Epicardial Adipose Tissue: A Potential Target to Improve Left Ventricular Diastolic Dysfunction

Left ventricular diastolic dysfunction (LVDD) can progress to heart failure, a condition associated with diminished quality of life as well as high mortality. Meanwhile, timely diagnosis and effective treatment of LVDD rely on a thorough understanding of the pathogenesis involved in LVDD. Echocardiography and cardiac magnetic resonance are the primary imaging modalities for evaluating left ventricular diastolic function. Several strands of evidence indicate that increased epicardial adipose tissue (EAT) correlates with LVDD in various clinical settings, such as hypertension, coronary artery diseases, diabetes, and obesity. Conversely, therapeutic strategies aimed at reducing EAT may improve the restoration of diastolic function. Some interventions have shown promise in decreasing EAT, including medications (hypoglycemic and hypolipidemic agents), lifestyle modifications (diet and exercise), and bariatric surgery. Notably, these interventions have concurrently been linked to improvements in diastolic parameters. This review compiles recent advancements in the clinical evaluation of LVDD to elucidate the pathophysiological and therapeutic roles of EAT in LVDD.