Adipose Tissue Inflammation and Adiponectin Resistance in Patients with Advanced Heart Failure: Correction after Ventricular Assist Device Implantation

Background —Heart failure (HF) is characterized by inflammation, insulin resistance and progressive catabolism. We hypothesized that patients with advanced HF also develop adipose tissue inflammation associated with impaired adipokine signaling and that hemodynamic correction through implantation of ventricular assist devices (VADs) would reverse adipocyte activation and correct adipokine signaling in advanced HF. Methods and Results —Circulating insulin, adiponectin, leptin and resistin levels were measured in 36 patients with advanced HF before and after VAD implantation and 10 healthy controls. Serum adiponectin was higher in HF patients pre-VAD compared to controls (13.3±4.9 vs. 6.4±2.1 μg/ml, p=0.02). VAD implantation (mean 129±99 days) reduced serum adiponectin (7.4±3.4 μg/ml, p 2 vs. 5583±142 μm 2 in controls; p<0.05), which increased after VAD placement. Of note, macrophage infiltration in adipose tissue was higher in advanced HF patients compared to controls (+25%; p<0.01), which normalized after VAD implantation. Conclusions —Adipose tissue inflammation and adiponectin resistance develop in advanced HF. Mechanical unloading of the failing myocardium reverses adipose tissue macrophage infiltration, inflammation and adiponectin resistance in patients with advanced HF.