Adipositas und HFpEF – Henne oder Ei?

Zusammenfassung

Herzinsuffizienz mit erhaltener Pumpfunktion (HFpEF) ist wahrscheinlich eine der am häufigsten übersehenen Ursachen für das Vorliegen einer Belastungsdyspnoe bei Patienten mit Adipositas. Patienten mit Adipositas-assoziierter HFpEF machen bis zu 80 % aller HFpEF Patienten aus, und eine individualisierte Therapie für diese Patientengruppe zu finden ist von größter Wichtigkeit. Patienten mit Adipositas-assoziierter HFpEF sind gekennzeichnet durch eine progressive Expansion und Umwandlung des vor allem epikardialen Fettgewebes, einer Erhöhung des Plasmavolumens, einer verstärkten lokalen und systemischen Inflammation sowie einer ausgeprägten myokardialen Fibrose. Diese Veränderungen münden in einer ausgeprägten Belastungsintoleranz, Anfälligkeit für Volumenänderungen sowie einer sich intensivierenden Kaskade von Komorbiditäten. Individualisierte Therapien zur Behandlung der Adipositas-assoziierten HFpEF sind auf dem Weg und könnten erstmalige Erfolge bei der Behandlung des heterogenen HFpEF-Syndroms bringen.

Abstract

Heart failure with preserved ejection fraction (HFpEF) is likely one of the most underdiagnosed causes of exertional dyspnea in patients with obesity. Patients with HFpEF and obesity make up approximately 80 % of all HFpEF patients and identifying a tailored therapy for this population is of utmost importance. Patients with HFpEF and obesity show characteristic pathophysiological features that are marked by expanding and dysfunctional adipose tissue, especially in the epicardial region, plasma volume expansion, enhanced local and systemic inflammation, as well as increased myocardial fibrosis. These changes lead to extensive intolerance to physical exertion, susceptibility to increased preload, as well as an intensifying burden of co-morbidities. Individualized treatment approaches for patients with HFpEF and obesity are being developed and might provide effective therapies for the heterogeneous HFpEF syndrome for the first time.

Schlüsselwörter

Adipositas - HFpEF - Inflammation - Fibrose

Key words

Obesity - HFpEF - inflammation - fibrosis

Publication History

Article published online:
12 March 2021

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