Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study

Abstract

Background Low cardiorespiratory fitness (CRF), high body mass index, and excess visceral adiposity are each associated with impairment in left ventricular (LV) peak circumferential strain (Ecc), an intermediate phenotype that precedes the development of clinical heart failure (HF). However, the association of regional fat distribution and CRF with Ecc independent of each other and other potential confounders is not known. Methods Participants from the Dallas Heart Study Phase 2 who underwent dual energy X-ray absorptiometry assessment of regional fat distribution, CRF assessment by submaximal treadmill test, and Ecc quantification by tissue-tagged cardiovascular magnetic resonance were included in the analysis. The cross-sectional associations of measures of regional adiposity, namely visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and lower-body fat (LBF) with Ecc after adjustment for CRF and other potential confounders (independent variables) were assessed using multivariable linear regression analysis. Results The study included 1089 participants (55% female, 39% black). In the unadjusted analysis, higher VAT was associated with greater impairment in Ecc. After adjustment for baseline risk factors, CRF, parameters of LV structure and function, and other fat depots such as SAT and LBF, higher VAT remained associated with greater impairment in Ecc (β: 0.19, P = 0.002). SAT and LBF were not significantly associated with Ecc, however, CRF remained associated with Ecc in the fully adjusted model including all fat depots (β: − 0.15, P < 0.001). Conclusions VAT and CRF are each independently associated with impairment in Ecc, suggesting that higher VAT burden and low CRF mediate pathological cardiac remodeling through distinct mechanisms.

The effect of hyperlipidemia and body fat distribution on subclinical left ventricular function in obesity: a cardiovascular magnetic resonance study

“…Our result demonstrated that central fat distribution (visceral and android fat) had a negative association, while peripheral fat distribution (gynoid fat) had a positive association on LV function. Prior study have also revealed that VAT is independently associated with impairment of LV strain, while lower-body fat is not associated with it [ 17 ].…”

“…Dual X-ray absorptiometry (DXA) is widely used for assess body fat distribution. Several studies have reported the associations of LV remodeling or peak circumferential strain with DXA-derived fat distribution parameters, such as total body fat, lean mass, lower body fat, and visceral or subcutaneous fat [ 15 – 17 ]. A recent study revealed the different effects of central and peripheral fat distributions on right ventricular function [ 18 ].…”

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“…A high-throughput cell-free test was developed as an HDL function surrogate based on lipid peroxidation of HDL, and it was reported to be consistent with CV events risk [ 12 ]. The Dallas Heart Study [ 13 ] and other studies with big groups of people evaluated CEC as a measure of HDL function using cell techniques, such as fluorescent reagents (e.g., bodipy—boron dipyrromethene difluoride) and radioactively labeled cholesterol. The highest quartile indicated a 67% decrease in cardiovascular risk compared with the lowest quartile of CEC.…”

Elucidating the primary mechanisms of high-intensity interval training for improved cardiac fitness in obesity

“…EAT is anatomically and functionally continuous with the myocardium, whereas PAT is located between the visceral and parietal pericardium ( Rafeh et al, 2020 ; Despres et al, 2021 ). The accumulation of excess VAT and PAT plays independent and crucial roles in the pathophysiology of cardiac structural and functional changes ( Kenchaiah et al, 2021 ; Kim et al, 2021 ; Kondamudi et al, 2021 ; Sorimachi et al, 2021 ).…”