What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiac diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF) (n=43113). Intervention: Abnormal fat distribution vs. Controls. Primary outcome: Abnormal fat distribution in participants with cardiac diastolic dysfunction vs controls (SMD 0.88, 95% CI 0.69-1.08, p=<0.05).

What does this research mean for the field?

Abnormal fat distribution, particularly in epicardial adipose tissue, is significantly greater in individuals with cardiac diastolic dysfunction compared to controls and is correlated with an increased risk of developing the condition. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 31, 2024Open Access

Linking abnormal fat distribution with HFpEF and diastolic dysfunction: a systematic review, meta-analysis, and meta-regression of observational studies

Q: What are the key findings of this study?

Abnormal fat distribution was significantly greater in participants with cardiac diastolic dysfunction compared to controls (SMD 0.88).

Q: What does this research mean for the field?

Abnormal fat distribution, particularly in epicardial adipose tissue, is significantly greater in individuals with cardiac diastolic dysfunction compared to controls and is correlated with an increased risk of developing the condition. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Abnormal fat distribution was significantly greater in participants with cardiac diastolic dysfunction compared to controls (SMD 0.88).

Study Design

Type

Meta-Analysis (n=43,113)

Structured PICO

Does abnormal fat distribution correlate with the risk of developing cardiac diastolic dysfunction in adults?

Population

43,113 participants from 63 observational studies (43 cross-sectional, 9 case-control, 11 cohort) including individuals diagnosed with HFpEF or cardiac diastolic dysfunction (CDD) older than 18 years and controls. Overall weighted average age 57.84 years, weighted BMI 27.08 kg/m2.

Intervention

Abnormal fat distribution (visceral adipose tissue, epicardial adipose tissue, pericardial adipose tissue, nonalcoholic fatty liver disease)

Comparator

Controls (individuals without cardiac diastolic dysfunction or with normal fat distribution)

Outcome

Quantitative measurements of abnormal fat (SMD) and correlation (Pearson/Spearman) between abnormal fat distribution and cardiac diastolic function parameters (E/A, E/E', e, E, global circumferential strain, global longitudinal strain, LVEDV, LVEDD)surrogate

Abnormal fat distribution, particularly epicardial adipose tissue and nonalcoholic fatty liver disease, is significantly associated with an increased risk of cardiac diastolic dysfunction.

Main Result

Effect estimate: SMD 0.88 (95% CI 0.69-1.08)

p-value: p=<0.05

Limitations

Many studies failed to distinguish between epicardial adipose tissue and pericardial adipose tissue.
Significant heterogeneity across studies, likely due to differences in fat distribution and sample size.

Abstract

BACKGROUND: The global prevalence of obesity has escalated into a formidable health challenge intricately linked with the risk of developing cardiac diastolic disfunction and heart failure with preserved ejection fraction (HFpEF). Abnormal fat distribution is potentially strongly associated with an increased risk of cardiac diastolic dysfunction, and we aimed to scrutinize and elucidate the correlation between them. METHODS: Following the Cochrane Handbook and PRISMA 2020 guidelines, we systematically reviewed the literature from PubMed, Embase, and Web of Science. We focused on studies reporting the mean and standard deviation (SD) of abnormal fat in HFpEF or cardiac diastolic dysfunction patients and the Pearson/Spearman correlation coefficients for the relationship between abnormal fat distribution and the risk of developing cardiac diastolic dysfunction. Data were standardized to the standard mean difference (SMD) and Fisher's z value for meta-analysis. RESULTS: After progressive filtering and selection, 63 studies (43,113 participants) were included in the quantitative analyses. Abnormal fat distribution was significantly greater in participants with cardiac diastolic dysfunction than in controls SMD 0.88 (0.69, 1.08), especially in epicardial adipose tissue SMD 0.99 (0.73, 1.25). Abnormal fat distribution was significantly correlated with the risk of developing cardiac diastolic dysfunction E/E': 0.23 (0.18, 0.27), global longitudinal strain: r=-0.11 (-0.24, 0.02). Meta-regression revealed sample size as a potential heterogeneous source, and subgroup analyses revealed a stronger association between abnormal fat distribution and the risk of developing cardiac diastolic dysfunction in the overweight and obese population. CONCLUSION: Abnormal fat distribution was significantly associated with the risk of developing cardiac diastolic dysfunction. TRIAL REGISTRATION: CRD42024543774.

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