Epicardial Adipose Tissue and Invasive Hemodynamics in Heart Failure With Preserved Ejection Fraction

OBJECTIVES This study examined associations between epicardial adipose tissue (EAT), invasive hemodynamics, and exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND EAT is increased in patients with HFpEF and may play a rote in the pathophysiology of this disorder. METHODS Patients with heart failure and a left ventricular ejection fraction >45% who underwent right and left heart catheterization with simultaneous echocardiography were included. Pulmonary capillary wedge pressure (PCWP), left ventricular end-diastolic pressure (LVEDP), right ventricular end-diastolic pressure (RVEDP), and pulmonary vascular resistance (PVR) were invasively measured. Obesity was defined as body mass index (BMI) >= 30 kg/m(2). EAT thickness alongside the right ventricle was measured on echocardiographic tong- and short-axis views. Cardiopulmonary exercise testing was performed to obtain maximal oxygen uptake (VO2-max). RESULTS This study examined 75 patients, mean age 74 +/- 9 years; 68% were women, mean BMI was 29 +/- 6 kg/m(2), and 36% were obese. Higher BMI was strongly assodated with increased EAT (r = 0.74; p < 0.001). Increased EAT was associated with higher RVEDP, independent of PVR (odds ratio (OR): 1.16; 95% confidence interval [CI]: 1.02 to 1.34; p = 0.03), but not independent of obesity (p = 0.10). Increased EAT and higher RVEDP were both associated with tower VO2-max (r -0.43; p < 0.001 and r = 0.43; p = 0.001, respectively). increased EAT remained associated with tower VO2 -max after adjustment for PVR (OR: 0.64; 95% 0: 0.49 to 0.84; p = 0.002) and obesity (OR: 0.69; 95% CI: 0.53 to 0.92; p = 0.01). EAT thickness was not associated with left-sided filling pressures (i.e., PCWP and LVEDP). CONCLUSIONS In HFpEF, obesity and increased EAT were associated with higher right-sided filling pressures and with reduced exercise capacity. (C) 2020 by the American College of Cardiology Foundation.