Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction

Hidemi Sorimachi, Masaru Obokata, Naoki Takahashi, Yogesh N.V. Reddy, Christopher C. Jain, Frederik H. Verbrugge, Katlyn E. Koepp, Sundeep Khosla, Michael D. Jensen, Barry A. Borlaug

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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 cm2, P = 0.006), while VAT area was not significantly different in men with or without HFpEF (294 ± 158 vs. 252 ± 92 cm2, 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 cm2 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.

Original languageEnglish (US)
Pages (from-to)1595-1605
Number of pages11
JournalEuropean heart journal
Issue number16
StatePublished - Apr 21 2021


  • Haemodynamics
  • Heart failure
  • Obesity
  • Visceral adipose tissue

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction'. Together they form a unique fingerprint.

Cite this