Obesity Surgery

, Volume 19, Issue 9, pp 1324–1332 | Cite as

Relationship Between Adiponectin and Left Atrium Size in Uncomplicated Obese Patients: Adiponectin, a Link Between Fat and Heart

  • Juan YbarraEmail author
  • Eugenia Resmini
  • Francesc Planas
  • Francesc Navarro-López
  • Susan Webb
  • Jose Maria Pou
  • Alicia Santos
  • Carlos Ballesta-López
Clinical Research



It is well known that obesity is a risk factor for severe cardiovascular complications, such as coronary heart disease, heart failure, stroke, venous thromboembolic disease, and atrial fibrillation. Left ventricle (LV) and left atrium (LA) enlargement is a characteristic feature of these patients with the consequent cardiovascular risk. Factors other than hemodynamic may influence LA remodeling. The aim of the study is to evaluate the relationship between adiponectin and LA size in uncomplicated obese patients.


Seventy-four asymptomatic obese patients and an age- and sex-matched control group (N = 70) were recruited. A detailed clinical, echocardiographic, and analytical study was performed. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR) method. Insulin sensitivity was assessed measuring serum total adiponectin concentrations.


Adiponectin levels were lower in the obese group (P < 0.001) and particularly so in those obese participants with enlarged LA (32%; P < 0.0005). LA sizes were higher in the obese group (P < 0.0005). Adiponectin displayed significant correlations with body mass index, glucose, insulin, high-density lipoprotein cholesterol, and triglyceride concentrations as well as HOMA-IR (P < 0.001 for all). Adiponectin displayed significant correlations with LV mass and LA size, diastolic and systolic cardiac volumes and diameters, and cardiac output (P < 0.001 for all). Adiponectin correlations with LA size (r = −0.429; P < 0.001) persisted after adjustment for HOMA-IR, age, sex, and LV mass.


A novel inverse relationship between adiponectin and LA size independent of age, sex, insulin resistance, and LV mass appears in our series. Adiponectin could be a link between adipose tissue and the heart, having an influence on cardiac remodeling.


Morbid obesity Adiponectin Left atrium size 


Conflicts of interest

None to be disclosed.


  1. 1.
    Mokdad AH, Bowman BA, Ford ES, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195–200.CrossRefGoogle Scholar
  2. 2.
    Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364:937–52.CrossRefGoogle Scholar
  3. 3.
    National Institutes of Health Consensus Development Conference. Health implications of obesity. Ann Intern Med. 1985;103:977.Google Scholar
  4. 4.
    Hubert HB, Feinleib M, McNamara PM, et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67:968–77.CrossRefGoogle Scholar
  5. 5.
    Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.CrossRefGoogle Scholar
  6. 6.
    Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrium fibrillation. JAMA. 2004;292:2471–7.CrossRefGoogle Scholar
  7. 7.
    Murphy NF, MacIntyre K, Stewart S, et al. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15.000 middle-aged men and women (the Renfrew–Paisley study). Eur Heart J. 2006;27:96–106.CrossRefGoogle Scholar
  8. 8.
    Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–25.CrossRefGoogle Scholar
  9. 9.
    Pascual DA, Soria F, Vicente T, et al. Effects of isolated obesity on systolic and diastolic left ventricle function. Heart. 2003;89:1152–6.CrossRefGoogle Scholar
  10. 10.
    Scaglione R, Dichiara MA, Indovina A, et al. Left ventricle diastolic and systolic function in normotensive obese subjects: influence of degree and duration of obesity. Eur Heart J. 1992;13:738–42.CrossRefGoogle Scholar
  11. 11.
    Bayes-Genis A, Vazquez R, Puig T, et al. Left atrium enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure. Eur J Heart Fail. 2007;9:802–7.CrossRefGoogle Scholar
  12. 12.
    Zarich SW, Kowalchuk GJ, McGuire MP, et al. Left ventricle filling abnormalities in asymptomatic morbid obesity. Am J Cardiol. 1991;68:377–81.CrossRefGoogle Scholar
  13. 13.
    Chakko S. Obesity and ventricle function in man: diastolic dysfunction. In: Alpeert MAAJ, editor. Obesity. New York: Armonk; 1998. p. 57–76.Google Scholar
  14. 14.
    Zile MR, Baicu CF, Gaasch WH, et al. Diastolic heart failure—abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350:1953–9.CrossRefGoogle Scholar
  15. 15.
    Mont L, Tamborero D, Elosua R, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace. 2008;10:15–20.CrossRefGoogle Scholar
  16. 16.
    Tsang TS, Barnes ME, Miyasaka Y, et al. Obesity as a risk factor for the progression of paroxysmal to permanent atrium fibrillation: a longitudinal cohort study of 21 years. Eur Heart J. 2008;29:2227–33.CrossRefGoogle Scholar
  17. 17.
    Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology. 2003;144:2195–200.CrossRefGoogle Scholar
  18. 18.
    Scherer PE, Williams S, Fogliano M, et al. A novel serum protein similar to C1q, produced exclusively in adipocytes. J Biol Chem. 1995;270:26746–9.CrossRefGoogle Scholar
  19. 19.
    Yoda-Murakami M, Taniguchi M, Takahashi K, et al. Change in expression of GBP28/adiponectin in carbon tetrachloride administrated mouse liver. Biochem Biophys Res Commun. 2001;285:372–7.CrossRefGoogle Scholar
  20. 20.
    Delaigle AM, Jonas JC, Bauche IB, et al. Induction of adiponectin in skeletal muscle by inflammatory cytokines: in vivo and in vitro studies. Endocrinology. 2004;145:5589–97.CrossRefGoogle Scholar
  21. 21.
    Piñeiro R, Iglesias MJ, Gallego R, et al. Adiponectin is synthesized and secreted by human and murine cardiomyocytes. FEBS Lett. 2005;579:5163–9.CrossRefGoogle Scholar
  22. 22.
    Gualillo O, González-Juanatey JR, Lago F. The emerging role of adipokines as mediators of cardiovascular function: physiologic and clinical perspectives. Trends Cardiovasc Med. 2007;17:275–83.CrossRefGoogle Scholar
  23. 23.
    Hermann TS, Li W, Domínguez H, et al. Quinapril treatment increases insulin-stimulated endothelial function and adiponectin gene expression in patients with type 2 diabetes. J Clin Endocrinol Metab. 2006;91:1001–8.CrossRefGoogle Scholar
  24. 24.
    Bora PS, Kaliappan S, Lyzogubov VV, et al. Expression of adiponectin in choroidal tissue and inhibition of laser induced choroidal neovascularization by adiponectin. FEBS Lett. 2007;581:1977–82.CrossRefGoogle Scholar
  25. 25.
    Izumiya Y, Sato K, Papanicolaou K, et al. Adiponectin protects against the development of systolic dysfunction following myocardial infarction. J Mol Cell Cardiol. 2007;42:1065–74.CrossRefGoogle Scholar
  26. 26.
    Ding G, Qin Q, He N, et al. Adiponectin and its receptors are expressed in adult ventricle cardiomyocytes and upregulated by activation of peroxisome proliferator-activated receptor gamma. J Mol Cell Cardiol. 2007;43:73–84.CrossRefGoogle Scholar
  27. 27.
    Shimano M, Shibata R, Tsuji Y, et al. Circulating adiponectin levels in patients with atrial fibrillation. Circ J. 2008;72:1120–4.CrossRefGoogle Scholar
  28. 28.
    Mancia G, de Backer G, Dominiczak A, et al. Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87.CrossRefGoogle Scholar
  29. 29.
    Teichholz LE, Kreulen TH, Herman MV, et al. Problems in echocardiographic volume determinations: echocardiographic–angiographic correlation in the presence of absence of asynergy. Am J Cardiol. 1976;37:7–11.CrossRefGoogle Scholar
  30. 30.
    Devereux RB, Reiche N. Echocardiographic determination of left ventricular mass in man. Anatomic evaluation of the method. Circulation. 1987;59:956–60.Google Scholar
  31. 31.
    Levy D, Savage DD, Garrison RJ, et al. Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol. 1987;59:956–60.CrossRefGoogle Scholar
  32. 32.
    Quinones MA, Otto CM, Stoddard M, et al. Recommendations for quantification of Doppler echocardiography. A report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15:167–84.CrossRefGoogle Scholar
  33. 33.
    Alam M, Wardell J, Anderson E, et al. Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects. J Am Soc Echocardiogr. 1999;12:618–28.CrossRefGoogle Scholar
  34. 34.
    Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788–94.CrossRefGoogle Scholar
  35. 35.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28:412–9.CrossRefGoogle Scholar
  36. 36.
    Steffes MW, Gross MD, Lee DH, et al. Adiponectin, visceral fat, oxidative stress, and early macrovascular disease: the Coronary Artery Risk Development in Young Adults Study. Obesity. 2006;14:319–26.CrossRefGoogle Scholar
  37. 37.
    Herrera MF, Oseguera J, Gamino R, et al. Cardiac abnormalities associated with morbid obesity. World J Surg. 1998;22:993–7.CrossRefGoogle Scholar
  38. 38.
    Arita Y, Kihara S, Ouchi N, et al. Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun. 1999;257:79–83.CrossRefGoogle Scholar
  39. 39.
    Iwashima Y, Katsuya T, Ishikawa K, et al. Hypoadiponectinemia is an independent risk factor for hypertension. Hypertension. 2004;43:1318–23.CrossRefGoogle Scholar
  40. 40.
    Kolovou GD, Kostakou PM, Anagnostopoulou KK, et al. Therapeutic effects of fibrates in postprandial lipemia. Am J Cardiovasc Drugs. 2008;8:243–55.CrossRefGoogle Scholar
  41. 41.
    Tinahones FJ, Murri-Pierri M, Garrido-Sánchez L, et al. Oxidative stress in severely obese persons is greater in those with insulin resistance. Obesity (Silver Spring). 2009;17:240–6.CrossRefGoogle Scholar
  42. 42.
    Ybarra J, Pou J, Planas F, et al. Correlation between insulin resistance surrogates and echocardiographic findings in asymptomatic patients with morbid obesity: a cross-sectional study. Endocr Pract. 2007;13:590–600.CrossRefGoogle Scholar
  43. 43.
    Bonora E, Targher G, Alberich M, et al. Homeostasis model assessment mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies on subjects with various degrees of glucose intolerance and insulin sensitivity. Diabetes Care. 2000;23:57–63.CrossRefGoogle Scholar
  44. 44.
    Scherer PE. Adipose tissue: from lipid storage compartment to endocrine organ. Diabetes. 2006;55:1537–45.CrossRefGoogle Scholar
  45. 45.
    Silha JV, Krsek M, Skrha JV, et al. Plasma resistin, adiponectin and leptin levels in lean and obese subjects: correlations with insulin resistance. Eur J Endocrinol. 2003;149:331–5.CrossRefGoogle Scholar
  46. 46.
    Patel JV, Abraheem A, Dotsenko O, et al. Circulating serum adiponectin levels in patients with coronary artery disease: relationship to atherosclerotic burden and cardiac function. J Intern Med. 2008;264:593–8.CrossRefGoogle Scholar
  47. 47.
    Cavusoglu E, Chopra V, Battala V, et al. Baseline plasma adiponectin levels as a predictor of left ventricle systolic dysfunction in patients referred for coronary angiography. Am J Cardiol. 2008;101:1073–8.CrossRefGoogle Scholar
  48. 48.
    Takano H, Obata JE, Kodama Y, et al. Adiponectin is released from the heart in patients with heart failure. Int J Cardiol. 2009;132:221–6.CrossRefGoogle Scholar
  49. 49.
    Aristizabal D, Gallo J, Fernández R, et al. The insulin gradient phenomenon: a manifestation of the effects of body weight on blood pressure and insulin resistance. J Cardiometab Syndr. 2008;3:218–23.CrossRefGoogle Scholar
  50. 50.
    Ebinç H, Ebinç FA, Ozkurt ZN, et al. Impact of adiponectin on left ventricle mass index in non-complicated obese subjects. Endocr J. 2008;55:523–8.CrossRefGoogle Scholar
  51. 51.
    Lau DCW, Dhillon B, Yan H, et al. Adipokines: molecular links between obesity and atherosclerosis. Am J Physiol Heart Circ Physiol. 2005;288:2031–41.CrossRefGoogle Scholar
  52. 52.
    Fontana L, Eagon JC, Trujillo ME, et al. Visceral fat adipokine secretion is associated with systemic inflammation in obese subjects. Diabetes. 2007;56:1010–13.CrossRefGoogle Scholar
  53. 53.
    Lago F, Diéguez C, Gómez-Reino J, et al. The emerging role of adipokines as mediators of inflammation and immune responses. Cytokine Growth Factor Rev. 2007;18:313–25.CrossRefGoogle Scholar
  54. 54.
    Lazar MA. How obesity causes diabetes: not a at all tale. Science. 2005;307:373–5.CrossRefGoogle Scholar
  55. 55.
    Zhou YT, Grayburn P, Karim A, et al. Lipotoxic heart disease in obese rats implication for human obesity. Proc Natl Acad Sci U S A. 2000;97:1784–9.CrossRefGoogle Scholar
  56. 56.
    Leichman JG, Aguilar D, King TM, et al. Association of plasma free fatty acids and left ventricular diastolic function in patients with clinically severe obesity. Am J Clin Nutr. 2006;84:336–41.CrossRefGoogle Scholar
  57. 57.
    Di Bello V, Santini F, Di Cori A, et al. Obesity cardiomyopathy: is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr. 2006;19:1063–71.CrossRefGoogle Scholar
  58. 58.
    Galderisi M. Diastolic dysfunction and diabetic cardiomyopathy: evaluation by Doppler echocardiography. J Am Coll Cardiol. 2006;48:1548–51.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Juan Ybarra
    • 1
    • 2
    • 3
    • 4
    Email author
  • Eugenia Resmini
    • 2
    • 3
    • 4
  • Francesc Planas
    • 1
  • Francesc Navarro-López
    • 1
  • Susan Webb
    • 2
    • 3
    • 4
  • Jose Maria Pou
    • 2
    • 3
  • Alicia Santos
    • 4
  • Carlos Ballesta-López
    • 5
  1. 1.Instituto de Cardiología y Medicina Avanzada (ICAMED)Centro Médico TeknonBarcelonaSpain
  2. 2.Endocrinology DepartmentAutonomous University of BarcelonaBarcelonaSpain
  3. 3.Medicine DepartmentAutonomous University of BarcelonaBarcelonaSpain
  4. 4.Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant PauAutonomous University of BarcelonaBarcelonaSpain
  5. 5.Centro Laparoscópico Barcelona (CLB)Centro Médico TeknonBarcelonaSpain

Personalised recommendations