Adverse right ventricular remodelling, function, and stress responses in obesity: insights from cardiovascular magnetic resonance
| Autor: | Oliver J Rider, James P. Byrne, Barry A. Borlaug, Jennifer J Rayner, Andrew Lewis, Ines Abdesselam, Stefan Neubauer |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Magnetic Resonance Spectroscopy Ventricular Dysfunction Right Diastole Weight loss Internal medicine Dobutamine Weight Loss medicine Humans Radiology Nuclear Medicine and imaging Obesity Ejection fraction Ventricular Remodeling Class III obesity business.industry Stroke Volume General Medicine medicine.disease Obesity Morbid Heart failure Cardiology Ventricular Function Right medicine.symptom Cardiology and Cardiovascular Medicine business Body mass index medicine.drug |
| Zdroj: | European heart journal. Cardiovascular Imaging. 23(10) |
| ISSN: | 2047-2412 |
| Popis: | Aims We aimed to determine the effect of increasing body weight upon right ventricular (RV) volumes, energetics, systolic function, and stress responses using cardiovascular magnetic resonance (CMR). Methods and results We first determined the effects of World Health Organization class III obesity [body mass index (BMI) > 40 kg/m2, n = 54] vs. healthy weight (BMI < 25 kg/m2, n = 49) upon RV volumes, energetics and systolic function using CMR. In less severe obesity (BMI 35 ± 5 kg/m2, n = 18) and healthy weight controls (BMI 21 ± 1 kg/m2, n = 9), we next performed CMR before and during dobutamine to evaluate RV stress response. A subgroup undergoing bariatric surgery (n = 37) were rescanned at median 1 year to determine the effects of weight loss. When compared with healthy weight, class III obesity was associated with adverse RV remodelling (17% RV end-diastolic volume increase, P < 0.0001), impaired cardiac energetics (19% phosphocreatine to adenosine triphosphate ratio reduction, P < 0.001), and reduction in RV ejection fraction (by 3%, P = 0.01), which was related to impaired energetics (R = 0.3, P = 0.04). Participants with less severe obesity had impaired RV diastolic filling at rest and blunted RV systolic and diastolic responses to dobutamine compared with healthy weight. Surgical weight loss (34 ± 15 kg weight loss) was associated with improvement in RV end-diastolic volume (by 8%, P = 0.006) and systolic function (by 2%, P = 0.03). Conclusion Increasing body weight is associated with significant alterations in RV volumes, energetic, systolic function, and stress responses. Adverse RV modelling is mitigated with weight loss. Randomized trials are needed to determine whether intentional weight loss improves symptoms and outcomes in patients with obesity and heart failure. |
| Databáze: | OpenAIRE |
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