Obesity, Preserved Ejection Fraction Heart Failure, and Left Ventricular Remodeling

Menopause, epicardial adiposity and preserved ejection fraction heart failure

Postmenopausal women are overrepresented in the preserved ejection heart failure population. Expansion of visceral and epicardial adipose tissue during the menopause transition leads to local and low-grade systemic inflammation that in turn contributes to left ventricular concentric remodeling, diastolic dysfunction and the development and progression of preserved ejection fraction. In contrast to visceral adipose tissue imaging, epicardial adipose tissue can be inexpensively imaged on low radiation coronary calcium score computerized tomography examination. The menopause transition provides a unique time frame to evaluate the contribution of epicardial adipose tissue expansion to the pathogenesis of preserved ejection heart failure.

[Cardiometabolic effects of weight loss]

The prevalence of overweight and obesity, and, consequently, associated comorbidities, is increasing significantly worldwide. The guidelines recommend a percentage of weight loss> 5% to achieve beneficial effects on metabolic comorbidities associated with obesity. Furthermore, greater weight losses (> 10%) produce more significant improvements, and may even produce remission of some of these comorbidities. In this chapter, we review the evidence of the effect of weight loss through different strategies (lifestyle intervention, pharmacological treatment, or bariatric surgery) on the main cardiometabolic pathologies associated with excess adipose tissue (type 2 diabetes, high blood pressure, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, inflammation, cardiovascular diseases, and mortality).

Epicardial Adipose Tissue Thickness and Preserved Ejection Fraction Heart Failure

PURPOSE OF THE REVIEW

Preserved ejection fraction heart failure and obesity frequently coexist. Whether obesity plays a consistent role in the pathogenesis of preserved ejection fraction heart failure is unclear. Accumulation of visceral adiposity underlies the pathogenic aftermaths of obesity. However, visceral adiposity imaging is assessed by computed tomography or magnetic resonance and thus not routinely available. In contrast, epicardial adiposity thickness is assessed by echocardiography and thus routinely available. We review the rationale for assessing epicardial adiposity thickness in patients with preserved ejection fraction heart failure and elevated body mass index.

RECENT FINDINGS

Body mass index correlates poorly with visceral, and epicardial adiposity. Visceral and epicardial adiposity enlarges as preserved ejection fraction heart failure progresses. Epicardial adiposity may hasten the progression of coronary artery disease and impairs left ventricular sub-endocardial perfusion and diastolic function. Epicardial adiposity thickness may help monitor the therapeutic response in patients with preserved ejection failure heart failure and elevated body mass index.

Effect of Astragalus membranaceus on left ventricular remodeling in HFrEF: a systematic review and meta-analysis

Background: Left ventricular remodeling (LVR) is a key factor leading to the onset and progression of heart failure with reduced ejection fraction (HFrEF). Improving LVR can delay the progression of HFrEF and improve quality of life. Objective: To evaluate the improvement effect of Astragalus membranaceus (A. membranaceus) on LVR in patients with HFrEF. Method: We retrieved randomized controlled trials (RCTs) of A. membranaceus in treating HFrEF from eight Chinese and English databases, up until 31 October 2023. To assess the quality of the literature, we utilized the bias risk tool from the Cochrane Handbook. For meta-analysis, we employed Review Manager 5.4.1 software. Additionally, we performed sensitivity analysis and publication bias assessment using Stata 17.0 software. Result: Totally 1,565 patients were included in 19 RCTs. Compared to conventional treatment (CT), the combination therapy of A. membranaceus with CT demonstrated significant improvements in LVR, specifically increasing left ventricular ejection fraction (LVEF, MD = 5.82, 95% CI: 4.61 to 7.03, p < 0.00001), decreasing left ventricular end-diastolic diameter (LVEDD, MD = -4.05, 95% CI: -6.09 to -2.01, p = 0.0001), and left ventricular end-systolic diameter (LVESD, MD = -12.24, 95% CI: -15.24 to -9.24, p < 0.00001). The combination therapy of A. membranaceus with CT also improved clinical efficacy (RR = 4.81, 95% CI: 3.31 to 7.00, p < 0.00001), reduced brain natriuretic peptide (BNP, MD = -113.57, 95% CI: -146.91 to -81.22, p < 0.00001) level, and increased 6-min walking distance (6-MWD, MD = 67.62, 95% CI: 41.63 to 93.60, p < 0.00001). In addition, the combination therapy of A. membranaceus with CT mitigated inflammatory responses by reducing tumor necrosis factor-alpha (TNF-α, MD = -16.83, 95% CI: -22.96 to -10.71, p < 0.00001), interleukin-6 (IL-6, MD = -29.19, 95% CI: -36.08 to -22.30, p < 0.00001), and high-sensitivity C-reactive protein (hs-CRP, MD = -0.98, 95% CI: -1.43 to -0.52, p < 0.0001). Notably, the combination therapy of A. membranaceus with CT did not increase the incidence of adverse reactions (RR = 0.86, 95% CI: 0.25 to 2.96, p = 0.81). Conclusion: This systematic review and meta-analysis revealed that the combination therapy of A. membranaceus with CT has more advantages than CT alone in improving LVR and clinical efficacy in HFrEF patients, without increasing the incidence of adverse reactions. However, due to the limited quality of included studies, more high-quality investigations are required to provide reliable evidence for clinical use. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=397571, Identifier: CRD42023397571.