Connecting epicardial adipose tissue and heart failure with preserved ejection fraction: mechanisms, management and modern perspectives

Gijs van Woerden, Dirk J. van Veldhuisen, B. Daan Westenbrink, Rudolf A. de Boer, Michiel Rienstra, Thomas M. Gorter*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)
9 Downloads (Pure)


Obesity is very common in patients with heart failure with preserved ejection fraction (HFpEF) and it has been suggested that obesity plays an important role in the pathophysiology of this disease. While body mass index defines the presence of obesity, this measure provides limited information on visceral adiposity, which is probably more relevant in the pathophysiology of HFpEF. Epicardial adipose tissue is the visceral fat situated directly adjacent to the heart and recent data demonstrate that accumulation of epicardial adipose tissue is associated with the onset, symptomatology and outcome of HFpEF. However, the mechanisms by which epicardial adipose tissue may be involved in HFpEF remain unclear. It is also questioned whether epicardial adipose tissue may be a specific target for therapy for this disease. In the present review, we describe the physiology of epicardial adipose tissue and the pathophysiological transformation of epicardial adipose tissue in response to chronic inflammatory diseases, and we postulate conceptual mechanisms on how epicardial adipose tissue may be involved in HFpEF pathophysiology. Lastly, we outline potential treatment strategies, knowledge gaps and directions for further research.

Original languageEnglish
Pages (from-to)2238-2250
Number of pages13
JournalEuropean Journal of Heart Failure
Issue number12
Early online date17-Nov-2022
Publication statusPublished - Dec-2022


  • Epicardial adipose tissue
  • HFpEF
  • Inflammation
  • Pathophysiology

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