Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Heart Fail. 2022 Dec;24(12):2238-2250. doi: 10.1002/ejhf.2741. Epub 2022 Nov 29.
Obesity is very common in patients with heart failure with preserved ejection fraction (HFpEF) and it has been suggested that obesity plays an important role in the pathophysiology of this disease. While body mass index defines the presence of obesity, this measure provides limited information on visceral adiposity, which is probably more relevant in the pathophysiology of HFpEF. Epicardial adipose tissue is the visceral fat situated directly adjacent to the heart and recent data demonstrate that accumulation of epicardial adipose tissue is associated with the onset, symptomatology and outcome of HFpEF. However, the mechanisms by which epicardial adipose tissue may be involved in HFpEF remain unclear. It is also questioned whether epicardial adipose tissue may be a specific target for therapy for this disease. In the present review, we describe the physiology of epicardial adipose tissue and the pathophysiological transformation of epicardial adipose tissue in response to chronic inflammatory diseases, and we postulate conceptual mechanisms on how epicardial adipose tissue may be involved in HFpEF pathophysiology. Lastly, we outline potential treatment strategies, knowledge gaps and directions for further research.
肥胖在射血分数保留的心力衰竭（HFpEF）患者中非常常见，有人认为肥胖在该病的病理生理学中起着重要作用。虽然体重指数定义了肥胖的存在，但这种方法提供的内脏脂肪信息有限，而内脏脂肪在 HFpEF 的病理生理学中可能更为相关。心外膜脂肪组织是紧邻心脏的内脏脂肪，最近的数据表明，心外膜脂肪组织的堆积与 HFpEF 的发生、症状和结局相关。然而，心外膜脂肪组织如何可能参与 HFpEF 的机制尚不清楚。也有人质疑心外膜脂肪组织是否可能成为治疗这种疾病的特定靶点。在本综述中，我们描述了心外膜脂肪组织的生理学以及心外膜脂肪组织对慢性炎症性疾病的病理生理转化，并推测了心外膜脂肪组织如何可能参与 HFpEF 病理生理学的概念性机制。最后，我们概述了潜在的治疗策略、知识空白和进一步研究的方向。
