Impact of obesity and epicardial fat on early left atrial dysfunction assessed by cardiac MRI strain analysis
Tóm tắt
Diastolic dysfunction is a major cause of morbidity in obese individuals. We aimed to assess the ability of magnetic resonance imaging (MRI) derived left atrial (LA) strain to detect early diastolic dysfunction in individuals with obesity and type 2 diabetes, and to explore the association between cardiac adipose tissue and LA function. Twenty patients with obesity and T2D (55 ± 8 years) and nineteen healthy controls (48 ± 13 years) were imaged using cine steady state free precession and 2-point Dixon cardiovascular magnetic resonance. LA function was quantified using a feature tracking technique with definition of phasic longitudinal strain and strain rates, as well as radial motion fraction and radial velocities. Systolic left ventricular size and function were similar between the obesity and type 2 diabetes and control groups by MRI. All patients except four had normal diastolic assessment by echocardiography. In contrast, measures of LA function using magnetic resonance feature tracking were uniformly altered in the obesity and type 2 diabetes group only. Although there was no significant difference in intra-myocardial fat fraction, Dixon 3D epicardial fat volume(EFV) was significantly elevated in the obesity and type 2 diabetes versus control group (135 ± 31 vs. 90 ± 30 mL/m2, p < 0.001). There were significant correlations between LA functional indices and both BMI and EFV (p ≤ 0.007). LA MRI-strain may be a sensitive tool for the detection of early diastolic dysfunction in individuals with obesity and type 2 diabetes and correlated with BMI and epicardial fat supporting a possible association between adiposity and LA strain.
Trials Registration Australian New Zealand Clinical Trials Registry No. ACTRN12613001069741
Tài liệu tham khảo
Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function: epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol. 2004;43:317–27.
Gillebert TC, De Buyzere ML. HFpEF, diastolic suction, and exercise. JACC Cardiovasc Imaging. 2012;5:871–3.
Pirozzi F, Paglia A, Sasso L, Abete P, Carlomagno A, Tocchetti CG, Bonaduce D, Petretta M. Mitral peak early diastolic filling velocity to deceleration time ratio as a predictor of prognosis in patients with chronic heart failure and preserved or reduced ejection fraction. J Geriatr Cardiol: JGC. 2015;12:346–52.
Buffle E, Kramarz J, Elazar E, Aviram G, Ingbir M, Nesher N, Biner S, Keren G, Topilsky Y. Added value of pulmonary venous flow Doppler assessment in patients with preserved ejection fraction and its contribution to the diastolic grading paradigm. Eur Heart J Cardiovasc Imaging. 2015;16:1191–7.
Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J. 2011;32(6):670–9.
Nanayakkara S, Kaye DM. Management of heart failure with preserved ejection fraction: a review. Clin Ther. 2015;37(10):2186–98
Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009;2:10–5.
Santos ABS, Kraigher-Krainer E, Gupta DK, Claggett B, Zile MR, Pieske B, Voors AA, Lefkowitz M, Bransford T, Shi V, et al. Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16:1096–103.
Mookadam F, Goel R, Alharthi MS, Jiamsripong P, Cha S. Epicardial fat and its association with cardiovascular risk: a cross-sectional observational study. Heart Views. 2010;11:103–8.
Kilicaslan B, Ozdogan O, Aydin M, Dursun H, Susam I, Ertas F. Increased epicardial fat thickness is associated with cardiac functional changes in healthy women. The Tohoku J Exp Med. 2012;228:119–24.
Fox CS, Gona P, Hoffmann U, Porter SA, Salton CJ, Massaro JM, Levy D, Larson MG, D’Agostino RB, O’Donnell CJ, et al. Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham Heart Study. Circulation. 2009;119:1586–91.
Evin M, Redheuil A, Soulat G, Perdrix L, Ashrafpoor G, Giron A, Lamy J, Defrance C, Roux C, Hatem SN, et al. Left atrial aging: a cardiac magnetic resonance feature tracking study. Am J Phys Heart Circ Physiol. 2016;310(5):H542–9.
Inoue YY, Alissa A, Khurram IM, Fukumoto K, Habibi M, Venkatesh BA, Zimmerman SL, Nazarian S, Berger RD, Calkins H, et al. Quantitative tissue-tracking cardiac magnetic resonance (CMR) of left atrial deformation and the risk of stroke in patients with atrial fibrillation. Am Heart J. 2015;4:e001844.
Evin M, Cluzel P, Lamy J, Rosenbaum D, Kusmia S, Defrance C, Soulat G, Mousseaux E, Roux C, Clement K, et al. Assessment of left atrial function by MRI myocardial feature tracking. J Magn Res Imaging. 2015;42:379–89.
Liu C-Y, Redheuil A, Ouwerkerk R, Lima JAC, Bluemke DA. Myocardial fat quantification in humans: evaluation by two-point water-fat imaging and localized proton spectroscopy. Magn Res Med. 2010;63:892–901.
Heiberg E, Sjögren J, Ugander M, Carlsson M, Engblom H, Arheden H. Design and validation of segment—freely available software for cardiovascular image analysis. BMC Med Imaging. 2010;10:1.
Nagueh SF, Bierig SM, Budoff MJ, Desai M, Dilsizian V, Eidem B, Goldstein SA, Hung J, Maron MS, Ommen SR, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: endorsed by the American society of nuclear cardiology, society for cardiovascular magnetic resonance, and society of cardiovascular computed tomography. J Am Soc Echocardiogr. 2011;24:473–98.
Kawata T, Daimon M, Miyazaki S, Ichikawa R, Maruyama M, Chiang S-J, Ito C, Sato F, Watada H, Daida H. Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2015;14:98.
Mochizuki Y, Tanaka H, Matsumoto K, Sano H, Toki H, Shimoura H, Ooka J, Sawa T, Motoji Y, Ryo K, et al. Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus. Cardiovasc Diabetol. 2015;14:37.
Gabrielli L, Enríquez A, Córdova S, Yáñez F, Godoy I, Corbalán R. Assessment of left atrial function in hypertrophic cardiomyopathy and athlete’s heart: a left atrial myocardial deformation study. Echocardiography. 2012;29:943–9.
Lavie CJ, Amodeo C, Ventura HO, Messerli FH. LEft atrial abnormalities indicating diastolic ventricular dysfunction in cardiopathy of obesity. Chest. 1987;92:1042–6.
Tsang TSM, Barnes ME, Miyasaka Y, Cha SS, Bailey KR, Verzosa GC, Seward JB, Gersh BJ. Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years. Eur Heart J. 2008;29:2227–33.
Wierzbowska-Drabik K, Chrzanowski L, Kapusta A, Uznańska-Loch B, Płońska E, Krzemińska-Pakuła M, Kurpesa M, Rechciński T, Trzos E, Kasprzak JD. Severe obesity impairs systolic and diastolic heart function—the significance of pulsed tissue Doppler, strain, and strain rate parameters. Echocardiography. 2013;30:904–11.
Patil VC, Patil HV, Shah KB, Vasani JD, Shetty P. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res. 2011;2:213–22.
Enomoto M, Ishizu T, Seo Y, Yamamoto M, Suzuki H, Shimano H, Kawakami Y, Aonuma K. Subendocardial systolic dysfunction in asymptomatic normotensive diabetic patients. Circ J. 2015;79(8):1749–55.
Cassidy S, Hallsworth K, Thoma C, MacGowan GA, Hollingsworth KG, Day CP, Taylor R, Jakovljevic DG, Trenell MI. Cardiac structure and function are altered in type 2 diabetes and non-alcoholic fatty liver disease and associate with glycemic control. Cardiovasc Diabetol. 2015;14:23.
Kadappu KK, Boyd A, Eshoo S, Haluska B, Yeo AET, Marwick TH, Thomas L. Changes in left atrial volume in diabetes mellitus: more than diastolic dysfunction? Eur Heart J Cardiovasc Imaging. 2012;13:1016–23.
Wang Y, Hou D, Ma R, Ding G, Yin L, Zhang M. Early detection of left atrial energy loss and mechanics abnormalities in diabetic patients with normal left atrial size: a study combining vector flow mapping and tissue tracking echocardiography. Med Sci Monit. 2016;22:958–68.
Guan Z, Zhang D, Huang R, Zhang F, Wang Q, Guo S. Association of left atrial myocardial function with left ventricular diastolic dysfunction in subjects with preserved systolic function: a strain rate imaging study. Clin Cardiol. 2010;33:643–9.
Sosnovik DE, Wang R, Dai G, Reese TG, Wedeen VJ. Diffusion MR tractography of the heart. J Cardiovasc Magn Reson. 2009;11:47.
Ling L-H, McLellan AJA, Taylor AJ, Iles LM, Ellims AH, Kumar S, Teh A, Lee G, Wong MCG, Azzopardi S, et al. Magnetic resonance post-contrast T1 mapping in the human atrium: validation and impact on clinical outcome after catheter ablation for atrial fibrillation. Heart Rhythm. 2014;11:1551–9.
Hudsmith LE, Neubauer S. Magnetic resonance spectroscopy in myocardial disease. JACC Cardiovasc Imaging. 2009;2(1):87–96.
Chao T-F, Lai Y-H, Yun C-H, Yen C-H, Wang K-L, Lin Y-J, Chang S-L, Lo L-W, Hu Y-F, Hung C-L, et al. The association between atrium electromechanical interval and pericardial fat. PLoS One. 2014;9(5):e97472.
Homsi R, Meier-Schroers M, Gieseke J, Dabir D, Luetkens JA, Kuetting DL, Naehle CP, Marx C, Schild HH, Thomas DK, et al. 3D-Dixon MRI based volumetry of peri- and epicardial fat. Int J Cardiovasc Imaging. 2016;32(2):291–9.