Cardiac-Adipose Axis in Heart Failure With Preserved Ejection Fraction: Mechanisms and Therapeutics

Area of Science:

• Cardiology
• Metabolic Syndrome
• Molecular Biology

Background:

• Heart failure with preserved ejection fraction (HFpEF) comprises 50% of heart failure cases, with limited effective treatments.
• Obesity-related HFpEF is a prevalent phenotype associated with increased cardiovascular mortality, yet its molecular mechanisms are not fully understood.

Purpose of the Study:

• To review the role of the cardiac-adipose axis in the pathophysiology of obesity-related HFpEF.
• To explore the contribution of epicardial adipose tissue (EAT) and non-EAT depots to cardiac dysfunction.

Main Methods:

• Literature review of studies investigating the cardiac-adipose axis in HFpEF.
• Analysis of molecular mechanisms linking adipose tissue to cardiac dysfunction, including adipokines, inflammation, and oxidative stress.

Main Results:

• Increased EAT in obesity-associated HFpEF contributes to diastolic dysfunction via pericardial restriction.
• Both EAT and non-EAT promote cardiac dysfunction through secreted factors and inflammatory mediators.
• EAT thickness is identified as a potential diagnostic marker for HFpEF.

Conclusions:

• The cardiac-adipose axis is a key driver of obesity-related HFpEF pathophysiology.
• A dual-screening approach using waist-to-height ratio and NT-proBNP may aid diagnosis.
• Adipose-targeted therapies show promise for future HFpEF treatment strategies.