Adiposity in HFpEF

Adiposity in Heart Failure with Preserved Ejection Fraction

Epicardial fat can cause heart failure with preserved ejection fraction.

Heart failure with preserved ejection fraction is a complex disease that affects millions of patients worldwide. At the moment, there are no effective therapies to improve the lifespan or quality of life of patients suffering from this disease. Many of the patients with HFpEF are obese and we think that adipose tissue and its associated inflammation may play a role in the pathophysiology of HFpEF.

From historical standpoint it was thought that adipose tissue was merely a storage and supplier of energy. This view has changed over the last decades and it is now thought that adipose tissue could be an active player in the pathophysiology of HFpEF. It was recently discovered by us and others that patients with HFpEF have an increased amount of epicardial fat arount their heart. Epicardial fat is of special interest as there is direct contact between this adipose compartment and the heart , potentially facilitating direct interaction. There are several possible ways that epicardial fat could influence the heart. For instance, epicardial fat is a source of inflammatory cytokines that can have detrimental effect on the myocardium and increase myocardial fibrosis and myocardial stiffness. Epicardial fat could also infiltrate the myocardium and change myocardial ultrastructure or cardiac metabolism.


In the current project we will try to unravel if and how epicardial fat contributes to the pathophysiology of HFpEF. If adipose tissue is truly involved, this may lead to new therapeutic options for patients with HFpEF.

“Unraveling the relationship between adiposity and heart failure with preserved ejection fraction may open up new therapeutic options for patients suffering from this disease.”

People involved

Principal investigator

Dirk Jan van Veldhuisen


Michiel Rienstra


Daan Westenbrink


Aad Withaar


Gijs van Woerden


Press & publications

Epicardial fat in heart failure patients with mid-range and preserved ejection fraction.

van Woerden G, Gorter TM, Westenbrink BD, Willems TP, van Veldhuisen DJ, Rienstra M. Eur J Heart Fail. 2018.

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Myocardial adiposity in heart failure with preserved ejection fraction: the plot thickens.

van Woerden G, van Veldhuisen DJ, Rienstra M, Westenbrink BD. Eur J Heart Fail. 2019.

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Incident heart failure risk after bariatric surgery: the role of epicardial fat.

van Woerden G, van Veldhuisen SL, Rienstra M. Eur Heart J 2020

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Epicardial Adipose Tissue and Invasive Hemodynamics in Heart Failure with Preserved Ejection Fraction

Thomas M Gorter, Gijs van Woerden, Michiel Rienstra, Michael G Dickinson, Yoran M Hummel, Adriaan A Voors, Elke S Hoendermis, Dirk J van Veldhuisen. JACC Heart Fail 2020.

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Preoperative cardiac screening using NT-proBNP in obese patients 50 years and older undergoing bariatric surgery: a study of 310 consecutive patients

Sophie L van Veldhuisen, Gijs van Woerden, Martin E W Hemels, Yves G C J America, Rudolf A de Boer, Michiel Rienstra, Dirk J van Veldhuisen, Eric J Hazebroek. Surg Obes Relat Dis 2021.

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External links