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Sarcopenic Obesity and the Pathogenesis of Exercise Intolerance in Heart Failure with Preserved Ejection Fraction

Current Heart Failure Reports volume 12, pages 205–214 (2015)Cite this article

Abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults. The primary chronic symptom in patients with HFpEF, even when well compensated, is severe exercise intolerance. Cardiac and peripheral functions contribute equally to exercise intolerance in HFpEF, though the latter has been the focus of fewer studies. Of note, multiple studies with exercise training have shown that exercise intolerance can improve significantly in the absence of improvements in exercise cardiac output, indicating a role of peripheral, noncardiac adaptations. In addition, clinical drug trials performed to date in HFpEF, all of which have focused on influencing cardiovascular function, have not been positive on primary clinical outcomes and most have not improved exercise capacity. Mounting evidence indicates that sarcopenic obesity, characterized by the coexistence of excess fat mass and decreased muscle mass, could contribute to the pathophysiology of exercise intolerance in older HFpEF patients and may provide avenues for novel treatments.

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Acknowledgments

This review was supported in part by NIH grant R01AG18915, P30AG021332, R01AG045551.

Compliance with Ethics Guidelines

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Conflict of Interest

Bharathi Upadhya declares that she has no conflict of interest.

Mark J. Haykowsky declares that he has no conflict of interest.

Joel Eggebeen declares that he has no conflict of interest.

Dalane W. Kitzman has received compensation from GlaxoSmithKline, Relypsa, DC Devices, AbbVie, Regeneron, and Westat for service as a consultant; grant support from Novartis; and claims stock ownership in Gilead Sciences and Relypsa.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Affiliations

  1. Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA

    Bharathi Upadhya, Joel Eggebeen & Dalane W. Kitzman

  2. Faculty of Rehabilitation Medicine, Alberta Cardiovascular and Stroke Research Centre (ABACUS), Mazankowski Alberta Heart Institute, University of Alberta, 3-16 Corbett Hall, Edmonton, AB, T6G 2G4, Canada

    Mark J. Haykowsky

  3. Cardiology and Geriatrics, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157-1045, USA

    Dalane W. Kitzman

Authors
  1. Bharathi Upadhya
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  2. Mark J. Haykowsky
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  3. Joel Eggebeen
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  4. Dalane W. Kitzman
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Corresponding author

Correspondence to Dalane W. Kitzman.

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This article is part of the Topical Collection on Pathophysiology: Neuroendocrine, Vascular, and Metabolic Factors

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Upadhya, B., Haykowsky, M.J., Eggebeen, J. et al. Sarcopenic Obesity and the Pathogenesis of Exercise Intolerance in Heart Failure with Preserved Ejection Fraction. Curr Heart Fail Rep 12, 205–214 (2015). https://doi.org/10.1007/s11897-015-0257-5

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Keywords

  • Heart failure with preserved ejection fraction
  • Exercise intolerance
  • Skeletal muscle
  • Peak oxygen consumption
  • Sarcopenia
  • Obesity
  • Aging
  • Exercise training