Regional Adipose Distribution and Its Relationship to Exercise Intolerance in Older Obese HFpEF Patients Mark J. Haykowsky, Ph.D. 1 , Barbara J. Nicklas, Ph.D. 2 , Peter H. Brubaker, Ph.D. 5 , W. Gregory Hundley, M.D. 3 , Tina E. Brinkley, Ph.D. 2 , Bharathi Upadhya, M.D. 3 , J. Thomas Becton, M.S. 3 , Michael D. Nelson, Ph.D. 1 , Haiying Chen, Ph.D. 4 , and Dalane W. Kitzman, M.D. 2,3 1 College of Nursing and Health Innovation, University of Texas at Arlington 2 Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC, USA 3 Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC, USA 4 Department of Biostatistical Science, Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC, USA 5 Department of Exercise and Health Science, Wake Forest University, Winston Salem, NC, USA Abstract Background—Recent studies indicate that excess total body adipose contributes to exercise intolerance in heart failure with preserved ejection fraction (HFpEF). However, the impact of the pattern of regional (abdominal, cardiac, intermuscular) adipose deposition on exercise intolerance in HFpEF is unknown. Methods—We measured total body (dual-energy x-ray absorptiometry) and regional adipose (magnetic resonance imaging), peak oxygen uptake (peak VO 2 ), 6-minute walk distance (6MWD), short physical performance battery (SPPB), and leg press power in 100 older obese HFpEF patients and 61 healthy controls (HC), and adjusted for age, gender, race, and body surface area. Address for Correspondence: Dalane W. Kitzman, MD, Kermit Glenn Phillips II Chair in Cardiovascular Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, Tel: 336-716-3274, Fax: 336-716-4995, dkitzman@wakehealth.edu. Disclosures: Dr. Kitzman has been a consultant for Relypsa, Abbvie, GlaxoSmithKline, St. Luke’s Medical Center, DCRI, and Corvia Medical; received grants from Novartis and St. Luke’s Medical Center; and owns stock in Gilead Sciences. Competency in Medical Knowledge Metabolic/obese HFpEF patients have excess intra-abdominal and intemuscular adipose that is independently related to exercise capacity, beyond total body adipose. Translational Outlook Strategies to differentially impact regional adipose could improve exercsie intolerance in metabolic/obese HFpEF. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author manuscript JACC Heart Fail. Author manuscript; available in PMC 2019 August 01. Published in final edited form as: JACC Heart Fail. 2018 August ; 6(8): 640–649. doi:10.1016/j.jchf.2018.06.002. Author Manuscript Author Manuscript Author Manuscript Author Manuscript