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Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction.

  • Sorimachi, Hidemi1
  • Obokata, Masaru1
  • Takahashi, Naoki2
  • Reddy, Yogesh N V1
  • Jain, Christopher C1
  • Verbrugge, Frederik H1, 3
  • Koepp, Katlyn E1
  • Khosla, Sundeep4
  • Jensen, Michael D4
  • Borlaug, Barry A1
  • 1 Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
  • 2 Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
  • 3 Department of Medicine, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, BE3500 Hasselt, Belgium. , (Belgium)
  • 4 Division of Endocrinology, Department of Medicine, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Published Article
European Heart Journal
Oxford University Press
Publication Date
Nov 23, 2020
DOI: 10.1093/eurheartj/ehaa823
PMID: 33227126


Central obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF), particularly in women, but the mechanisms remain unclear. We hypothesized that sex-specific differences in visceral adipose tissue (VAT) content would differentially relate to haemodynamic severity of HFpEF in women and men. Abdominal computed tomography (CT) and invasive haemodynamic exercise testing were performed in 105 subjects with HFpEF (63 women) and 105 age-, sex-, and body mass index-matched controls. Visceral adipose tissue area was quantified by CT. As compared with control women, VAT area was 34% higher in women with HFpEF (186 ± 112 vs. 139 ± 72 cm2, P = 0.006), while VAT area was not significantly different in men with or without HFpEF (294 ± 158 vs. 252 ± 92 cm2, P = 0.1). During exercise, pulmonary capillary wedge pressure (PCWP) increased markedly and to similar extent in both men and women with HFpEF. Women with increased VAT area displayed 33% higher PCWP during exercise compared with women with normal VAT area (28 ± 10 vs. 21 ± 10 mmHg, P = 0.001), whereas exercise PCWP was similar in men with or without excess VAT (24 ± 9 vs. 25 ± 6, P = 0.89). In women, each 100 cm2 increase in VAT area was associated with a 4.0 mmHg higher PCWP (95% CI 2.1, 6.0 mmHg; P < 0.0001), but there was no such relationship in men (interaction P = 0.009). These data suggest that accumulation of excess VAT plays a distinct and important role in the pathophysiology of HFpEF preferentially in women. Further research is needed to better understand the mechanisms and treatment implications for visceral fat in HFpEF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected]

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