Crum, Yoran (2024) Associations between epicardial adiposity and invasive hemodynamics in patients with heart failure with preserved ejection fraction. thesis, Medicine.
Full text available on request.Abstract
Background: In patients with heart failure (HF) with preserved ejection fraction (HFpEF), epicardial adipose tissue (EAT) accumulation may play a role in the pathophysiology of the disease. It has been speculated that excessive EAT might exert direct mechanical compression on the myocardium and may cause elevated filling pressures. Aims: This study examined the association of the amount of EAT, with invasive filling pressures and with signs of pericardial constraint in men and women with HFpEF. Methods: Patients were enrolled in a prospective, sham-controlled, multicentered REDUCE LAP-HF II trial that investigated the value of an atrial shunt device in HF with a left ventricular ejection fraction (LVEF) ≥40% and exercise pulmonary capillary wedge pressure (PCWP) ≥25mmHg. Central hemodynamics such as right atrial pressure (RAP) and PCWP were invasively measured both at rest and at 20Watt (W) and peak exercise. RAP/PCWP ratio (surrogate measure of pericardial constraint) and PCWP-RAP gradient (left heart fillings pressures controlled for right heart fillings pressures) were calculated. EAT thickness alongside the right ventricle was assessed using echocardiography on the parasternal long- and short-axis views and EAT thickness was expressed in mm. Results: We studied 510 HFpEF patients, mean age 71 ± 9 years, 69% were women and mean body mass index (BMI) was 31 ± 6 kg/m2. Women had greater EAT thickness than men (6.2 vs. 5.6 mm, p=0.005), despite having comparable BMI. At rest, increased EAT was not associated with RAP, PCWP, RAP/PCWP ratio PCWP – RAP gradient (p>0.05 for all analysis). During 20W and peak exercise, RAP/PCWP ratio was similar between all EAT tertiles. On the contrary, during peak exercise, patients in the highest EAT tertile had a higher PCWP – RAP gradient compared to patients in the second EAT tertile (18 ± 7 and 16 ± 7 mmHg, respectively; p<0.018). When separated by sex, an association between increased EAT and higher PCWP-RAP gradient at peak exercise was mainly present in men (r=0.205, p=0.006) and not in women (r=0.069, p=0.219). Conclusion: Increased EAT in HFpEF patients was associated with a higher PCWP – RAP gradient during exercise, but not with increased RAP/PCWP ratio. This indicates that increased EAT was more strongly related to restrictive-like hemodynamics than pericardial constraint. This hemodynamic feature was primarily seen in men with HFpEF and not in women.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Gorter, Dr. T.M. MD PhD and Veldhuisen, Prof. Dr. D.J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 30 Sep 2025 11:54 |
| Last Modified: | 30 Sep 2025 11:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3829 |
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