Regional Fat Distributions Are Associated With Subclinical Right Ventricular Dysfunction in Adults With Uncomplicated Obesity

Abstract

ObjectiveObesity is a prominent public health problem that has increased cardiovascular mortality risks. However, the specific effects of obesity, independent of comorbidities, on cardiac structure and function have not been well clarified, especially those effects on the right ventricle (RV). Cardiovascular magnetic resonance (CMR) tissue tracking can assess detailed RV mechanical features. This study aimed to evaluate RV strain using CMR in uncomplicated obese adults and assess its association with fat distributions.MethodsA total of 49 obese patients and 30 healthy controls were included. The RV global systolic function and strain parameters based on CMR were assessed. Body fat distributions were measured with dual X-ray absorptiometry. RV function indices of obese patients were compared with those of healthy controls. Correlations among related body fat distribution parameters and RV function indices were conducted with multivariable linear regression.ResultsCompared with healthy controls, the obese group had impaired RV strain with lower global longitudinal peak strain (PS), longitudinal peak systolic strain rate (PSSR), circumferential and longitudinal peak diastolic strain rates (PDSR) (all P < 0.05), while LV and RV ejection fractions were not significantly different between the two groups (P > 0.05). Multivariable linear regression analysis demonstrated that android fat% was independently associated with longitudinal PS (β = −0.468, model R2 = 0.219), longitudinal PDSR (β = −0.487, model R2 = 0.237), and circumferential PSSR (β = −0.293, model R2 = 0.086). Trunk fat% was independently associated with longitudinal PSSR (β = −0.457, model R2 = 0.209). In addition, the strongest correlations of circumferential PDSR were BMI and gynoid fat% (β = −0.278, β = 0.369, model R2 = 0.324).ConclusionsExtensive subclinical RV dysfunction is found in uncomplicated obese adults. BMI, as an index of overall obesity, is independently associated with subclinical RV dysfunction. In addition, central obesity (android fat and trunk fat distributions) has a negative effect on subclinical RV function, while peripheral obesity (gynoid fat distribution) may have a positive effect on it.Clinical Trials RegistrationEffect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).

Right ventricular-pulmonary arterial coupling impairment and exercise capacity in obese adults

“…Higher QI at maximum exercise in controls was associated with a further decrease in TAPSE/sPAP ratio. The changes in TAPSE/sPAP ratio with exercise were correlated to the android fat mass which confirms that central obesity has a negative effect on RV function (8).…”

“…Previous echocardiographic and magnetic resonance imaging studies have shown that obesity is associated with increased RV dimensions and hypertrophy, and depressed indices of systolic function (6)(7)(8). This was confirmed by an invasive study, which reported on a decreased RV/PA coupling assessed by gold standard Ees/Ea that was correlated to a decreased exercise capacity and decreased PA compliance (9).…”

“…Subjects with obesity display a higher RV mass and larger RV end-diastolic volumes as compared with normo-weighted controls (4,7). Recent studies also showed extensive subclinical RV dysfunction in uncomplicated obese adults, which was independently associated with BMI and central fat mass distribution (6,8).…”

The relationship between fat distribution in central region and comorbidities in obese people: Based on NHANES 2011–2018

“…We know that fat in obese people is often centrally accumulated, which is reflected in visceral fat, abdominal subcutaneous fat, hip fat and other regional fat. Previous studies have shown that the excessive distribution of Android fat and trunk fat may have a deleterious impact on subclinical right ventricular function, while the peripheral fat distribution may have a positive impact ( 13 ).…”

Epicardial adipose tissue thickness is related to early subclinical myocardial dysfunction, particularly in patients with type 2 diabetes mellitus: a case control study

“…In the clinical practice, longitudinal strain (deformation in the base-apex direction) is useful for evaluating left ventricle contractile function [2]. Some cardiometabolic conditions like type 2 Diabetes Mellitus (t2DM), insulin resistance or obesity may induce cardiac myofibrillary dysfunction [3][4][5].…”