Dynamic Relation of Changes in Weight and Indices of Fat Distribution With Cardiac Structure and Function: The Dallas Heart Study

Abstract

BackgroundObesity may increase heart failure risk through cardiac remodeling. Cross‐sectional associations between adiposity and cardiac structure and function have been elucidated, but the impact of longitudinal changes in adiposity on cardiac remodeling is less well understood.Methods and ResultsParticipants in the Dallas Heart Study without cardiovascular disease or left ventricular dysfunction underwent assessment of body weight, anthropometrics, and cardiac magnetic resonance imaging at baseline and 7 years later. Associations between changes in indices of generalized and central adiposity with changes in left ventricular mass, volume, mass/volume ratio (concentricity), wall thickness, and ejection fraction were assessed using multivariable linear regression. The study cohort (n=1262) mean age was 44 years with 57% women, 44% black, and 36% obese participants. At follow‐up, 41% had ≥5% weight gain, and 15% had ≥5% weight loss. Greater weight gain was associated with younger age, lower risk factor burden, and lower body mass index at baseline. In multivariable models adjusting for age, sex, race, comorbid conditions at baseline and follow‐up, baseline adiposity, and cardiac measurement, increasing weight was associated with increases in left ventricular mass (β=0.10, P<0.0001), wall thickness (β=0.10, P<0.0001), and concentricity (β=0.06, P=0.002), with modest effects on end‐diastolic volume (β=0.04, P=0.044) and ejection fraction (β=0.05, P=0.046). Similar results were seen with other adiposity indices.ConclusionsConcentric left ventricular remodeling is the predominant phenotype linked to increasing adiposity in middle age. Our findings support the importance of weight management to prevent secular changes in adiposity, concentric remodeling, and eventual heart failure over time.

Relationship between left ventricular preload and N-terminal pro-brain natriuretic peptide in obese patients

“…The finding about left ventricular wall thickness in obese patients was consistent with previous reports [23,24]. The significant decrease of log (CS-AO) NT-proBNP in overweight patients compared with normal patients may be due to lower left ventricular end-diastolic wall stress, because the left ventricular end-diastolic dimension was not different between these two groups and LVPW was significantly thicker in overweight patients compared with normal patients.…”

Cardiac remodeling and higher sensitivity to ischemia–reperfusion injury in female rats submitted to high-fat high-sucrose diet: An in vivo/ex vivo longitudinal follow-up

“…Indeed, HFS rats did not display weight gain but MRI and dissection highlighted an abdominal obesity with significant increase of fat mass percentage (of both VAT and SCAT). Multiple human studies have shown that waist circumference, an indicator of abdominal obesity, is more representative of total body fat than BMI [33]. Interestingly, the amount of VAT was correlated with changes in plasma FFAs and hepatic TG content.…”

Arterial and Cardiac Remodeling Associated With Extra Weight Gain in an Isolated Abdominal Obesity Cohort

“…As already detailed elsewhere (17), isolated abdominal obesity subjects were prospectively recruited through an advertising campaign and ultimately included subjects ranging from 40 to 65 years of age, with obvious abdominal obesity defined by a waist circumference >102 cm for men and >88 cm for women (18), and excluding any of the following: (1) morbid obesity [i.e., body mass index (BMI) > 40 Kg.m −2 ], (2) a history of any cardiovascular disease or of any medical treatment with cardiovascular effects, (3) a history of medically-treated hypertension or diabetes, (4) inflammatory disease, (5) renal, hepatic or pulmonary insufficiency, (6) an MRI contraindication, (7) absence of cardiac sinus rhythm and ( 8) any women of childbearing potential. An additional control group of non-obese healthy volunteers with a similar sex ratio and age range (40-65 years), had also been prospectively recruited through an unrelated concurrent advertising campaign (17).…”

“…A weight gain dynamic was also found to be associated with the onset or exacerbation of a phenotype involving concentric left ventricular (LV) remodeling, with an increase in LV mass relative to the LV cavity size, in large cohorts of obese as well as non-obese subjects (6,7). The specific prognostic impact of this concentric remodeling, as well as its associations with concomitant obesityrelated arterial remodeling and increasing blood pressure (BP), need to be specifically determined in obese subjects.…”