific Figure 1 Graphical overview of pseudo-cardiac tamponade due to increased epicardial adipose tissue volume in obese individuals (body mass index [BMI] >35 kg/m 2 ).…”

supporting

confidence: 47%

“…In addition, in women with HFpEF, every 100 cm 2 increase in visceral adipose tissue was associated with a 4.0 mmHg increase in post‐capillary wedge pressure, and this did not happen in men 14 . Besides a potential mechanistic effect of increased fat mass, we have previously suggested that these sex‐specific observations could be a result of sex‐specific properties of the fat tissue itself 15 . Interestingly, in this study, no sex effect was observed and circulatory congestion was underestimated in men and women to a similar extent.…”

Section: Figurementioning

confidence: 87%

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Underestimation of congestion in very obese heart failure with preserved ejection fraction patients: EAT your heart out…?!

Meems

Veldhuisen

Boer

2022

European J of Heart Fail

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supporting

confidence: 47%

Section: Figurementioning

confidence: 87%

Underestimation of congestion in very obese heart failure with preserved ejection fraction patients: EAT your heart out…?!

Meems

Veldhuisen

Boer

2022

European J of Heart Fail

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“…Obesity is an important comorbidity in patients with HFpEF and has been suggested to play an import role in (development of) HFpEF. 149 , 150 In pre-clinical models, unhealthy food consumption is mimicked by a high fat diet (HFD) (>60% fat of daily caloric intake) or by a Western diet (36% fat and 36% sucrose of daily intake). Both of these diets are able to induce an unfavourable cardiometabolic phenotype with obesity and glucose intolerance in young male and female animals 138 , 151–155 albeit in a strain-specific manner.…”

Section: Validation and Translation Of The H2fpef And Hfa-peff Scores In Animal Modelsmentioning

confidence: 99%

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Withaar

Lam

Schiattarella

et al. 2021

European Heart Journal

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Heart failure (HF) with preserved ejection fraction (HFpEF) is a multifactorial disease accounting for a large and increasing proportion of all clinical HF presentations. As a clinical syndrome, HFpEF is characterized by typical signs and symptoms of HF, a distinct cardiac phenotype and raised natriuretic peptides. Non-cardiac comorbidities frequently co-exist and contribute to the pathophysiology of HFpEF. To date, no therapy has proven to improve outcomes in HFpEF, with drug development hampered, at least partly, by lack of consensus on appropriate standards for pre-clinical HFpEF models. Recently, two clinical algorithms (HFA-PEFF and H2FPEF scores) have been developed to improve and standardize the diagnosis of HFpEF. In this review, we evaluate the translational utility of HFpEF mouse models in the context of these HFpEF scores. We systematically recorded evidence of symptoms and signs of HF or clinical HFpEF features and included several cardiac and extra-cardiac parameters as well as age and sex for each HFpEF mouse model. We found that most of the pre-clinical HFpEF models do not meet the HFpEF clinical criteria, although some multifactorial models resemble human HFpEF to a reasonable extent. We therefore conclude that to optimize the translational value of mouse models to human HFpEF, a novel approach for the development of pre-clinical HFpEF models is needed, taking into account the complex HFpEF pathophysiology in humans.

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“…However, sophisticated classification of patients in various categories using imaging and biomarkers may enhance adequate phenotyping, 11 , 17 and imaging of non-cardiac tissues such as fat may have relevance to HF phenotyping, too. 18 , 19 Furthermore, next-generation genetic analyses has been shown to have a consequence for prognosis 20 and diagnosis 21 of HF. In addition, a recent article highlighted the indications of endomyocardial biopsies.…”

Section: Diagnostics and Risk Stratificationmentioning

confidence: 99%

The year in cardiovascular medicine 2021: heart failure and cardiomyopathies

Bauersachs

Boer

Lindenfeld

et al. 2022

European Heart Journal

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In the year 2021, the universal definition and classification of heart failure (HF) was published that defines HF as a clinical syndrome with symptoms and/or signs caused by a cardiac abnormality and corroborated by elevated natriuretic peptide levels or objective evidence of cardiogenic congestion. This definition and the classification of HF with reduced ejection fraction (HFrEF), mildly reduced, and HF with preserved ejection fraction (HFpEF) is consistent with the 2021 ESC Guidelines on HF. Among several other new recommendations, these guidelines give a Class I indication for the use of the sodium–glucose co-transporter 2 (SGLT2) inhibitors dapagliflozin and empagliflozin in HFrEF patients. As the first evidence-based treatment for HFpEF, in the EMPEROR-Preserved trial, empagliflozin reduced the composite endpoint of cardiovascular death and HF hospitalizations. Several reports in 2021 have provided novel and detailed analyses of device and medical therapy in HF, especially regarding sacubitril/valsartan, SGLT2 inhibitors, mineralocorticoid receptor antagonists, ferric carboxymaltose, soluble guanylate cyclase activators, and cardiac myosin activators. In patients hospitalized with COVID-19, acute HF and myocardial injury is quite frequent, whereas myocarditis and long-term damage to the heart are rather uncommon.

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Fighting HFpEF in women: taking aim at belly fat

Abstract: Abstract

Cited by 8 publications

References 45 publications

Underestimation of congestion in very obese heart failure with preserved ejection fraction patients: EAT your heart out…?!

Underestimation of congestion in very obese heart failure with preserved ejection fraction patients: EAT your heart out…?!

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

The year in cardiovascular medicine 2021: heart failure and cardiomyopathies

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