PMID- 33939300
OWN - NLM
STAT- MEDLINE
DCOM- 20211028
LR  - 20211028
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 8
IP  - 4
DP  - 2021 Aug
TI  - Visceral adiposity, muscle composition, and exercise tolerance in heart failure 
      with preserved ejection fraction.
PG  - 2535-2545
LID - 10.1002/ehf2.13382 [doi]
AB  - AIMS: Visceral adipose tissue (AT) promotes inflammation and may be associated 
      with disease progression in heart failure with preserved ejection fraction 
      (HFpEF). We characterized regional AT distribution in HFpEF patients and controls 
      and analysed associations with co-morbidities and exercise tolerance. METHODS AND 
      RESULTS: Magnetic resonance imaging was performed to quantify epicardial, liver, 
      abdominal, and thigh skeletal muscle AT. We assessed New York Heart Association 
      (NYHA) class, 6 min walk distance, and global well-being score. Multivariable 
      linear regression models adjusting for body surface area were used. We studied 55 
      HFpEF patients (41 women, mean age 67 +/- 11 years) and 33 controls (21 women, mean 
      age 57 +/- 10 years). Epicardial AT (median [interquartile range] 4.6 [2.0] vs. 3.2 
      [1.4] mm, P < 0.001), thigh intermuscular fat (11.0 [11.5] vs. 5.0 [2.7] cm(2) , 
      P < 0.001) and liver fat fraction (6.4% [6.1] vs. 4.1% [5.5], P = 0.001) were 
      higher in HFpEF patients than controls. Women with HFpEF had higher abdominal and 
      thigh subcutaneous AT than men. Greater thigh intermuscular fat was associated 
      with higher blood pressure (beta [SE] 0.73 [0.17], P < 0.001) and diabetes (odds 
      ratio [95% confidence interval] 1.2 [1.0-1.5], P = 0.03). Greater thigh 
      intramuscular fat was associated with both worse NYHA class (beta [SE] 2.7 [1.0], 
      P = 0.01) and shorter 6 min walk distance (beta [SE] -4.1 [1.9], P = 0.03), and 
      greater epicardial AT (beta [SE] -0.2 [0.1], P < 0.001) and liver fat fraction (beta 
      [SE] -0.4 [0.2], P = 0.04) were associated with lower global well-being score. 
      CONCLUSIONS: Heart failure with preserved ejection fraction patients have 
      increased epicardial, liver, and skeletal muscle fat compared with controls out 
      of proportion to their increased body size, and adiposity was associated with 
      worse NYHA class and exercise tolerance in HFpEF. These results provide the basis 
      for further investigation into the effect of interventions to reduce regional AT 
      distribution in relation to HFpEF symptoms and pathophysiology.
CI  - (c) 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of European Society of Cardiology.
FAU - Ying, Wendy
AU  - Ying W
AUID- ORCID: 0000-0002-7862-5508
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
FAU - Sharma, Kavita
AU  - Sharma K
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
FAU - Yanek, Lisa R
AU  - Yanek LR
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
FAU - Vaidya, Dhananjay
AU  - Vaidya D
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
AD  - Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
FAU - Schar, Michael
AU  - Schar M
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
FAU - Markl, Michael
AU  - Markl M
AD  - Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
FAU - Subramanya, Vinita
AU  - Subramanya V
AD  - Rollins School of Public Health, Emory University, Atlanta, GA, USA.
FAU - Soleimani, Sahar
AU  - Soleimani S
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
FAU - Ouyang, Pamela
AU  - Ouyang P
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
FAU - Michos, Erin D
AU  - Michos ED
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
AD  - Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
FAU - Shah, Sanjiv J
AU  - Shah SJ
AD  - Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
FAU - Hays, Allison G
AU  - Hays AG
AUID- ORCID: 0000-0003-2138-1589
AD  - School of Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, 
      21287, USA.
LA  - eng
GR  - R01 HL147660/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20210503
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
SB  - IM
MH  - Adiposity
MH  - Aged
MH  - *Exercise Tolerance
MH  - Female
MH  - *Heart Failure
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Muscle, Skeletal
MH  - Stroke Volume
PMC - PMC8318398
OTO - NOTNLM
OT  - Adipose tissue
OT  - Exercise tolerance
OT  - Heart failure with preserved ejection fraction
OT  - Magnetic resonance imaging
OT  - Obesity
OT  - Risk factors
COIS- The authors report no relevant conflicts of interest.
EDAT- 2021/05/04 06:00
MHDA- 2021/10/29 06:00
PMCR- 2021/05/03
CRDT- 2021/05/03 12:53
PHST- 2021/03/25 00:00 [revised]
PHST- 2020/12/10 00:00 [received]
PHST- 2021/04/12 00:00 [accepted]
PHST- 2021/05/04 06:00 [pubmed]
PHST- 2021/10/29 06:00 [medline]
PHST- 2021/05/03 12:53 [entrez]
PHST- 2021/05/03 00:00 [pmc-release]
AID - EHF213382 [pii]
AID - 10.1002/ehf2.13382 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2021 Aug;8(4):2535-2545. doi: 10.1002/ehf2.13382. Epub 2021 May 
      3.