Li Qiuxuan, Muhib Ur Rehman, Ma Xiaoteng, Liu Zaiqiang, Gao Fei, Wang Zhijian
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, 100029 Beijing, China.
Rev Cardiovasc Med. 2024 Sep 3;25(9):311. doi: 10.31083/j.rcm2509311. eCollection 2024 Sep.
Heart failure (HF) is the predominant terminal stage and the leading cause of mortality in cardiac disease. Heart failure with preserved ejection fraction (HFpEF) affects roughly 50% of HF patients globally. Due to the global aging population, the prevalence, morbidity, and mortality of HFpEF have gradually increased. Epicardial adipose tissue (EAT), as a key visceral adipose tissue around the heart, affects cardiac diastolic function and exercise reserve capacity. EAT closely adheres to the myocardium and can produce inflammatory factors, neurotransmitters, and other factors through autocrine or paracrine mechanisms, affecting the heart function by inflammatory response, cardiac metabolism and energy supply, cardiomyocyte structure and electrical activity, and pericardial vascular function. Currently, research on the mechanism and treatment methods of HFpEF is constantly improving. EAT may play a multi-level impact on the occurrence and development of HFpEF. This review also summarizes the potential impact of EAT on the heart in HFpEF combined with other metabolism-related diseases such as obesity or diabetes over other obesity-related measures, such as body mass index (BMI) or other adipose tissue. Above all, this review comprehensively summarizes the potential mechanisms by which EAT may affect HFpEF. The objective is to enhance our comprehension and management of HFpEF. Future research should delve into the mechanistic relationship between EAT and HFpEF, and investigate interventions aimed at EAT to improve the prognosis of patients with HFpEF.
心力衰竭（HF）是心脏病的主要终末期阶段和主要死亡原因。射血分数保留的心力衰竭（HFpEF）在全球约50%的HF患者中存在。由于全球人口老龄化，HFpEF的患病率、发病率和死亡率逐渐上升。心外膜脂肪组织（EAT）作为心脏周围关键的内脏脂肪组织，影响心脏舒张功能和运动储备能力。EAT紧密附着于心肌，可通过自分泌或旁分泌机制产生炎症因子、神经递质等因子，通过炎症反应、心脏代谢和能量供应、心肌细胞结构和电活动以及心包血管功能影响心脏功能。目前，关于HFpEF的发病机制和治疗方法的研究在不断完善。EAT可能在HFpEF的发生发展中发挥多层次影响。本综述还总结了与肥胖或糖尿病等其他代谢相关疾病相比，EAT在HFpEF中对心脏的潜在影响，以及与体重指数（BMI）或其他脂肪组织等其他肥胖相关指标的比较。最重要的是，本综述全面总结了EAT可能影响HFpEF的潜在机制。目的是加强我们对HFpEF的理解和管理。未来的研究应深入探讨EAT与HFpEF之间的机制关系，并研究针对EAT的干预措施以改善HFpEF患者的预后。
