Myocardial Triglyceride Content and Epicardial Fat Mass in Human Obesity: Relationship to Left Ventricular Function and Serum Free Fatty Acid Levels

Kankaanpää, M.; Lehto, Hanna-Riikka; Pärkkä, Jussi P.; Komu, Markku; Viljanen, Antti; Ferrannini, Ele; Knuuti, Juhani; Nuutila, Pirjo; Parkkola, Riitta; Iozzo, Patricia

doi:10.1210/jc.2006-0584

Cited by 303 publications

(249 citation statements)

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“…Previous studies have suggested an association between pericardial fat and cardiac function. 31,32 Kankaanpaa et al 32 showed in a very limited population (n ¼ 9) that EF was inversely correlated with CI. By contrast, Iozzo et al showed that MTGC was independently and positively associated with cardiac output, LV forward work, cardiac work and CI, but not with pericardial fat.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29][30] MRI was recently used in mildly obese patients to suggest that the increase in MTGC could be associated with cardiac dysfunction. [31][32][33] To date, no study has addressed the relationship between EFV and MTGC in morbidly obese patients, a population with an abundance of fat in different depots and a high risk of cardiac failure, 34 because of the relatively small diameter of the MRI magnet bore. In this study, we had the opportunity to quantify EFV and MTGC in a cohort of severely obese subjects using a 70-cm bore, 3-T MRI system.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: relationship to metabolic profile, cardiac function and visceral fat

et al. 2011

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Objective: To assess epicardial fat volume (EFV), myocardial TG content (MTGC) and metabolic profile in severely obese patients, and to determine whether ectopic fat depots are linked to metabolic disorders or myocardial function. Research design and methods: Sixty-three subjects with normal LV function and no coronary artery disease, including 33 lean (BMI: 21.4 ± 2.0 kg m À2 ) and 30 obese (BMI: 41.8 ± 6 kg m À2 ) patients, underwent 3-T cardiovascular MRI, and anthropometric, biological and visceral abdominal fat (VAT) assessments. EFV was measured by short-axis slice imaging and myocardial (intra-myocellular) TG content was measured by proton magnetic resonance spectroscopy. Results: EFV and MTGC were positively correlated (r ¼ 0.52, Po0.0001), and were both strongly correlated with age, BMI, waist circumference and VAT, but not with severity of obesity. EFV and MTGC were significantly higher in obese patients than in lean controls (141±18 versus 79±7 ml, P ¼ 0.0001; 1.0±0.1 versus 0.6±0.1%, P ¼ 0.01, respectively), but some differences were found between the two cardiac depots: EFV was higher in diabetic obese subjects as compared with that in non-diabetic obese subjects (213±34 versus 141±18 ml, P ¼ 0.03), and was correlated with parameters of glucose tolerance (fasting plasma glucose, insulin and HOMA-IR), whereas MTGC was not. EFV and MTGC were both associated with parameters of lipid profile or inflammation (TGs, CRP). Remarkably, this was VAT-dependent, as only VAT remained independently associated with metabolic parameters (Po0.01). Concerning myocardial function, MTGC was the only parameter independently associated with stroke volume (b ¼ À0.38, P ¼ 0.01), suggesting an impact of cardiac steatosis in cardiac function. Conclusions: These data show that VAT dominates the relationship between EFV, MTGC and metabolic measures, and uncover specific partitioning of cardiac ectopic lipid deposition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: relationship to metabolic profile, cardiac function and visceral fat

et al. 2011

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“…Although a limit-based error analysis of the relaxation correction has been published [37], many studies report CV's based only on repeated acquisitions and do not include the uncertainty of the T 2 correction [5,8,9,12]. For species with comparatively long T 2 's, such as brain metabolites, the additional uncertainty is minor.…”

Section: Relaxationmentioning

confidence: 99%

“…Localized magnetic resonance spectroscopy (LMRS), which uses gradient-enabled imaging systems, is increasingly used both in basic and clinical assays including qualitative and quantitative compositional, temperature, and pH measurements [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Kreiss [16] summarized the main aspects of LMRS, including spectral artifacts, systematic errors, and general criteria for ensuring spectral quality.…”

Section: Introductionmentioning

confidence: 99%

Limits of a localized magnetic resonance spectroscopy assay for ex vivo myocardial triacylglycerol

O’Connor

Gropler

Peterson

et al. 2007

Journal of Pharmaceutical and Biomedical Analysis

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Localized magnetic resonance spectroscopy (LMRS) promises a powerful noninvasive means to determine myocardial triacylglycerol (TAG) in a clinical setting. Here, the linearity, specificity, robustness, precision, and accuracy, of an ex vivo mouse-heart LMRS TAG assay are assessed by quantifying the spatial, spectral, and relaxation induced uncertainties. The protocol, which is based on localization by adiabatic selective refocusing (LASER) using frequency offset corrected inversion pulses (FOCI), alternating gradient polarity, and simple post-processing, is shown to have good characteristics. The presented protocol has a benchmark, phantom-based, accuracy of 3%, and when applied to ex vivo mouse-hearts the accuracy is 6%, making the LMRS assay comparable to the typical destructive bioanalytical assay.

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“…A progressive increase in myocardial fat content has been observed in obese and type 2 diabetic patients [1], and has been shown to correlate with a decline in left ventricular function and signs of cardiomyopathy [2,3]. Increased myocardial triacylglycerol (TG) storage may reflect an imbalance between the supply and utilisation of fatty acids.…”

Section: Introductionmentioning

confidence: 99%

Independent effects of circulating glucose, insulin and NEFA on cardiac triacylglycerol accumulation and myocardial insulin resistance in a swine model

et al. 2014

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Aims/hypothesis Cardiac steatosis and myocardial insulin resistance elevate the risk of cardiac complications in obesity and diabetes. We aimed to disentangle the effects of circulating glucose, insulin and NEFA on myocardial triacylglycerol (TG) content and myocardial glucose uptake. Methods Twenty-two pigs were stratified according to four protocols: low NEFA+low insulin (nicotinic acid), high NEFA+low insulin (fasting) and high insulin+low NEFA± high glucose (hyperinsulinaemia-hyperglycaemia or hyperinsulinaemia-euglycaemia). Positron emission tomography, [U-13 C]palmitate enrichment techniques and tissue biopsies were used to assess myocardial metabolism. Heart rate and rate-pressure product (RPP) were monitored. Results Myocardial glucose extraction was increased by NEFA suppression and was similar in the hyperinsulinaemiahypergylcaemia, hyperinsulinaemia-euglycaemia and nicotinic acid groups. Hyperglycaemia enhanced myocardial glucose uptake due to a mass action. Myocardial TG content was greatest in the fasting group, whereas hyperinsulinaemia had a mild effect. Heart rate and RPP increased in hyperinsulinaemia-euglycaemia, in which cardiac glycogen content was reduced. Heart rate correlated with myocardial TG and glycogen content. Conclusions/interpretation Elevated NEFA levels represent a powerful, self-sufficient promoter of cardiac TG accumulation and are a downregulator of myocardial glucose uptake, indicating that the focus of treatment should be to 'normalise' adipose tissue function to lower the risk of cardiac TG accumulation and myocardial insulin resistance. The observation that hyperinsulinaemia and nicotinic acid led to myocardial fuel deprivation provides a potential explanation for the cardiovascular outcomes reported in recent intensive glucoselowering and NEFA-lowering clinical trials.

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Myocardial Triglyceride Content and Epicardial Fat Mass in Human Obesity: Relationship to Left Ventricular Function and Serum Free Fatty Acid Levels

Abstract: The accumulation of triglyceride in and around the myocardium of moderately obese individuals is significant, and it is related to FFA exposure, generalized ectopic fat excess, and peripheral vascular resistance. These changes precede LV overload and hypertrophy.

Cited by 303 publications

References 30 publications

Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: relationship to metabolic profile, cardiac function and visceral fat

Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: relationship to metabolic profile, cardiac function and visceral fat

Limits of a localized magnetic resonance spectroscopy assay for ex vivo myocardial triacylglycerol

Independent effects of circulating glucose, insulin and NEFA on cardiac triacylglycerol accumulation and myocardial insulin resistance in a swine model

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