Original Research
Myocardial Tissue-Level Characteristics of Adults With Metabolically Healthy Obesity

https://doi.org/10.1016/j.jcmg.2023.01.022Get rights and content

Abstract

Background

It remains unclear whether adults with metabolically healthy obesity (MHO) have altered myocardial tissue-level characteristics.

Objectives

This study aims to assess the subclinical myocardial tissue-level characteristics of adults with MHO.

Methods

The EARLY-MYO-OBESITY (EARLY Assessment of MYOcardial Tissue Characteristics in OBESITY; NCT05277779) registry was a prospective, 3-center, cardiac imaging study of obese nondiabetic individuals without cardiac symptoms who underwent cardiac magnetic resonance. Myocardial tissue-level characteristics, including extracellular volume fraction (ECV) and native T2 values, were measured as indicators of myocardial fibrosis and edema. Global longitudinal peak systolic strain and early diastolic longitudinal strain rate were assessed by tissue tracking analysis to detect subclinical systolic and diastolic dysfunction.

Results

A total of 120 participants were included: MHO (n = 32; mean age, 38 years; 41% men), metabolically healthy controls without obesity (n = 32; mean age: 37 years; 41% men), and metabolically unhealthy obesity (MUHO) (n = 56; mean age: 37 years; 55% men). The MHO group had higher ECV and native T2 values than healthy controls (both P < 0.001); furthermore, the ECV was higher in the MUHO group than in the MHO group (P = 0.002). The prevalence of myocardial fibrosis was 44% (14 of 32) in the MHO group and 71% (40 of 56) in the MUHO group. Although there was no intergroup difference in left ventricular ejection fraction, the MHO group had reduced global longitudinal peak systolic and early diastolic longitudinal strain rates, indicating subclinical systolic and diastolic dysfunction. Multivariate regression analysis identified increased body mass index to be an independent risk factor for myocardial fibrosis (OR: 6.28 [95% CI: 3.17-12.47]; P < 0.001).

Conclusions

This study provides the first evidence of subclinical myocardial tissue-level remodeling in adults with obesity, regardless of metabolic health. Early identification of cardiac impairment may facilitate preventive strategies against heart failure in the MHO population. (EARLY Assessment of MYOcardial Tissue Characteristics in OBESITY [EARLY-MYO-OBESITY]; NCT05277779)

Section snippets

Study population

The EARLY-MYO-OBESITY (EARLY Assessment of MYOcardial Tissue Characteristics in OBESITY; NCT05277779) registry was a prospective, 3-center, cardiac imaging study that enrolled nondiabetic obese participants without cardiovascular disease. The study was approved by an institutional review committee at each participating center and was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent. A complete list of the inclusion and exclusion

Participant characteristics

Between January 2020 and May 2021, 121 nondiabetic individuals with obesity were enrolled in the EARLY-MYO-OBESITY registry. A total of 94 study participants were selected based on the eligibility criteria. After the exclusion of participants who refused CMR because of claustrophobia (n = 2) and those with inadequate CMR image quality (n = 4), a total of 88 nondiabetic individuals with obesity (mean age: 38 ± 11 years, 50% men) were included (Figure 1). There were 32 participants (36%) in the

Discussion

This study had 3 main findings. First, individuals with MHO had subclinical alterations in the myocardial tissue matrix, which was characterized by an increased ECV and native T2 value, indicating myocardial fibrosis and inflammatory edema. Second, myocardial tissue-level remodeling was correlated with subclinical LV systolic and diastolic dysfunction. Third, in nondiabetic individuals, increased BMI was independently associated with alteration of myocardial tissue characterization (Central

Conclusions

To the best of our knowledge, this is the first study to describe alteration of myocardial tissue characteristics in MHO. Our findings provide tissue-level evidence that MHO is not a benign condition, and suggest that myocardial fibrosis and inflammation are underlying mechanisms for the subclinical cardiac dysfunction observed in individuals with MHO. Our study provides insights into obesity-associated cardiac dysfunction and offers a rationale for aggressive strategies to prevent progression

Funding Support and Author Disclosures

This study received funding support from National Natural Science Foundation of China (U21A20341, 81971570, 81930007, 82202159, 31900821), Science and Technology Commission of Shanghai Municipality (21XD1432100, 22JC1402100, 22DZ2292400, 20Y11910500, 2022ZZ01008, 201409005200), Shanghai Hospital Development Center (SHDC2020CR2025B, SHDC12022102), Shanghai Municipal Health Commission (2022JC013, SHSLCZDZK06204), Shanghai Pudong New Area Health Commission (PW2019D-11), Shanghai Jiao Tong

Acknowledgments

The authors are indebted to the generous dedication to the EARLY-MYO-OBESITY registry by all coinvestigators as well as the support from Innovative Research Team of High-level Local Universities in Shanghai.

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    The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

    Drs Zhao and Huang are joint first authors.

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