Left Ventricular Function Impairment in Patients With Normal-Weight Obesity

Abstract

Background-Obesity predisposes to left ventricular (LV) dysfunction and heart failure; however, the risk of these complications has not been assessed in patients with a normal body mass index (BMI) but increased body fat content (normal-weight obesity, NWO). We hypothesized that LV performance in NWO may be impaired and sought to investigate potential contributors to cardiac functional abnormalities. Methods and Results-One hundred sixty-eight subjects (age, 38Ϯ7 years) with BMI Ͻ25kg/m 2 and no history of any disease affecting the myocardium were classified on the basis of body fat content into 2 groups: with NWO and without NWO. Echocardiographic indices of LV systolic and diastolic function, including myocardial velocities and deformation, serological fibrosis markers, indicators of proinflammatory activation, and metabolic control, were evaluated. Subjects with NWO demonstrated impaired LV systolic and diastolic function, increased fibrosis intensity (assessed by procollagen type I carboxy-terminal propeptide [PICP]), impaired insulin sensitivity, and increased proinflammatory activation as compared with individuals with normal body fat. The independent correlates of LV systolic and diastolic function variables were as follows: for strain, PϽ0.006

Perioperative management of the severely obese patient: a selective pathophysiological review

“…Body mass index may be misleading in patients with significant muscle bulk. It is also critical to understand that patients can have elevated body fat content despite a normal BMI, so-called ''normal weight obesity'', and this too can have an impact on organ function, 3 with the risk of metabolic abnormalities and hypertension increasing as the percent of body fat (%BF) increases. 4 Obesity impacts virtually all organ systems and is an independent risk factor for both morbidity 5 and mortality.…”

Rationale of the FIBROTARGETS study designed to identify novel biomarkers of myocardial fibrosis

“…One of the many challenges is that fibrosis is a mechanism involved in a number of overlapping and/or coexisting risk and disease states and co‐morbidities48, 49 such as hypertension, chronic kidney disease, diabetes mellitus, obesity, atrial fibrillation, ischaemic heart disease, and prevalent HF, such that a number of circulating biomarkers can be present in these various conditions 26, 46, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61. Our hypothesis is that novel ‘mechanistic’ markers of cardiac fibrosis are differentially expressed in various risk and disease states and co‐morbidities.…”

Impact of Comorbidities on Myocardial Remodeling and Dysfunction In Heart Failure with Preserved Ejection Fraction

“…In subjects with normal BMI, abdominal fat distribution was associated with impaired systolic and diastolic function, increased myocardial fibrosis markers, impaired insulin sensitivity and proinflammatory activation [148]. Excess visceral fat and IR, but not general adiposity, were independently associated with incident prediabetes and DMII in obese adults [108,148]. Moreover, in mesenteric arteries of morbidly obese individuals, endothelial dysfunction was only observed in the presence of IR, which related to augmented mitochondrial superoxide production and increased systemic inflammation mediated by TNF-α [149].…”

“…Abdominal rather than subcutaneous, fat releases pro-inflammatory cytokines and adipokines, causing low-grade systemic inflammation, increased circulating endothelial adhesion molecules and endothelial dysfunction [147]. In subjects with normal BMI, abdominal fat distribution was associated with impaired systolic and diastolic function, increased myocardial fibrosis markers, impaired insulin sensitivity and proinflammatory activation [148]. Excess visceral fat and IR, but not general adiposity, were independently associated with incident prediabetes and DMII in obese adults [108,148].…”