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Nagata R, Obokata M, Matsui M, Matsui H, Seki Y, Igarashi T, Sunaga H, Kawakami R, Harada T, Kagami K, Saeki H, Shirabe K, Iso T, Ishii H. Pathophysiologic Contributions of Visceral Adiposity to Left Ventricular Diastolic Dysfunction. J Cardiovasc Dev Dis 2023; 10:247. [PMID: 37367412 PMCID: PMC10299441 DOI: 10.3390/jcdd10060247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Visceral fat produces inflammatory cytokines and may play a major role in heart failure with preserved ejection fraction (HFpEF). However, little data exist regarding how qualitative and quantitative abnormalities of visceral fat would contribute to left ventricular diastolic dysfunction (LVDD). METHODS We studied 77 participants who underwent open abdominal surgery for intra-abdominal tumors (LVDD, n = 44; controls without LVDD, n = 33). Visceral fat samples were obtained during the surgery, and mRNA levels of inflammatory cytokines were measured. Visceral and subcutaneous fat areas were measured using abdominal computed tomography. RESULTS Patients with significant LVDD had greater LV remodeling and worse LVDD than controls. While body weight, body mass index, and subcutaneous fat area were similar in patients with LVDD and controls, the visceral fat area was larger in patients with LVDD than in controls. The visceral fat area was correlated with BNP levels, LV mass index, mitral e' velocity, and E/e' ratio. There were no significant differences in the mRNA expressions of visceral adipose tissue cytokines (IL-2, -6, -8, and -1β, TNFα, CRP, TGFβ, IFNγ, leptin, and adiponectin) between the groups. CONCLUSIONS Our data may suggest the pathophysiological contribution of visceral adiposity to LVDD.
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Affiliation(s)
- Reika Nagata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
- Department of Laboratory Sciences, Gunma University Graduate School of Health Science, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (M.M.); (H.M.)
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
| | - Miki Matsui
- Department of Laboratory Sciences, Gunma University Graduate School of Health Science, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (M.M.); (H.M.)
| | - Hiroki Matsui
- Department of Laboratory Sciences, Gunma University Graduate School of Health Science, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (M.M.); (H.M.)
| | - Yuko Seki
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi 371-8511, Gunma, Japan
| | - Takamichi Igarashi
- Department of General Surgery, Gunma University Graduate School of Medical Sciences, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (T.I.); (H.S.); (K.S.)
| | - Hiroaki Sunaga
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
| | - Ryo Kawakami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
| | - Kazuki Kagami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
- Division of Cardiovascular Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
| | - Hiroshi Saeki
- Department of General Surgery, Gunma University Graduate School of Medical Sciences, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (T.I.); (H.S.); (K.S.)
| | - Ken Shirabe
- Department of General Surgery, Gunma University Graduate School of Medical Sciences, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (T.I.); (H.S.); (K.S.)
| | - Tatsuya Iso
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan; (R.N.); (Y.S.); (H.S.); (R.K.); (T.H.); (K.K.); (T.I.); (H.I.)
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Echocardiography in the diagnostic evaluation and phenotyping of heart failure with preserved ejection fraction. J Cardiol 2021; 79:679-690. [PMID: 34857430 DOI: 10.1016/j.jjcc.2021.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents one of the greatest unmet needs in modern cardiology given its diagnostic difficulty and limited therapeutic options. Echocardiography provides valuable information on cardiac structure, function, and hemodynamics and plays a central role in the evaluation of HFpEF. Echocardiography is crucial in identifying HFpEF among patients with dyspnea, especially when overt congestion is absent. The combination of echocardiographic indices of diastolic function, clinical characteristics, and natriuretic peptide tests has been proposed in the diagnostic evaluation of patients with suspected HFpEF. Echocardiography also provides valuable insight into the pathophysiology and underlying phenotypes of HFpEF. Exercise stress echocardiography can also detect abnormalities that develop only during exercise. This may enhance the diagnosis of HFpEF by demonstrating elevation in the left ventricular filling pressure and may have potential for better pathophysiological characterization. This review focuses on the role of echocardiography in the diagnostic evaluation and phenotyping of HFpEF. We also discuss the potential role of exercise stress echocardiography for the diagnosis and disease phenotyping of HFpEF.
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