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

Abstract

Introduction: This study aims to assess the changes in cardiovascular remodeling attributable to bodyweight gain in a middle-aged abdominal obesity cohort. A remodeling worsening might explain the increase in cardiovascular risk associated with a dynamic of weight gain.Methods: Seventy-five middle-aged subjects (56 ± 5 years, 38 women) with abdominal obesity and no known cardiovascular disease underwent MRI-based examinations at baseline and at a 6.1 ± 1.2-year follow-up to monitor cardiovascular remodeling and hemodynamic variables, most notably the effective arterial elastance (Ea). Ea is a proxy of the arterial load that must be overcome during left ventricular (LV) ejection, with increased EA resulting in concentric LV remodeling.Results: Sixteen obese subjects had significant weight gain (>7%) during follow-up (WG+), whereas the 59 other individuals did not (WG–). WG+ and WG– exhibited significant differences in the baseline to follow-up evolutions of several hemodynamic parameters, notably diastolic and mean blood pressures (for mean blood pressure, WG+: +9.3 ± 10.9 mmHg vs. WG–: +1.7 ± 11.8 mmHg, p = 0.022), heart rate (WG+: +0.6 ± 9.4 min−1 vs. −8.9 ± 11.5 min−1, p = 0.003), LV concentric remodeling index (WG: +0.08 ± 0.16 g.mL−1 vs. WG−: −0.02 ± 0.13 g.mL−1, p = 0.018) and Ea (WG+: +0.20 ± 0.28 mL mmHg−1 vs. WG−: +0.01 ± 0.30 mL mmHg−1, p = 0.021). The evolution of the LV concentric remodeling index and Ea were also strongly correlated in the overall obese population (p < 0.001, R2 = 0.31).Conclusions: A weight gain dynamic is accompanied by increases in arterial load and load-related concentric LV remodeling in an isolated abdominal obesity cohort. This remodeling could have a significant impact on cardiovascular risk.

Relationship Between Left Ventricular Ejection Fraction Variation and Systemic Vascular Resistance: A Prospective Cardiovascular Magnetic Resonance Study

“…(1) The "Role of the Renin-Angiotensin Aldosterone System in the Mechanisms of Transition to Heart Failure in Abdominal Obesity (R2C2-II)" cohort has already been described elsewhere (12,14,15). The cohort included middle-aged subjects (40-65 years) with abdominal obesity, no cardiovascular medication and no cardiovascular disease except for stage 1 hypertension.…”

“…CMRs were performed on a 3-T or 1.5-T magnet (GE Medical Systems, Milwaukee, WI, USA) (12)(13)(14)(15). An automated sphygmomanometer (Maglife C, Schiller Medical, Wissembourg, France) was used to measure brachial blood pressure (BP) during the CMR examinations.…”

“…A steady-state free precession pulse sequence and dedicated software (MASS TM , Medis, The Netherlands) were used to measure LV end-diastolic volume, end-diastolic mass, and EF in contiguous short-axis. The concentric remodeling (CR) index was defined as LV mass/end-diastolic volume ratio (12)(13)(14)(15).…”

“…Cardiac output was determined using a velocity-encoded phase-contrast gradient-echo sequence on a slice positioned perpendicularly to the ascending aorta (12)(13)(14)(15). Stroke volume (SV) was determined with the "CV flow" software (Medis, The Netherlands), with velocities corrected using an ROI-based method in instances of obvious offset errors.…”

“…Values of cardiac output and stroke volume were used to estimate systemic vascular resistance (SVR: mean pressure/cardiac output) (12)(13)(14)(15)(16)(17)(18)(19), effective arterial elastance [Ea = 0.9 × systolic BP (mmHg)/stroke volume (mL)] (12,(15)(16)(17)(18)(19), and total arterial compliance index [TAC = stroke volume (mmHg)/pulse pressure (mmHg)] (12, 14-17). All these CMRderived parameters were indexed to body surface area, except for EF and CR.…”