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Cited by 179Cardiovascular Disease and AdiposityHeart Failure Treatment and ManagementCardiovascular and exercise physiology

Regional Adipose Distribution and its Relationship to Exercise Intolerance in Older Obese Patients Who Have Heart Failure With Preserved Ejection Fraction

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Haykowsky, Mark J., Nicklas, Barbara J., Brubaker, Peter H., Hundley, W. Gregory, Brinkley, Tina E., Upadhya, Bharathi, Becton, J. Thomas, Nelson, Michael D. +2 more·2018·JACC: Heart Failure
DOI 10.1016/j.jchf.2018.06.002PMC PMC6086374
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Abstract

Objectives This study sought to test the hypothesis that older obese patients with heart failure with preserved ejection fraction (HFpEF) have significantly greater abdominal, cardiac, and intermuscular fat than healthy, age-matched controls, out of proportion to total body fat, and that these abnormalities are associated with objective measurements of physical function.Background Recent studies indicate that excess total body adipose tissue contributes to exercise intolerance in patients with HFpEF. However, the impact of the pattern of regional (abdominal, cardiac, intermuscular) adipose deposition on exercise intolerance in patients with HFpEF is unknown.Methods We measured total body adiposity (using dual-energy x-ray absorptiometry) and regional adiposity (using cardiac magnetic resonance), peak oxygen uptake (Vo 2), 6-min walk distance (6MWD), short physical performance battery (SPPB), and leg press power in 100 older obese patients with HFpEF and 61 healthy controls (HCs) and adjusted for age, sex, race, and body surface area.Results Peak Vo 2 (15.7 ± 0.4 ml/kg/min vs. 23.0 ± 0.6 ml/kg/min, respectively; p < 0.001), 6MWD (427 ± 7 m vs. 538 ± 10 m, respectively; p < 0.001), SPPB (10.3 ± 0.2 vs. 10.9 ± 0.2, respectively; p < 0.05), and leg power (117 ± 5 W vs. 152 ± 9 W, respectively; p = 0.004) were significantly lower in patients with HFpEF than HCs. Total fat mass, total percent fat, abdominal subcutaneous fat, intra-abdominal fat, and thigh intermuscular fat were significantly higher, whereas epicardial fat was significantly lower in patients with HFpEF than in HC. After we adjusted for total body fat, intra-abdominal fat remained significantly higher, while epicardial fat remained significantly lower in patients with HFpEF. Abdominal subcutaneous fat, thigh subcutaneous fat, and thigh intermuscular fat:skeletal muscle ratio were inversely associated, whereas epicardial fat was directly associated with peak Vo 2, 6MWD, SPPB, and leg power. Using multiple stepwise regression, we found intra-abdominal fat was the strongest independent predictor of peak Vo 2 and 6MWD.Conclusions In metabolic obese HFpEF, the pattern of regional adipose deposition may have important adverse consequences beyond total body adiposity. Interventions targeting intra-abdominal and intermuscular fat could potentially improve exercise intolerance. (Exercise Intolerance in Elderly Patients With Diastolic Heart Failure [SECRET]; NCT00959660).

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  • Growing evidence suggests that adipose tissue may play a pivotal role in the development, progression, and adverse outcomes of heart failure with preserved ejection fraction.

    “growing evidence suggests that adipose tissue may play a pivotal role in the development, progression, and adverse outcomes of heart failure with preserved ejection fraction. 4-8”

    From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [6]

    The Discussion (page unavailable) says increased adiposity contributes to HFpEF pathophysiology and links abdominal fat to impaired exercise tolerance in older obese patients. This supports a possible role for adipose tissue, but the paper does not establish its role in HFpEF progression or in adverse clinical outcomes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Obesity and excess adiposity may play a role in the development and progression of heart failure with preserved ejection fraction.

    “growing evidence suggests that obesity and excess adiposity are not simply coexisting conditions but may play a role in the development and progression of heart failure with preserved ejection fraction. 4-8”

    From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [6]

  • Epidemiologic data indicate that the majority of patients with heart failure with preserved ejection fraction have obesity.

    “epidemiologic data indicate that the majority of patients with heart failure with preserved ejection fraction have obesity”

    From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [6]

    The Methods (Study Participants) specify that HFpEF patients were enrolled only if they had a BMI of at least 30 kg/m². The Results (Participant Characteristics) describe that selected group, but neither passage gives an epidemiologic estimate of obesity among all patients with HFpEF. Searches for a majority or prevalence estimate found none in our copy. (LLM, conf=0.75)

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Authors
Haykowsky, M. J., Nicklas, B. J., Brubaker, P. H., Hundley, W. G., Brinkley, T. E., Upadhya, B., Becton, J. T., Nelson, M. D., Chen, H., & Kitzman, D. W.
Affiliations
  • The University of Texas at Arlington (US)
  • Wake Forest University (US)
  • Wake Forest University Health Sciences (US)
Corresponding author
Kitzman, Dalane W.
ORCID
Venue
JACC: Heart Failure
Publisher
Elsevier BV
Published
2018-08
Volume
6
Issue
8
Pages
640-649
ISSN
2213-1779 (ISSN-L)
DOI
10.1016/j.jchf.2018.06.002
PMC
PMC6086374
OpenAlex
W2871286142
Cited by
179
References
47
Citations by year
2026: 16 · 2025: 26 · 2024: 24 · 2023: 20 · 2022: 30 · 2021: 20 · 2020: 23 · 2019: 15 · 2018: 4
FWCI
11.73
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC Heart Failure (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR001420, KL2TR001421)
  • National Institute on Aging (R01AG018917, R01AG018915, K01AG033652, R01AG045551, R37AG018915, P30AG021332, U24AG059624)
  • National Heart, Lung, and Blood Institute (R01HL107257, R01HL093713)
  • National Institute of Nursing Research (R15NR016826)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
heart failure with preserved ejection fraction, obesity, intra-abdominal fat, intermuscular fat, cardiac fat, exercise intolerance, physical function, older adults, metabolically unhealthy obesity, 6-minute walk distance, Short Physical Performance Battery
MeSH terms
Walk Test, Physical Functional Performance, Aged, Female, Heart, Heart Failure, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Obesity, Oxygen Consumption, Stroke Volume, Thigh, Absorptiometry, Photon, Case-Control Studies, Exercise Tolerance, Muscle, Skeletal, Intra-Abdominal Fat, Abdominal Fat, Body Fat Distribution, Subcutaneous Fat, Abdominal, Muscle Strength

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