Epicardial adipose tissue and pericardial constraint in heart failure with preserved ejection fraction

Area of Science:

• Cardiology
• Cardiovascular Physiology
• Medical Imaging

Background:

• Obesity and epicardial adiposity are implicated in the pathophysiology of heart failure with preserved ejection fraction (HFpEF).
• These conditions are associated with elevated filling pressures and diminished exercise capacity in HFpEF patients.
• The precise hemodynamic mechanisms underlying these associations remain incompletely understood.

Purpose of the Study:

• To investigate the hypothesis that increased epicardial adipose tissue (EAT) within the pericardial sac is associated with hemodynamic indicators of pericardial constraint.
• To explore the relationship between EAT and specific hemodynamic parameters in HFpEF.

Main Methods:

• Inclusion of HFpEF patients undergoing simultaneous invasive heart catheterization and echocardiography.
• Invasive measurement of right atrial pressure (RAP), right ventricular end-diastolic pressure, and pulmonary capillary wedge pressure (PCWP).
• Assessment of pericardial constraint using the square root sign on the right ventricular pressure waveform and the RAP/PCWP ratio.
• Echocardiographic measurement of EAT thickness.

Main Results:

• A square root sign, indicative of pericardial constraint, was present in 73% of the 64 studied patients.
• The presence of a square root sign correlated with higher body mass index (BMI), greater EAT thickness, and elevated RAP.
• Women exhibited higher EAT and stronger associations between EAT, RAP, and pericardial constraint indicators compared to men.

Conclusions:

• Obesity and epicardial adiposity are associated with hemodynamic signs of pericardial constraint in HFpEF.
• These findings suggest a potential role for EAT in the hemodynamic alterations observed in HFpEF.
• Further research is needed to elucidate the pathophysiological and therapeutic implications of these associations.