Epikardiales Fett: kardiovaskuläre Risiken und Manifestation einer veränderten Fettverteilung

Zusammenfassung

Die Prävalenz einer chronischen Herzinsuffizienz (heart failure, HF) ist in der westlichen Bevölkerung sehr hoch. Bei der HF spielen neben einer koronaren Herzerkrankung gerade bei den Patienten mit einer erhaltenen Pumpfunktion (Heart Failure with preserved Ejection Fraction, HFpEF) weitere metabolische Faktoren, wie z. B. Übergewicht und Diabetes, eine wichtige Rolle.

Ektopes Fettgewebe, insbesondere epikardiales Fett (epicardial adipose tissue, EAT), könnte ein neues Bindeglied zwischen ischämischer Herzerkrankung inklusive Remodeling, Übergewicht/Adipositas und der Entwicklung einer HFpEF sein. EAT besitzt eine dichotome Funktion als Energiepuffer oder Risikofaktor der Koronarkalzifizierung und beeinflusst als endokrines Gewebe insbesondere durch Adipokine wie Adiponectin den weiteren Krankheitsprogress nach Myokardinfarkt. Seneszenzvorgänge im Fettgewebe verändern dessen endokrines Verhalten sowie dessen immunzelluläre Zusammensetzung, was den Krankheitsprogress und auch die Entwicklung einer HFpEF begünstigen könnte. Interessanterweise reduziert körperliche Aktivität Prozesse der Seneszenz und Gewichtsreduktion die Menge an EAT.

Abstract

The prevalence of chronic heart failure (HF) is of very high amount in the Western population. In addition to coronary heart disease, other metabolic factors such as obesity and diabetes play an important role in HF, especially in patients with preserved LV function (Heart Failure with preserved Ejection Fraction, HFpEF).

Ectopic adipose tissue, especially epicardial adipose tissue (EAT), could be a new link between ischaemic heart disease, including remodelling, and overweight/obesity and the development of HFpEF. EAT has a dichotomous function as an energy buffer or risk factor for coronary calcification and, as an endocrine tissue, influences further disease progression after myocardial infarction, particularly through adipokines such as adiponectin. Senescence processes in adipose tissue change its endocrine behaviour as well as its immune cellular composition, which could promote disease progression and the development of HFpEF. Interestingly, physical activity reduces senescence processes and weight reduction reduces the amount of EAT.

Was ist wichtig?

Ektopes Fettgewebe scheint ein neues Bindeglied zwischen Koronarrisiko sowie Übergewicht und Herzinsuffizienz mit erhaltener Ejektionsfraktion (HFpEF) zu sein. Seneszenzvorgänge beeinflussen zudem die Funktionalität und proinflammatorische Vorgänge des Fettgewebes und damit möglicherweise auch direkt krankheitsrelevante Prozesse bei der Atherosklerose und auch der Myokardfunktion sowie den Krankheitsprogress. Bildgebende und laborchemische Diagnostik für das epikardiale Fettgewebe (EAT) stehen bereits zur Verfügung und sollten ggf. häufiger zur weitere Risikostratifizierung von Patienten eingesetzt werden.

Schlüsselwörter

heart failure with preserved ejection fraction - epikardiales Fett - ektope Fettverteilung - kardiale Dysfunktion - kardiales Remodeling - zelluläre Seneszenz

Keywords

epicardial adipose tissue - ectopic fat distribution - cardiac disorders - senescence - cardiac remodeling - heart failure with preserved ejection fraction

Publication History

Article published online:
31 July 2024

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