Relation of regional fat distribution to left ventricular structure and function.
BACKGROUND
The relation of body fat distribution to left ventricular (LV) structure and function is poorly defined.


RESULTS
A total of 2710 participants without heart failure or LV dysfunction in the Dallas Heart Study underwent dual energy x-ray absorptiometry and MRI assessment of fat distribution, LV morphology, and hemodynamics. Cross-sectional associations of fat distribution with LV structure and function were examined after adjustment for age, sex, race, comorbidities, and lean mass. Mean age was 44 years with 55% women; 48% blacks; and 44% obese. After multivariable adjustment, visceral adipose tissue was associated with concentric remodeling characterized by lower LV end-diastolic volume (β=-0.21), higher concentricity (β=0.20), and wall thickness (β=0.09; P<0.0001 for all). In contrast, lower body subcutaneous fat was associated with higher LV end-diastolic volume (β=0.48), reduced concentricity (β=-0.50), and wall thickness (β=-0.28, P<0.0001 for all). Visceral adipose tissue was also associated with lower cardiac output (β=-0.10, P<0.05) and higher systemic vascular resistance (β=0.08, P<0.05), whereas lower body subcutaneous fat associated with higher cardiac output (β=0.20, P<0.0001) and lower systemic vascular resistance (β=-0.18, P<0.0001). Abdominal subcutaneous fat showed weaker associations with concentric remodeling and was not associated with hemodynamics. Among the subset of obese participants, visceral adipose tissue, but not abdominal subcutaneous fat, was significantly associated with concentric remodeling.


CONCLUSIONS
Visceral adipose tissue, a marker of central adiposity, was independently associated with concentric LV remodeling and adverse hemodynamics. In contrast, lower body subcutaneous fat was associated with eccentric remodeling. The impact of body fat distribution on heart failure risk requires prospective study.
Division of Cardiology, Department of Internal Medicine, Department of Clinical Sciences, and Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas; and Cardiovascular Research Institute, University of Pennsylvania, Philadelphia.
Ian J
IJ
Neeland
Sachin
S
Gupta
Colby R
CR
Ayers
Aslan T
AT
Turer
J Eduardo
JE
Rame
Sandeep R
SR
Das
Jarett D
JD
Berry
Amit
A
Khera
Darren K
DK
McGuire
Gloria L
GL
Vega
Scott M
SM
Grundy
James A
JA
de Lemos
Mark H
MH
Drazner
D015502:Absorptiometry, Photon; D050154:Adiposity; D000328:Adult; D002302:Cardiac Output; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013781:Texas; D014655:Vascular Resistance; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
body fat distribution; concentric remodeling; hypertrophy, left ventricular; intra-abdominal fat; obesity