Limits...
An observational study of the association among interatrial adiposity by computed tomography measure, insulin resistance, and left atrial electromechanical disturbances in heart failure

View Article: PubMed Central - PubMed

ABSTRACT

Excessive visceral adiposity, hypothesized to be a key mediator in metabolic derangements, has recently been shown to exert toxic effects on cardiac structure and function. Data regarding the mechanistic link between regional adiposity, left atrial (LA) electromechanical remodeling, and heart failure with preserved ejection fraction (HFpEF) have been lacking.

Various visceral adiposity measures, including pericardial fat (PCF), thoracic periaortic (TAT) fat, regional inter-atrial fat (IAF), and atrioventricular groove fat (AV Groove Fat), were assessed by multidetector computed tomography in 2 study cohorts (an annual health survey cohort and an outpatient cohort). We related such measures to cardiometabolic profiles in health survey cohort and LA electromechanical indices in our outpatient cohort, with Cox proportional hazards performed to examine the temporal trends of heart failure (HF).

In our annual health survey cohort (n = 362), all 4 adiposity measures were positively related to unfavorable anthropometrics and systemic inflammation (high-sensitivity C-reactive protein) (all P < 0.05). In addition, both greater IAF and AV Groove Fat were positively associated with higher fasting glucose, HbA1c levels, and insulin resistance (all P < 0.05). In the outpatient cohort, the HFpEF group demonstrated the greatest adiposity measures, with greater IAF (≥8.2 mm, hazard ratio: 4.11, 95% confidence interval: 1.50–11.32) associated with reduced LA strain (ß-coef: –0.28), higher LA stiffness (ß-coef: 0.23), and longer P wave duration (ß-coef: 0.23) in multivariate models (all P < 0.05), and further related to higher HF hospitalization during follow-up.

We therefore propose a possible pathophysiologic link among greater visceral adiposity, systemic inflammation, cardiometabolic risks, and HFpEF. Regional adiposity, especially IAF, was tightly linked to altered LA electromechanical properties and likely plays a key role in HF prognosis.

No MeSH data available.


Related in: MedlinePlus

Comparisons of various adiposity measures among different metabolic score (MS) groups. Higher MSs were associated with a greater amount of various visceral adiposities accumulation, which is significantly larger in subjects with diagnosed metabolic syndrome compared with those with a smaller MS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998482&req=5

Figure 2: Comparisons of various adiposity measures among different metabolic score (MS) groups. Higher MSs were associated with a greater amount of various visceral adiposities accumulation, which is significantly larger in subjects with diagnosed metabolic syndrome compared with those with a smaller MS.

Mentions: The study participants from the cardiovascular outpatient clinic in the phase 2 study (from January 2010 to July 2011) are reported in Table 1. Compared with healthy and comorbidity groups, subjects in the HFpEF group tended to be older with a higher female percentage, had greater BMI, and higher blood pressure (Table 1, all P < 0.05). Subjects in the comorbidity and HFpEF groups also had higher fasting glucose levels, whereas the HFpEF group presented with much worse renal function in terms of lower eGFR, together with higher metabolic scores (all P < 0.05). There was a trend toward higher hs-CRP and brain natriuretic peptide levels in both the comorbidity and HFpEF groups (both P < 0.05). We also observed that there was a graded increase in body fat composition, PCF, AV Groove Fat, and IAF across healthy, comorbidity, and HFpEF groups (all ANOVA P < 0.05), and subjects with higher metabolic scores consistently showed greater visceral adiposity (Fig. 2, all P < 0.05). An age-, sex-, and BMI-matched study subgroup from the same cohort (total n = 162: n = 27, n = 95, and n = 40 in healthy, co-morbidity, and HFpEF groups, respectively) showed similar increase of visceral adiposity across the 3 groups, with AV Groove Fat and IAF differing substantially between comorbidity and HFpEF groups (Supplemental Material, Table 4). Finally, a greater proportion of hypertension, diabetes mellitus, cardiovascular diseases, and medication use for hyperlipidemia was observed in both the comorbidity and HFpEF groups (all P < 0.05).


An observational study of the association among interatrial adiposity by computed tomography measure, insulin resistance, and left atrial electromechanical disturbances in heart failure
Comparisons of various adiposity measures among different metabolic score (MS) groups. Higher MSs were associated with a greater amount of various visceral adiposities accumulation, which is significantly larger in subjects with diagnosed metabolic syndrome compared with those with a smaller MS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998482&req=5

Figure 2: Comparisons of various adiposity measures among different metabolic score (MS) groups. Higher MSs were associated with a greater amount of various visceral adiposities accumulation, which is significantly larger in subjects with diagnosed metabolic syndrome compared with those with a smaller MS.
Mentions: The study participants from the cardiovascular outpatient clinic in the phase 2 study (from January 2010 to July 2011) are reported in Table 1. Compared with healthy and comorbidity groups, subjects in the HFpEF group tended to be older with a higher female percentage, had greater BMI, and higher blood pressure (Table 1, all P < 0.05). Subjects in the comorbidity and HFpEF groups also had higher fasting glucose levels, whereas the HFpEF group presented with much worse renal function in terms of lower eGFR, together with higher metabolic scores (all P < 0.05). There was a trend toward higher hs-CRP and brain natriuretic peptide levels in both the comorbidity and HFpEF groups (both P < 0.05). We also observed that there was a graded increase in body fat composition, PCF, AV Groove Fat, and IAF across healthy, comorbidity, and HFpEF groups (all ANOVA P < 0.05), and subjects with higher metabolic scores consistently showed greater visceral adiposity (Fig. 2, all P < 0.05). An age-, sex-, and BMI-matched study subgroup from the same cohort (total n = 162: n = 27, n = 95, and n = 40 in healthy, co-morbidity, and HFpEF groups, respectively) showed similar increase of visceral adiposity across the 3 groups, with AV Groove Fat and IAF differing substantially between comorbidity and HFpEF groups (Supplemental Material, Table 4). Finally, a greater proportion of hypertension, diabetes mellitus, cardiovascular diseases, and medication use for hyperlipidemia was observed in both the comorbidity and HFpEF groups (all P < 0.05).

View Article: PubMed Central - PubMed

ABSTRACT

Excessive visceral adiposity, hypothesized to be a key mediator in metabolic derangements, has recently been shown to exert toxic effects on cardiac structure and function. Data regarding the mechanistic link between regional adiposity, left atrial (LA) electromechanical remodeling, and heart failure with preserved ejection fraction (HFpEF) have been lacking.

Various visceral adiposity measures, including pericardial fat (PCF), thoracic periaortic (TAT) fat, regional inter-atrial fat (IAF), and atrioventricular groove fat (AV Groove Fat), were assessed by multidetector computed tomography in 2 study cohorts (an annual health survey cohort and an outpatient cohort). We related such measures to cardiometabolic profiles in health survey cohort and LA electromechanical indices in our outpatient cohort, with Cox proportional hazards performed to examine the temporal trends of heart failure (HF).

In our annual health survey cohort (n = 362), all 4 adiposity measures were positively related to unfavorable anthropometrics and systemic inflammation (high-sensitivity C-reactive protein) (all P&#8202;&lt;&#8202;0.05). In addition, both greater IAF and AV Groove Fat were positively associated with higher fasting glucose, HbA1c levels, and insulin resistance (all P&#8202;&lt;&#8202;0.05). In the outpatient cohort, the HFpEF group demonstrated the greatest adiposity measures, with greater IAF (&ge;8.2&#8202;mm, hazard ratio: 4.11, 95% confidence interval: 1.50&ndash;11.32) associated with reduced LA strain (&szlig;-coef: &ndash;0.28), higher LA stiffness (&szlig;-coef: 0.23), and longer P wave duration (&szlig;-coef: 0.23) in multivariate models (all P&#8202;&lt;&#8202;0.05), and further related to higher HF hospitalization during follow-up.

We therefore propose a possible pathophysiologic link among greater visceral adiposity, systemic inflammation, cardiometabolic risks, and HFpEF. Regional adiposity, especially IAF, was tightly linked to altered LA electromechanical properties and likely plays a key role in HF prognosis.

No MeSH data available.


Related in: MedlinePlus