Current Heart Failure Reports

, Volume 4, Issue 4, pp 221–228 | Cite as

Is there a cardiomyopathy of obesity?



Obesity is associated with structural and functional changes in the heart. These changes may be precursors to more overt forms of cardiac dysfunction and heart failure. However, it is not known 1) whether cardiac hypertrophy in obese individuals results directly from increased adioposity or from the effects of comorbid conditions such as hypertension, diabetes, and sleep-disordered breathing and 2) whether functional changes (eg, mild reductions in systolic and diastolic function) in obese patients progress over time to the point where they cause heart failure, unless ischemic heart disease develops. Establishing a clear link between obesity and heart failure is complicated by the fact that obesity must be present for many decades before the risk of heart failure increases substantially. At present, there are no longitudinal studies of changes in cardiac size and function in humans with obesity. This article reviews data showing structural and functional changes in the heart in obesity and the evidence that these are or are not progressive over time. At present, we believe it is uncertain whether there is a true “cardiomyopathy of obesity.”


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References and Recommended Reading

  1. 1.
    Alexander JK: The cardiomyopathy of obesity. Prog Cardiovasc Dis 1985, 27:325–334.PubMedCrossRefGoogle Scholar
  2. 2.
    Kenchaiah S, Evans JC, Levy D, et al.: Obesity and the risk of heart failure. N Engl J Med 2002, 347:305–313.PubMedCrossRefGoogle Scholar
  3. 3.
    de Simone G, Devereux RB, Roman MJ, et al.: Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension 1994, 23:600–606.PubMedGoogle Scholar
  4. 4.
    Avelar E, Cloward TV, Walker JM, et al.: Left ventricular hypertrophy in severe obesity: interactions among blood pressure, nocturnal hypoxemia, and body mass. Hypertension 2007, 49:34–39.PubMedCrossRefGoogle Scholar
  5. 5.
    Peterson LR, Waggoner AD, Schechtman KB, et al.: Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol 2004, 43:1399–1404.PubMedCrossRefGoogle Scholar
  6. 6.
    Wong CY, O’Moore-Sullivan T, Leano R, et al.: Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 2004, 110:3081–3087.PubMedCrossRefGoogle Scholar
  7. 7.
    Morricone L, Malavazos AE, Coman C, et al.: Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res 2002, 10:489–498.PubMedGoogle Scholar
  8. 8.
    Crisostomo LL, Araujo LM, Camara E, et al.: Comparison of left ventricular mass and function in obese versus nonobese women <40 years of age. Am J Cardiol 1999, 84:1127–1129.PubMedCrossRefGoogle Scholar
  9. 9.
    Grandi AM, Zanzi P, Piantanida E, et al.: Obesity and left ventricular diastolic function: noninvasive study in normotensives and newly diagnosed never-treated hypertensives. Int J Obes Relat Metab Disord 2000, 24:954–958.PubMedCrossRefGoogle Scholar
  10. 10.
    Mensah GA, Treiber FA, Kapuku GK, et al.: Patterns of body fat deposition in youth and their relation to left ventricular markers of adverse cardiovascular prognosis. Am J Cardiol 1999, 84:583–588.PubMedCrossRefGoogle Scholar
  11. 11.
    Berkalp B, Cesur V, Corapcioglu D, et al.: Obesity and left ventricular diastolic dysfunction. Int J Cardiol 1995, 52:23–26.PubMedCrossRefGoogle Scholar
  12. 12.
    Otto ME, Belohlavek M, Khandheria B, et al.: Comparison of right and left ventricular function in obese and nonobese men. Am J Cardiol 2004, 93:1569–1572.PubMedCrossRefGoogle Scholar
  13. 13.
    Wong CY, O’Moore-Sullivan T, Leano R, et al.: Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol 2006, 47:611–616.PubMedCrossRefGoogle Scholar
  14. 14.
    Iacobellis G, Ribaudo MC, Zappaterreno A, et al.: Adapted changes in left ventricular structure and function in severe uncomplicated obesity. Obes Res 2004, 12:1616–1621.PubMedGoogle Scholar
  15. 15.
    Krishnan R, Becker RJ, Beighley LM, et al.: Impact of body mass index on markers of left ventricular thickness and mass calculation: results of a pilot analysis. Echocardiography 2005, 22:203–210.PubMedCrossRefGoogle Scholar
  16. 16.
    Di Bello V, Santini F, Di Cori A, et al.: Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a color Doppler imaging study. Int J Obes (Lond) 2006, 30:948–956.CrossRefGoogle Scholar
  17. 17.
    Chinali M, de Simone G, Roman MJ, et al.: Impact of obesity on cardiac geometry and function in a population of adolescents: the Strong Heart Study. J Am Coll Cardiol 2006, 47:2267–2273.PubMedCrossRefGoogle Scholar
  18. 18.
    Alpert MA, Terry BE, Lambert CR, et al.: Factors influencing left ventricular systolic function in nonhypertensive morbidly obese patients, and effect of weight loss induced by gastroplasty. Am J Cardiol 1993, 71:733–737.PubMedCrossRefGoogle Scholar
  19. 19.
    Alpert MA, Lambert CR, Terry BE, et al.: Interrelationship of left ventricular mass, systolic function and diastolic filling in normotensive morbidly obese patients. Int J Obes Relat Metab Disord 1995, 19:550–557.PubMedGoogle Scholar
  20. 20.
    Kaltman AJ, Goldring RM: Role of circulatory congestion in the cardiorespiratory failure of obesity. Am J Med 1976, 60:645–653.PubMedCrossRefGoogle Scholar
  21. 21.
    Chinali M, Devereux RB, Howard BV, et al.: Comparison of cardiac structure and function in American Indians with and without the metabolic syndrome (the Strong Heart Study). Am J Cardiol 2004, 93:40–44.PubMedCrossRefGoogle Scholar
  22. 22.
    Kasper EK, Hruban RH, Baughman KL: Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure. Am J Cardiol 1992, 70:921–924.PubMedCrossRefGoogle Scholar
  23. 23.
    Lavie CJ, Messerli FH: Cardiovascular adaptation to obesity and hypertension. Chest 1986, 90:275–259.PubMedCrossRefGoogle Scholar
  24. 24.
    Quan SF, Gersh BJ: Cardiovascular consequences of sleep-disordered breathing: past, present and future: report of a workshop from the National Center on Sleep Disorders Research and the National Heart, Lung, and Blood Institute. Circulation 2004, 109:951–957.PubMedCrossRefGoogle Scholar
  25. 25.
    de Simone G: Morbid obesity and left ventricular geometry. Hypertension 2007, 49:7–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Niroumand M, Kuperstein R, Sasson Z, et al.: Impact of obstructive sleep apnea on left ventricular mass and diastolic function. Am J Respir Crit Care Med 2001, 163:1632–1636.PubMedGoogle Scholar
  27. 27.
    Noda A, Okada T, Yasuma F, et al.: Cardiac hypertrophy in obstructive sleep apnea syndrome. Chest 1995, 107:1538–1544.PubMedGoogle Scholar
  28. 28.
    Sukhija R, Aronow WS, Sandhu R, et al.: Prevalence of left ventricular hypertrophy in persons with and without obstructive sleep apnea. Cardiol Rev 2006, 14:170–172.PubMedCrossRefGoogle Scholar
  29. 29.
    Cloward TV, Walker JM, Farney RJ, et al.: Left ventricular hypertrophy is a common echocardiographic abnormality in severe obstructive sleep apnea and reverses with nasal continuous positive airway pressure. Chest 2003, 124:594–601.PubMedCrossRefGoogle Scholar
  30. 30.
    Alpert MA, Terry BE, Kelly DL: Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol 1985, 55:783–786.PubMedCrossRefGoogle Scholar
  31. 31.
    Alpert MA, Terry BE, Mulekar M, et al.: Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol 1997, 80:736–740.PubMedCrossRefGoogle Scholar
  32. 32.
    Wikstrand J, Pettersson P, Bjorntorp, P: Body fat distribution and left ventricular morphology and function in obese females. J Hypertens 1993, 11:1259–1266.PubMedCrossRefGoogle Scholar
  33. 33.
    Pascual M, Pascual DA, Soria F, et al.: Effects of isolated obesity on systolic and diastolic left ventricular function. Heart 2003, 89:1152–1156.PubMedCrossRefGoogle Scholar
  34. 34.
    Wang TJ, Parise H, Levy D, et al.: Obesity and the risk of new-onset atrial fibrillation. JAMA 2004, 292:2471–2477.PubMedCrossRefGoogle Scholar
  35. 35.
    Alpert MA, Lambert CR, Panayiotou H, et al.: Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol 1995, 76:1194–1197.PubMedCrossRefGoogle Scholar
  36. 36.
    Ferraro S, Perrone-Filardi P, Desiderio A, et al.: Left ventricular systolic and diastolic function in severe obesity: a radionuclide study. Cardiology 1996, 87:347–353.PubMedGoogle Scholar
  37. 37.
    Iacobellis G, Ribaudo MC, Leto G, et al.: Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes Res 2002, 10:767–773.PubMedCrossRefGoogle Scholar
  38. 38.
    de Simone G, Devereux RB, Koren MJ, et al.: Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension. Circulation 1996, 93:259–265.PubMedGoogle Scholar
  39. 39.
    Seto S, Kapuku GK, Kawahara F, et al.: Influence of mild to moderate obesity on left ventricular stress filling pattern in hypertension. Hypertens Res 1998, 21:245–250.PubMedGoogle Scholar
  40. 40.
    Dokainish H, Zoghbi WA, Lakkis NM, et al.: Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation 2004, 109:2432–2439.PubMedCrossRefGoogle Scholar
  41. 41.
    Das SR, Drazner MH, Dries DL, et al.: Impact of body mass and body composition on circulating levels of natriuretic peptides: results from the Dallas Heart Study. Circulation 2005, 112:2163–2168.PubMedCrossRefGoogle Scholar
  42. 42.
    Her C, Cerabona T, Bairamian M, et al.: Right ventricular systolic function is not depressed in morbid obesity. Obes Surg 2006, 16:1287–1293.PubMedCrossRefGoogle Scholar
  43. 43.
    Poirier P, Giles TD, Bray GA, et al.: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006, 113:898–918.PubMedCrossRefGoogle Scholar
  44. 44.
    Sjostrom L, Lindroos AK, Peltonen M, et al.: Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004, 351:2683–2693.PubMedCrossRefGoogle Scholar
  45. 45.
    Alpert MA, Lambert CR, Terry BE, et al.: Effect of weight loss on left ventricular diastolic filling in morbid obesity. Am J Cardiol 1995, 76:1198–1201.PubMedCrossRefGoogle Scholar
  46. 46.
    Karason K, Wallentin I, Larsson B, et al.: Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study. BMJ 1997, 315:912–916.PubMedGoogle Scholar
  47. 47.
    Owan TE, Morley K, et al.: Cardiovascular determinants of improved exercise capacity after marked weight loss from gastric bypass surgery [abstract]. J Am Coll Cardiol 2007, 49(Suppl A):413A.Google Scholar
  48. 48.
    Karason K, Lindroos AK, Stenlof K, et al.: Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects study. Arch Intern Med 2000, 160:1797–1802.PubMedCrossRefGoogle Scholar
  49. 49.
    Klein S, Fontana L, Young VL, et al.: Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004, 350:2549–2557.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Cardiology 4A100 SOMUniversity of UtahSalt Lake CityUSA

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