Division of Cardiovascular Imaging, Weill Cornell Medical College, Houston Methodist DeBakey Heart & Vascular Center, 6505 Fanin St., Houston, TX, 77030, USA.
Section of Cardiology, John W. Deming Department of Medicine, Tulane Avenue, SL-48, New Orleans, LA, 70112, USA.
Curr Hypertens Rep. 2024 Sep;26(9):381-388. doi: 10.1007/s11906-024-01302-7. Epub 2024 Apr 20.
Preserved ejection fraction heart failure and obesity frequently coexist. Whether obesity plays a consistent role in the pathogenesis of preserved ejection fraction heart failure is unclear. Accumulation of visceral adiposity underlies the pathogenic aftermaths of obesity. However, visceral adiposity imaging is assessed by computed tomography or magnetic resonance and thus not routinely available. In contrast, epicardial adiposity thickness is assessed by echocardiography and thus routinely available. We review the rationale for assessing epicardial adiposity thickness in patients with preserved ejection fraction heart failure and elevated body mass index.
Body mass index correlates poorly with visceral, and epicardial adiposity. Visceral and epicardial adiposity enlarges as preserved ejection fraction heart failure progresses. Epicardial adiposity may hasten the progression of coronary artery disease and impairs left ventricular sub-endocardial perfusion and diastolic function. Epicardial adiposity thickness may help monitor the therapeutic response in patients with preserved ejection failure heart failure and elevated body mass index.
射血分数保留的心衰与肥胖常并存。肥胖在射血分数保留的心衰发病机制中是否起持续作用仍不清楚。内脏脂肪堆积是肥胖致病后果的基础。然而,内脏脂肪堆积的影像学评估是通过计算机断层扫描或磁共振成像进行的,因此无法常规获得。相比之下,心外膜脂肪厚度通过超声心动图进行评估,因此可常规获得。我们综述了评估射血分数保留的心衰和高体重指数患者的心外膜脂肪厚度的基本原理。
体重指数与内脏和心外膜脂肪相关性差。随着射血分数保留的心衰进展,内脏和心外膜脂肪堆积增加。心外膜脂肪可能会加速冠状动脉疾病的进展,并损害左心室心内膜下灌注和舒张功能。心外膜脂肪厚度可能有助于监测射血分数保留的心衰和高体重指数患者的治疗反应。