Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction
Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction
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DOI：
10.1093/eurheartj/ehaa823
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发表时间：
2021-04-21
影响因子：
39.3
通讯作者：
Borlaug, Barry A.
中科院分区：
文献类型：
--
作者：
Sorimachi, Hidemi;Obokata, Masaru;Borlaug, Barry A.
中心性肥胖是保留射血分数（HFpEF）心力衰竭的主要危险因素，尤其是女性，但其机制尚不清楚。我们假设内脏脂肪组织（VAT）含量的性别差异与女性和男性HFpEF的血流动力学严重程度有不同的关系。方法和结果对105例HFpEF患者（63名女性）和105例年龄、性别和体重指数匹配的对照组进行了腹部计算机断层扫描（CT）和有创血流动力学运动测试。CT量化内脏脂肪组织面积。与对照组女性相比，患有HFpEF的女性增值区面积高出34%(186 +/- 112对139 +/- 72 cm(2)， P= 0.006)，而患有或不患有HFpEF的男性增值区面积无显著差异（294 +/- 158对252 +/- 92 cm(2)， P= 0.1）。运动时，HFpEF患者的肺毛细血管楔压（PCWP）显著升高，且升高程度相似。与VAT面积正常的女性相比，VAT面积增加的女性在运动时的PCWP高出33%(28 +/- 10对21 +/- 10 mmHg， P= 0.001)，而VAT面积增加或不增加的男性运动PCWP相似（24 +/- 9对25 +/- 6，P= 0.89）。在女性中，VAT面积每增加100 cm(2)与PCWP升高4.0 mmHg相关（95% CI 2.1, 6.0 mmHg； P< 0.0001），但在男性中没有这种关系（相互作用P= 0.009）。结论这些数据表明，过量VAT的积累在HFpEF的病理生理中起着独特而重要的作用，尤其是在女性中。需要进一步的研究来更好地了解HFpEF中内脏脂肪的机制和治疗意义。
Aims 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.Methods and results 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 cm(2), P= 0.006), while VAT area was not significantly different in men with or without HFpEF (294 +/- 158 vs. 252 +/- 92 cm(2), 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 cm(2) 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).Conclusions 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.[GRAPHICS].