Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction

Abstract

Aims Central obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF), particularly in women, but the mechanisms remain unclear. We hypothesized that sex-specific differences in visceral adipose tissue (VAT) content would differentially relate to haemodynamic severity of HFpEF in women and men. Methods and results Abdominal computed tomography (CT) and invasive haemodynamic exercise testing were performed in 105 subjects with HFpEF (63 women) and 105 age-, sex-, and body mass index-matched controls. Visceral adipose tissue area was quantified by CT. As compared with control women, VAT area was 34% higher in women with HFpEF (186 ± 112 vs. 139 ± 72 cm2, P = 0.006), while VAT area was not significantly different in men with or without HFpEF (294 ± 158 vs. 252 ± 92 cm2, P = 0.1). During exercise, pulmonary capillary wedge pressure (PCWP) increased markedly and to similar extent in both men and women with HFpEF. Women with increased VAT area displayed 33% higher PCWP during exercise compared with women with normal VAT area (28 ± 10 vs. 21 ± 10 mmHg, P = 0.001), whereas exercise PCWP was similar in men with or without excess VAT (24 ± 9 vs. 25 ± 6, P = 0.89). In women, each 100 cm2 increase in VAT area was associated with a 4.0 mmHg higher PCWP (95% CI 2.1, 6.0 mmHg; P < 0.0001), but there was no such relationship in men (interaction P = 0.009). Conclusions These data suggest that accumulation of excess VAT plays a distinct and important role in the pathophysiology of HFpEF preferentially in women. Further research is needed to better understand the mechanisms and treatment implications for visceral fat in HFpEF.

Assessment of Computed Tomography-Defined Muscle and Adipose Tissue Features in Relation to Length of Hospital Stay and Recurrence of Hypertriglyceridemic Pancreatitis

“…More and more researchers have realized that the study of fat distribution is important in obesity research. 22–25 CT imaging is a reliable method for the analysis of fat distribution and the measurement of adipose tissues. 26 The axial CT image at L3 is known to represent muscle tissues and fat distribution.…”

“…The study of fat distribution is crucial to understanding the metabolic implications of excess adiposity. 22–25 Computed tomography (CT) is a reliable method for the analysis of fat distribution and the measurement of adipose tissues. 26 The aim of the present study was to assess the impact of body composition on the length of hospital stay (LOS) and risk of recurrence of HTGP.…”

Elevated plasma succinate levels are linked to higher cardiovascular disease risk factors in young adults

“…We recently showed that plasma succinate levels are positively associated with BMI in middle-aged and elderly adults with obesity and T2D [ 24 , 26 ]. In the present study, we found that young adults with higher succinate levels have higher VAT mass, an established marker of elevated CVD risk [ 37 – 39 ]. Visceral fat depots are linked to metabolic dysfunction through increased mitochondrial oxidative stress, a main driver of cellular insulin resistance [ 40 ].…”

Assessment of Computed Tomography-Defined Muscle and Adipose Tissue Features in Relation to Length of Hospital Stay and Recurrence of Hypertriglyceridemic Pancreatitis

“…The study of fat distribution is crucial to understanding the metabolic implications of excess adiposity. More and more researchers have realized that the study of fat distribution is important in obesity research [14][15][16][17]. CT imaging is a reliable method for the analysis of fat distribution and the measurement of adipose tissues [18].…”

“…However, most studies did not distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). The study of fat distribution is crucial to understanding the metabolic implications of excess adiposity [14][15][16][17]. Computed tomography (CT) is a reliable method for the analysis of fat distribution and the measurement of adipose tissues [18].…”