Impact of body mass index and diabetes on myocardial fat content, interstitial fibrosis and function

Xin Dong, Mark Strudwick, William Ys Wang, Barry A. Borlaug, Rob J. van der Geest, Austin Cc Ng, Victoria Delgado, Jeroen J. Bax, Arnold Ct Ng

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: We hypothesize that both increased myocardial steatosis and interstitial fibrosis contributes to subclinical myocardial dysfunction in patients with increased body mass index and diabetes mellitus. Background: Increased body weight and diabetes mellitus are both individually associated with a higher incidence of heart failure with preserved ejection fraction. However, it is unclear how increased myocardial steatosis and interstitial fibrosis interact to influence myocardial composition and function. Methods: A total of 100 subjects (27 healthy lean volunteers, 21 healthy but overweight volunteers, and 52 asymptomatic overweight patients with diabetes) were prospectively recruited to measure left ventricular (LV) myocardial steatosis (LV-myoFat) and interstitial fibrosis (by extracellular volume [ECV]) using magnetic resonance imaging, and then used to determine their combined impact on LV global longitudinal strain (GLS) analysis by 2-dimensional (2D) speckle tracking echocardiography on the same day. Results: On multivariable analysis, both increased body mass index and diabetes were independently associated with increased LV-myoFat. In turn, increased LV-myoFat was independently associated with increased LV ECV. Both increased LV-myoFat and LV ECV were independently associated with impaired 2D LV GLS. Conclusion: Patients with increased body weight and patients with diabetes display excessive myocardial steatosis, which is related to a greater burden of myocardial interstitial fibrosis. LV myocardial contractile function was determined by both the extent of myocardial steatosis and interstitial fibrosis, and was independent of increasing age. Further study is warranted to determine how weight loss and improved diabetes management can improve myocardial composition and function.

Original languageEnglish (US)
Pages (from-to)379-390
Number of pages12
JournalInternational Journal of Cardiovascular Imaging
Volume39
Issue number2
DOIs
StatePublished - Feb 2023

Keywords

  • Diabetes
  • Obesity
  • Speckle tracking
  • Steatosis
  • T1 mapping

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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