title: Myocardial steatosis as a possible mechanistic link between diastolic dysfunction and coronary microvascular dysfunction in women.
abstract: Women with coronary microvascular dysfunction (CMD) and no obstructive coronary artery disease (CAD) have increased rates of heart failure with preserved ejection fraction (HFpEF). The mechanisms of HFpEF are not well understood. Ectopic fat deposition in the myocardium, termed myocardial steatosis, is frequently associated with diastolic dysfunction in other metabolic diseases. We investigated the prevalence of myocardial steatosis and diastolic dysfunction in women with CMD and subclinical HFpEF. In 13 women, including eight reference controls and five women with CMD and evidence of subclinical HFpEF (left ventricular end-diastolic pressure >12 mmHg), we measured myocardial triglyceride content (TG) and diastolic function, by proton magnetic resonance spectroscopy and magnetic resonance tissue tagging, respectively. When compared with reference controls, women with CMD had higher myocardial TG content (0.83 ± 0.12% vs. 0.43 ± 0.06%; P = 0.025) and lower diastolic circumferential strain rate (168 ± 12 vs. 217 ± 15%/s; P = 0.012), with myocardial TG content correlating inversely with diastolic circumferential strain rate (r = -0.779; P = 0.002). This study provides proof-of-concept that myocardial steatosis may play an important mechanistic role in the development of diastolic dysfunction in women with CMD and no obstructive CAD. Detailed longitudinal studies are warranted to explore specific treatment strategies targeting myocardial steatosis and its effect on diastolic function.
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California; janet.wei@cshs.org.
authors.forename: Janet
authors.initials: J
authors.lastname: Wei
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Nelson
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Szczepaniak
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Laura
authors.initials: L
authors.lastname: Smith
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California;
authors.forename: Puja K
authors.initials: PK
authors.lastname: Mehta
authors.affiliation: S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Louise E J
authors.initials: LE
authors.lastname: Thomson
authors.affiliation: S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Debiao
authors.initials: D
authors.lastname: Li
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California;
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Lidia S
authors.initials: LS
authors.lastname: Szczepaniak
mesh_terms: D000273:Adipose Tissue / Q000737:chemistry / Q000473:pathology; D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016022:Case-Control Studies; D003326:Coronary Circulation; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008833:Microcirculation; D008875:Middle Aged; D009206:Myocardium / Q000737:chemistry / Q000473:pathology; D015995:Prevalence; D066244:Proton Magnetic Resonance Spectroscopy; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D014280:Triglycerides / Q000032:analysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016277:Ventricular Function, Left
chemical_list: D014280:Triglycerides
keywords: coronary microvascular dysfunction; diastolic dysfunction; magnetic resonance spectroscopy; myocardial steatosis; women