Cardiac magnetic resonance (CMR) may detect early signs of cardiomyopathy.
Purpose
The purpose of this CMR study was to evaluate epicardial fat volume (EFV), T1-relaxation times (T1), and left ventricular (LV) strain in non-obese (<30 kg/m2) and obese (>30 kg/m2) individuals with no other cardiovascular risk factor and with a normal LV ejection fraction (LVEF) to detect early changes of obesity cardiomyopathy.
Material and Methods
Seventy-five individuals (38 men) without additional cardiovascular risk factors were examined at 1.5 T. EFV was assessed by a 3D-Dixon sequence. A 3(3)3(3)5 MOLLI scheme was used to assess T1 (ms). Myocardial strain (%) was evaluated by longitudinal (LS) and circumferential strain (CS) analysis.
Results
Obese individuals (n = 34; age = 55.6 ± 13.8 years; BMI = 33.4 ± 2.9 kg/m2) had higher EFVs (70.2 ± 27.9 vs. 56.1 ± 25.2 mL/m2; P < 0.05) and T1 values (991.0 ± 38.6 vs. 974.6 ± 32.0; P = 0.061) as well as worse LS and CS values (LS = −21.0 ± 4.8 vs. −23.2 ± 3.7; CS = −23.8 ± 5.7 vs. −27.7 ± 4.2; P < 0.05, for all) compared to non-obese individuals (n = 41; age = 57.2 ± 15.5 years; BMI = 25.1 ± 2.3 kg/m2). Individuals with severe obesity (BMI > 35 kg/m2) had a significantly higher T1 compared to non-obese (1010.5 ± 39.9 vs. 974.6 ± 32.0 ms; P < 0.05). There were no significant differences regarding age or gender.
Conclusion
Obesity is associated with an increased EFV and a disturbed LV contractility despite a normal LVEF. Myocardial fibrosis as well as metabolic and inflammatory mechanisms of increased epicardial fat may play role. Multi-parametric CMR may be a valuable tool for the detection of such early signs of an obesity cardiomyopathy.
JensenMDRyanDHApovianCM, et al.
2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.Circulation2014;
129:S102–138.
2.
BaskinMLArdJFranklinF, et al.
Prevalence of obesity in the United States.Obes Rev2005;
6:5–7.
3.
CavaleraMWangJFrangogiannisNG.Obesity, metabolic dysfunction, and cardiac fibrosis: pathophysiological pathways, molecular mechanisms, and therapeutic opportunities.Transl Res2014;
164:323–335.
4.
KishiSArmstrongACGiddingSS, et al.
Association of obesity in early adulthood and middle age with incipient left ventricular dysfunction and structural remodeling: the CARDIA study (Coronary Artery Risk Development in Young Adults).JACC Heart Fail2014;
2:500–508.
5.
ShahRVAbbasiSANeilanTG, et al.
Myocardial tissue remodeling in adolescent obesity.J Am Heart Assoc2013;
2:e000279.
6.
DahiyaRShultzSPDahiyaA, et al.
Relation of reduced preclinical left ventricular diastolic function and cardiac remodeling in overweight youth to insulin resistance and inflammation.Am J Cardiol2015;
115:1222–1228.
7.
IacobellisGLeonettiFSinghN, et al.
Relationship of epicardial adipose tissue with atrial dimensions and diastolic function in morbidly obese subjects.Int J Cardiol2007;
115:272–273.
8.
NgoDTGokceN.Epicardial adipose tissue: a benign consequence of obesity?Circ Cardiovasc Imaging2015;
8:003156.
9.
AshrafianHle RouxCWDarziA, et al.
Effects of bariatric surgery on cardiovascular function.Circulation2008;
118:2091–2102.
10.
Homsi R, Meier-Schroers M, Gieseke J, et al. 3D-Dixon MRI based volumetry of peri- and epicardial fat. Int J Cardiovasc Imaging 2016;32(2):291–299.
11.
LiuCYLiuYCWuC, et al.
Evaluation of age-related interstitial myocardial fibrosis with cardiac magnetic resonance contrast-enhanced T1 mapping: MESA (Multi-Ethnic Study of Atherosclerosis).J Am Coll Cardiol2013;
62:1280–1287.
12.
MessroghliDRRadjenovicAKozerkeS, et al.
Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart.Magn Reson Med2004;
52:141–146.
13.
Homsi R, Luetkens JA, Skowasch D, et al. Left Ventricular Myocardial Fibrosis, Atrophy, and Impaired Contractility in Patients With Pulmonary Arterial Hypertension and a Preserved Left Ventricular Function: A Cardiac Magnetic Resonance Study. J Thorac Imaging 2017;32:36–42.
14.
FlettASHaywardMPAshworthMT, et al.
Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans.Circulation2010;
122:138–144.
15.
HorKNGottliebsonWMCarsonC, et al.
Comparison of magnetic resonance feature tracking for strain calculation with harmonic phase imaging analysis.JACC Cardiovasc Imaging2010;
3:144–151.
16.
Homsi R, Sprinkart AM, Gieseke J, et al. 3D-Dixon cardiac magnetic resonance detects an increased epicardial fat volume in hypertensive men with myocardial infarction. Eur J Radiol 2016;85(5):936–942.
17.
Homsi R, Thomas D, Gieseke J, et al. Epicardial Fat Volume and Aortic Stiffness in Healthy Individuals: A Quantitative Cardiac Magnetic Resonance Study. Rofo 2016;188:853–858.
18.
HeibergESjogrenJUganderM, et al.
Design and validation of Segment–freely available software for cardiovascular image analysis. BMC Med Imaging2010;
10:1.
19.
EbongIAGoffDCJrRodriguezCJ, et al.
Mechanisms of heart failure in obesity.Obes Res Clin Pract2014;
8:e540–548.
20.
KarmazynMPurdhamDMRajapurohitamV, et al.
Signalling mechanisms underlying the metabolic and other effects of adipokines on the heart.Cardiovasc Res2008;
79:279–286.
AlpertMALavieCJAgrawalH, et al.
Obesity and heart failure: epidemiology, pathophysiology, clinical manifestations, and management.Transl Res2014;
164:345–356.
23.
DorbalaSCrugnaleSYangD, et al.
Effect of body mass index on left ventricular cavity size and ejection fraction.Am J Cardiol2006;
97:725–729.
24.
WestenbergJJ.CMR for assessment of diastolic function.Curr Cardiovasc Imaging Rep2011;
4:149–158.
25.
KenchaiahSGazianoJMVasanRS.Impact of obesity on the risk of heart failure and survival after the onset of heart failure.Med Clin North Am2004;
88:1273–1294.
26.
WongCYO’Moore-SullivanTLeanoR, et al.
Alterations of left ventricular myocardial characteristics associated with obesity.Circulation2004;
110:3081–3087.
27.
Di SalvoGPacileoGDel GiudiceEM, et al.
Abnormal myocardial deformation properties in obese, non-hypertensive children: an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study.Eur Heart J2006;
27:2689–2695.
28.
NymanKGranerMPentikainenMO, et al.
Cardiac steatosis and left ventricular function in men with metabolic syndrome.J Cardiovasc Magn Reson2013;
15:103.
29.
Di BelloVSantiniFDi CoriA, et al.
Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a color Doppler imaging study.Int J Obes (Lond)2006;
30:948–956.
30.
CrisostomoLLAraujoLMCamaraE, et al.
Comparison of left ventricular mass and function in obese versus nonobese women <40 years of age.Am J Cardiol1999;
84:1127–1129, A11.
31.
AlpertMALambertCRPanayiotouH, et al.
Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss.Am J Cardiol1995;
76:1194–1197.
32.
CrendalEDutheilFNaughtonG, et al.
Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males. BMC Cardiovasc Disord2014;
14:95.
33.
MarchingtonJMPondCM.Site-specific properties of pericardial and epicardial adipose tissue: the effects of insulin and high-fat feeding on lipogenesis and the incorporation of fatty acids in vitro.Int J Obes1990;
14:1013–1022.
34.
BiernackaAFrangogiannisNG.Aging and cardiac fibrosis.Aging Dis2011;
2:158–173.
35.
OuwensDMDiamantMFodorM, et al.
Cardiac contractile dysfunction in insulin-resistant rats fed a high-fat diet is associated with elevated CD36-mediated fatty acid uptake and esterification.Diabetologia2007;
50:1938–1948.
36.
GuzzardiMAIozzoP.Fatty heart, cardiac damage, and inflammation.The review of diabetic studies: RDS2011;
8:403–417.
37.
GoldbergIJTrentCMSchulzePC.Lipid metabolism and toxicity in the heart.Cell Metab2012;
15:805–812.
38.
PittBZannadF.The detection of myocardial fibrosis: an opportunity to reduce cardiovascular risk in patients with diabetes mellitus?Circ Cardiovasc Imaging2012;
5:9–11.
39.
GranerMSirenRNymanK, et al.
Cardiac steatosis associates with visceral obesity in nondiabetic obese men.J Clin Endocrinol Metab2013;
98:1189–1197.
SchafferJE.Lipotoxicity: when tissues overeat.Curr Opin Lipidol2003;
14:281–287.
42.
SzczepaniakLSDobbinsRLMetzgerGJ, et al.
Myocardial triglycerides and systolic function in humans: in vivo evaluation by localized proton spectroscopy and cardiac imaging.Magn Reson Med2003;
49:417–423.
43.
GargSNarulaJChandrashekharY.Apoptosis and heart failure: clinical relevance and therapeutic target.J Mol Cell Cardiol2005;
38:73–79.
44.
QuilliotDAllaFBohmeP, et al.
Myocardial collagen turnover in normotensive obese patients: relation to insulin resistance.Int J Obes (Lond)2005;
29:1321–1328.
45.
TurerATHillJAElmquistJK, et al.
Adipose tissue biology and cardiomyopathy: translational implications.Circ Res2012;
111:1565–1577.
46.
HorwichTBFonarowGC.Glucose, obesity, metabolic syndrome, and diabetes relevance to incidence of heart failure. J Am Coll Cardiol2010;
55:283–293.
47.
AshrafianHDarziAAthanasiouT.Bariatric surgery - can we afford to do it or deny doing it?Frontline Gastroenterol2011;
2:82–89.
