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Background: Patients with symptoms of heart failure and preserved left ventricular systolic function are commonly encountered in clinical practice especially in peritoneal dialysis (PD) patients. Pericardial fat (PF) is an ectopic fat depot with possible paracrine or direct mechanical effects on myocardial function.

Methods: We designed a cross-sectional study in 149 prevalent PD patients with preserved left ventricular systolic function. Left ventricular diastolic dysfunction (LVDD) and was diagnosed by echocardiography (according to ESC guidelines) and PF volume was measured. PD patient without LVDD served as the control group. Serum inflammatory biomarkers were examined (C-reactive protein, CRP). The location and amount of adipose tissue were assessed by computerized tomography (CT) at the level of the fourth lumbar vertebra.

Results: Subjects with LVDD had higher levels of the inflammation cytokines, more visceral and peritoneal fat and larger PF volumes (all P<0.001) than control subjects. A significant correlation was found between visceral adipose tissue, CRP, PF and the development of LVDD (all P<0.05). Multivariable regression analysis found that the relationship between visceral adipose tissue and LVDD became insignificant when CRP, PF were introduced into the model, whereas PF still served as the most powerful determinants for the development of LVDD (OR=2.41, 95% CI = 1.43∼4.08, p<0.01). In addition, PF volume correlated significantly with the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e') (r=0.63, p<0.01),

Conclusion: PF volumes are significantly associated with the development of LVDD, independent of other factors such as visceral adiposity or inflammations. PF may be implicated in the pathogenesis of LVDD in PD patients with normal LVEF.

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The European Society of Cardiology
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