Epicardial Adipose Tissue in Heart Failure with Preserved Ejection Fraction

Heart failure is a health problem characterized by high morbidity and mortality, comparable to certain types of cancer. A growing number of patients with heart failure has a normal, or preserved, ejection fraction (HFpEF). This is problematic, as for this group of heart failure patients, currently no therapies exist that reduce mortality. One specific comorbidity that has gained interest in relation to HFpEF, is obesity. Obesity is defined as excessive fat accumulation that presents a risk to health and is often measured by body mass index. However, the problem with body mass index is that it captures no information on the actual amount and location of fat. Recent studies have shown that particularly the fat around the internal organs, called ‘visceral fat’ is associated with HFpEF. One specific visceral fat of interest is epicardial fat, the fatty tissue directly adjacent to the heart. In this thesis, we aimed to investigate epicardial fat in relation to HFpEF. We found that patients with HFpEF have increased epicardial fat compared to people without heart failure and that most of the fat is around the right ventricle. In addition, increased epicardial fat was related to thickened hearts, worse heart function and increased pressures inside the heart. Lastly, HFpEF patients with high epicardial fat were more often hospitalized for heart failure and more often died compared to HFpEF patients with low epicardial fat. The findings in this thesis strongly suggest that epicardial fat plays an important role in HFpEF, and should be further investigated.