An observational study of the association among interatrial adiposity by computed tomography measure, insulin resistance, and left atrial electromechanical disturbances in heart failure.
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.
Department of Internal Medicine, Division of Cardiology, Mackay Memorial Hospital, Taipei Department of Medical Research Department of Medicine, Mackay Medical College, New Taipei City, Taiwan Mackay Junior College of Medicine, Nursing and Management, New Taipei City Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, OH Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan Noninvasive Cardiovascular Research, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA Department of Internal Medicine, Division of Gastroenterology, Mackay Memorial Hospital Department of Medical Research and Education, Taipei Veterans General Hospital, Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan Cardiovascular MRI and CT Program, Baptist Cardiac Vascular Institute, Miami, FL.
Chung-Lieh
CL
Hung
Chun-Ho
CH
Yun
Yau-Huei
YH
Lai
Kuo-Tzu
KT
Sung
Hiram G
HG
Bezerra
Jen-Yuan
JY
Kuo
Charles Jia-Yin
CJ
Hou
Tze-Fan
TF
Chao
Bernard E
BE
Bulwer
Hung-I
HI
Yeh
Shou-Chuan
SC
Shih
Shing-Jong
SJ
Lin
Ricardo C
RC
Cury
D000273:Adipose Tissue / Q000000981:diagnostic imaging; D050154:Adiposity / Q000502:physiology*; D016280:Atrial Function, Right / Q000502:physiology*; D004562:Electrocardiography; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed / Q000379:methods*