Visceral adiposity and left ventricular remodeling: The Multi-Ethnic Study of Atherosclerosis

Abstract

Background and Aims Visceral fat (VF) is a source of pro-inflammatory adipokines implicated in cardiac remodeling. We sought to determine the impact of visceral fat (VF) and subcutaneous fat (SQ) depots on left ventricular (LV) structure, function, and geometry in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods and Results We performed a post-hoc analysis on 1,151 participants from MESA with cardiac magnetic resonance quantification of LV mass and LV mass-to-volume ratio (LVMV, an index of concentricity) and computed tomographic-derived SQ and VF area. Multivariable regression models to estimate association between height-indexed SQ and VF area (per cm2/m) with height-indexed LV mass (per height2.7) and LVMV were constructed, adjusted for clinical, biochemical, and demographic covariates. We found that both VF and SQ area were associated with height-indexed LV mass (ρ =0.36 and 0.12, P<0.0001, respectively), while only VF area was associated with LVMV (ρ =0.28, P<0.0001). Individuals with above-median VF had lower LV ejection fraction, greater indexed LV volumes and mass, and higher LVMV (all P < 0.001). In multivariable models adjusted for weight, VF (but not SQ) area was associated with LV concentricity and LV mass index, across both sexes. Conclusion Visceral adiposity is independently associated with LV concentricity, a precursor to heart failure. Further study into the role of VF in LV remodeling as a potential therapeutic target is warranted.

Factors Associated With Left Atrial Remodeling in the General Population

“…More importantly, assessment of regional fat distribution demonstrated that visceral adiposity was robustly associated with LA enlargement, with no association seen for subcutaneous or lower body fat mass. This finding extends prior studies linking visceral adiposity with adverse left ventricular remodeling 27, 28 , and adverse cardiovascular events 29 . It is possible that associations between visceral adiposity and atrial fibrillation may be reflective of systemic lipotoxicity, mediated via ectopic fat deposition in the peri-atrial epicardium or pericardium, resulting in local lipotoxic effects and subsequent atrial remodeling and enlargement 6, 30, 31 .…”

Ideal Cardiovascular Health, Cardiovascular Remodeling, and Heart Failure in Blacks

“…In the African-American community, hypertension is highly prevalent and an established risk factor for LV hypertrophy and ensuing HF development 32, 33 . We add to the current literature by identifying obesity and insulin resistance as correlates of unfavorable LV phenotypes and possible targets for personalized HF prevention in African-Americans in keeping with a prior report by Shah 5 and from others 34, 35 .…”

Visceral Adiposity Index and Lipid Accumulation Product Index: Two Alternate Body Indices to Identify Chronic Kidney Disease among the Rural Population in Northeast China

“…The visceral adiposity index (VAI) was found to increase cardiovascular risks in hypertension [18], left ventricular hypertrophy [19], diabetes [20], and CKD [21], and can even be associated with inflammation [22]. The lipid accumulation product index (LAPI) based on a combination of WC and the fasting concentration of circulating TG has been shown to predict the incident of diabetes [23] and the increased risk of CVD [24] and influenced all-cause mortality [24,25].…”