Skip to main content
SpringerLink
Log in

Intra-thoracic adiposity is associated with impaired contractile function in patients with coronary artery disease: a cardiovascular magnetic resonance imaging study

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The influence of visceral adiposity on left ventricular remodeling following coronary artery disease (CAD)-related events has not been examined to date. Using magnetic resonance imaging (MRI) we explored intra-thoracic fat volume (ITFV) and strain-based markers of adverse remodeling in patients with CAD. Forty-seven patients with known CAD (25 with prior MI, 22 without prior MI) were studied. ITFV was quantified using previously validated imaging techniques. Myocardial strain was derived from cine MRI using a validated 3D feature-tracking (FT) software. Segmental LGE quantification was performed and was used to incrementally constrain strain analyses to non-infarcted (i.e. remote) segments. Remote myocardial strain was compared to the non-MI control cohort and was explored for associations with ITFV. Mean age was 57 ± 13 years with a mean BMI of 30.0 ± 6.2 kg/m2 (range 20.3–38.4 kg/m2). Patients with versus without prior MI had similar demographics and BMI (29.4 ± 4.4 vs. 30.4 ± 7.9 kg/m2, p = 0.62). Patients with prior MI had lower mean peak strain than non-MI patients (p = 0.02), consistent with remote tissue contractile dysfunction. Inverse associations were identified between ITFV and mean peak strain in both the MI group (circumferential: r = 0.43, p = 0.03; radial: − 0.41, p = 0.04; minimum principal: r = 0.41, p = 0.04; maximum principal: r = − 0.43, p = 0.03) and non-MI group (circumferential: r = 0.42, p = 0.05; minimum principal: r = 0.45, p = 0.03). In those with prior MI higher ITFV was associated with a greater reduction in remote tissue strain. ITFV is associated with contractile dysfunction in patients with CAD. This association is prominent in the post-MI setting suggesting relevant influence on remote tissue health following ischemic injury. Expanded study of intra-thoracic adiposity as a modulator of myocardial health in patients with CAD is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

BSA:

Body surface area

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

CMR:

Cardiac magnetic resonance

HDL:

High density lipoproteins

ICC:

Intra-class correlation

ITFV:

Intra-thoracic fat volume

GFR:

Glomerular filtration rate

LDL:

Low density lipoproteins

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVEDV:

Left ventricular end-diastolic volume

LVEDVI:

Left ventricular end-diastolic volume index

LVEF:

Left ventricular ejection fraction

LVM:

Left ventricular mass

LVMI:

Left ventricular mass index

LVESVI:

Left ventricular end-systolic volume index

MI:

Myocardial infarction

MRI:

Magnetic resonance imaging

PCI:

Percutaneous coronary intervention

References

  1. Hubert HB, Feinleib M, McNamara PM, Castelli WP (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67:968–977

    Article  CAS  PubMed  Google Scholar 

  2. Mokdad AH, Ford ES, Bowman BA et al (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76–79

    Article  PubMed  Google Scholar 

  3. Coutinho T, Goel K, Corrêa de Sá D et al (2011) Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol 57:1877–1886. https://doi.org/10.1016/j.jacc.2010.11.058

    Article  PubMed  Google Scholar 

  4. Okorodudu DO, Jumean MF, Montori VM et al (2010) Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis. Int J Obes 34:791–799. https://doi.org/10.1038/ijo.2010.5

    Article  CAS  Google Scholar 

  5. Flint AJ, Rimm EB (2006) Commentary: Obesity and cardiovascular disease risk among the young and old–is BMI the wrong benchmark? Int J Epidemiol 35:187–189. https://doi.org/10.1093/ije/dyi298

    Article  PubMed  Google Scholar 

  6. Lau DCW, Dhillon B, Yan H et al (2005) Adipokines: molecular links between obesity and atheroslcerosis. Am J Physiol Heart Circ Physiol 288:H2031–H2041. https://doi.org/10.1152/ajpheart.01058.2004

    Article  CAS  PubMed  Google Scholar 

  7. Chen O, Sharma A, Ahmad I et al (2015) Correlation between pericardial, mediastinal, and intrathoracic fat volumes with the presence and severity of coronary artery disease, metabolic syndrome, and cardiac risk factors. Eur Heart J Cardiovasc Imaging 16:37–46. https://doi.org/10.1093/ehjci/jeu145

    Article  PubMed  Google Scholar 

  8. Patil HR, Patil NT, King SI et al (2014) Increased intrathoracic and hepatic visceral adipose tissue independently correlates with coronary artery calcification in asymptomatic patients. J Nucl Cardiol 21:880–889. https://doi.org/10.1007/s12350-014-9946-9

    Article  PubMed  Google Scholar 

  9. Jolly US, Soliman A, McKenzie C et al (2013) Intra-thoracic fat volume is associated with myocardial infarction in patients with metabolic syndrome. J Cardiovasc Magn Reson 15:77. https://doi.org/10.1186/1532-429X-15-77

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fox CS, Gona P, Hoffmann U et al (2009) Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham Heart Study. Circulation 119:1586–1591. https://doi.org/10.1161/CIRCULATIONAHA.108.828970

    Article  PubMed  PubMed Central  Google Scholar 

  11. Alpert MA (2001) Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 321:225–236

    Article  CAS  Google Scholar 

  12. Abel ED (2011) Obesity stresses cardiac mitochondria even when you are young. J Am Coll Cardiol 57:586–589. https://doi.org/10.1016/j.jacc.2010.09.039

    Article  CAS  PubMed  Google Scholar 

  13. Ku CS, Lin SL, Wang DJ et al (1994) Left ventricular filling in young normotensive obese adults. Am J Cardiol 73:613–615

    Article  CAS  PubMed  Google Scholar 

  14. Alexander JK, Dennis EW, Smith WG et al Blood volume, cardiac output, and distribution of systemic blood flow in extreme obesity. Cardiovasc Res Cent Bull 1:39–44

  15. Ng ACT, Goo SY, Roche N et al (2016) Epicardial adipose tissue volume and left ventricular myocardial function using 3-dimensional speckle tracking echocardiography. Can J Cardiol 32:1485–1492. https://doi.org/10.1016/j.cjca.2016.06.009

    Article  PubMed  Google Scholar 

  16. Center for Drug Evaluation and Research Drug Safety and Availability - FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction

  17. Kim RJ, Shah DJ, Judd RM (2003) How we perform delayed enhancement imaging. J Cardiovasc Magn Reson 5:505–514

    Article  PubMed  Google Scholar 

  18. Satriano A, Heydari B, Narous M et al (2015) 4-Dimensional left ventricular strain analysis by cardiovascular magnetic resonance imaging: validation versus 4D speckle tracking echocardiography. Can J Cardiol 31:S70–S71. https://doi.org/10.1016/j.cjca.2015.07.162

    Article  Google Scholar 

  19. Satriano A, Rivolo S, Martufi G et al (2015) In vivo strain assessment of the abdominal aortic aneurysm. J Biomech 48:354–360. https://doi.org/10.1016/j.jbiomech.2014.11.016

    Article  PubMed  Google Scholar 

  20. Satriano A, Heydari B, Narous M et al (2017) Clinical feasibility and validation of 3D principal strain analysis from cine MRI: comparison to 2D strain by MRI and 3D speckle tracking echocardiography. Int J Cardiovasc Imaging 33:1979–1992. https://doi.org/10.1007/s10554-017-1199-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mikami Y, Kolman L, Joncas SX et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85. https://doi.org/10.1186/s12968-014-0085-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mahabadi AA, Massaro JM, Rosito GA et al (2009) Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J 30:850–856. https://doi.org/10.1093/eurheartj/ehn573

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ding J, Hsu F-C, Harris TB et al (2009) The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 90:499–504. https://doi.org/10.3945/ajcn.2008.27358

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sharma AM (2002) Adipose tissue: a mediator of cardiovascular risk. Int J Obes Relat Metab Disord 26(Suppl 4):S5-S7. https://doi.org/10.1038/sj.ijo.0802210

    Article  CAS  Google Scholar 

  25. Peterson LR, Herrero P, Schechtman KB et al (2004) Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women. Circulation 109:2191–2196. https://doi.org/10.1161/01.CIR.0000127959.28627.F8

    Article  PubMed  Google Scholar 

  26. Szczepaniak LS, Victor RG, Orci L, Unger RH (2007) Forgotten but not gone: the rediscovery of fatty heart, the most common unrecognized disease in America. Circ Res 101:759–767. https://doi.org/10.1161/CIRCRESAHA.107.160457

    Article  CAS  Google Scholar 

  27. Goralski KB, Sinal CJ (2007) Type 2 diabetes and cardiovascular disease: getting to the fat of the matter. Can J Physiol Pharmacol 85:113–132. https://doi.org/10.1139/y06-092

    Article  CAS  PubMed  Google Scholar 

  28. Buchanan J, Mazumder PK, Hu P et al (2005) Reduced cardiac efficiency and altered substrate metabolism precedes the onset of hyperglycemia and contractile dysfunction in two mouse models of insulin resistance and obesity. Endocrinology 146:5341–5349. https://doi.org/10.1210/en.2005-0938

    Article  CAS  PubMed  Google Scholar 

  29. Sutton MGSJ, Sharpe N (2000) Left ventricular remodeling after myocardial infarction: pathophysiology and therapy. Circulation 101:2981–2988. https://doi.org/10.1161/01.CIR.101.25.2981

    Article  CAS  PubMed  Google Scholar 

  30. Mitchell GF, Lamas GA, Pfeffer MA (1993) Ventricular remodeling after myocardial infarction. Adv Exp Med Biol 346:265–276

    Article  CAS  PubMed  Google Scholar 

  31. Hombach V, Merkle N, Bernhard P et al (2010) Prognostic significance of cardiac magnetic resonance imaging: update 2010. Cardiol J 17:549–557

    PubMed  Google Scholar 

  32. Kramer SP, Powell DK, Haggerty CM et al (2013) Obesity reduces left ventricular strains, torsion, and synchrony in mouse models: a cine displacement encoding with stimulated echoes (DENSE) cardiovascular magnetic resonance study. 15:109

  33. Carrick D, Haig C, Rauhalammi S et al (2015) Pathophysiology of LV remodeling in survivors of STEMI. JACC Cardiovasc Imaging 8:779–789. https://doi.org/10.1016/j.jcmg.2015.03.007

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Dr. White received salary support from the Heart and Stroke Foundation of Alberta during this study, receives research grant support from the Circle Cardiovascular Inc. and is a shareholder of Cohesic Inc. Dr. Howarth receives consulting fees from Amgen. Dr. Matthias G. Friedrich is Chief Medical Officer of Circle Cardiovascular Inc. Dr. Fine receives consulting fees from Novartis and Pfizer.

Funding

This study was funded by Heart and Stroke Foundation of Alberta.

Author information

Author notes

  1. Anna Todd and Alessandro Satriano contributed equally to this study.

Authors and Affiliations

  1. Stephenson Cardiac Imaging Centre, Suite 0700 Foothills Medical Centre – 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

    Anna Todd, Alessandro Satriano, Kate Fenwick, Andrew G. Howarth & James A. White

  2. Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada

    Anna Todd, Alessandro Satriano, Andrew G. Howarth, Todd J. Anderson, Nowell M. Fine & James A. White

  3. Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada

    Naeem Merchant & Carmen P. Lydell

  4. McGill University Health Centre, Montreal, QC, Canada

    Matthias G. Friedrich

Authors
  1. Anna Todd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Satriano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kate Fenwick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naeem Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carmen P. Lydell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew G. Howarth
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matthias G. Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Todd J. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nowell M. Fine
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. James A. White
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James A. White.

Ethics declarations

Conflict of interest

Dr. Anna Todd has no conflict of interest. Dr. Alessandro Satriano declares that he has no conflict of interest. Ms. Kate Fenwick declares that she has no conflict of interest. Dr. Naeem Merchant declares that he has no conflict of interest. Dr. Carmen P. Lydell declares that she has no conflict of interest. Dr. Andrew G. Howarth receives consulting fees from Amgen. Dr. Matthias G. Friedrich is Chief Medical Officer of Circle Cardiovascular Inc. Dr. Todd J. Anderson declares that he has no conflict of interest. Dr. Nowell M. Fine receives consulting fees from Novartis and Pfizer. Dr. James A. White received salary support from the Heart and Stroke Foundation during this study, received research grants from Circle Cardiovascular Inc., and is a shareholder of Cohesic Inc.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involved in human or animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 46 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Todd, A., Satriano, A., Fenwick, K. et al. Intra-thoracic adiposity is associated with impaired contractile function in patients with coronary artery disease: a cardiovascular magnetic resonance imaging study. Int J Cardiovasc Imaging 35, 121–131 (2019). https://doi.org/10.1007/s10554-018-1430-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1430-1

Keywords

Search

Navigation