Epicardial, visceral and subcutaneous adipose tissue in heart failure with preserved ejection fraction

Obesity is common in patients with heart failure with preserved ejection fraction (HFpEF), and adipose tissue (AT) plays a key role in its pathophysiology. We examined the distribution and association of visceral AT (VAT), subcutaneous AT (SAT) and epicardial AT (EAT) in HFpEF using multimodality imaging.

Heart failure patients with left ventricular ejection fraction >40% were prospectively enrolled. All patients underwent cardiac magnetic resonance (CMR) imaging and total body computed tomography (CT). EAT was measured on CMR, and VAT, SAT and waist circumference (WC) were measured on CT. Linear regression analysis was used to assess associations between EAT and other AT depots.

In total, 68 patients were included. Mean age was 73 ± 8 years; 34 (50%) were women. Twenty-six patients (38%) were obese, while 60 (91%) had increased WC and 58 (85%) had increased VAT. Body mass index (BMI) and WC were comparable between men and women, but men had more EAT (217 vs. 180 mL, P < 0.001) and VAT (306 vs. 196 cm², P < 0.001), but less SAT (177 vs. 276 cm², P < 0.001), as compared with women. After adjusting for age, gender and BMI, VAT was only associated with EAT, albeit modest (β = 0.40, P < 0.001, R² = 0.40), but not with SAT.

The distribution of various AT depots is markedly different between men and women with HFpEF. Men have more VAT and EAT, but less SAT. The observed variation in AT depots may potentially contribute to gender-related differences in cardiovascular risk.