Epicardial adipose tissue ablation using high-intensity focused ultrasound as a treatment option for HFpEF

Nolan, Clare

Heart failure with preserved ejection fraction (HFpEF) is a complex and significant section of heart failure. It maintains a normal ejection fraction but shows impaired ventricular filling and relaxation. The prevalence of HFpEF is rising and it is contributing substantially to the global burden of heart failure. This thesis explores the multifaceted nature of HFpEF, including its anatomy, pathophysiology, prognosis, causes, risk factors, and current diagnostic and therapeutic strategies. A special emphasis is placed on the role of epicardial adipose tissue (EAT) in HFpEF, investigating both the mechanical and metabolic effects of EAT on cardiac function. The research hypothesizes a causal relationship between excess EAT and HFpEF, and proposes innovative treatment approaches aimed at reducing EAT. Novel solution directions are discussed, focusing on advanced liposuction techniques and high-intensity focused ultrasound (HIFU) as potential interventions to mitigate the adverse effects of EAT on the heart. Technical requirements, expert brainstorming sessions, and detailed analysis of surgical access methods are provided to support the development of these treatments. Additionally, the thesis outlines the design and potential limitations of HIFU devices, addressing safety, efficacy, and preclinical trial considerations. Finally, the commercial viability of the proposed solutions is examined, covering market opportunities, intellectual property considerations, regulatory strategies, and reimbursement pathways. The potential impact of targeted EAT reduction therapies on improving outcomes for HFpEF patients.
University of Galway
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