Forgotten but Not Gone: The Rediscovery of Fatty Heart, the Most Common Unrecognized Disease in America

• Published in: Circulation research Vol. 101; no. 8; pp. 759 - 767
• Main Authors: Szczepaniak, Lidia S, Victor, Ronald G, Orci, Lelio, Unger, Roger H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 12-10-2007; Lippincott
• Subjects: Animals; Biological and medical sciences; Cardiology. Vascular system; Dietary Fats - administration & dosage; Dietary Fats - adverse effects; Fundamental and applied biological sciences. Psychology; Heart; Heart - physiology; Heart Diseases - complications; Heart Diseases - metabolism; Heart Diseases - pathology; Humans; Lipids - blood; Medical sciences; Metabolic diseases; Metabolic Syndrome - complications; Metabolic Syndrome - metabolism; Metabolic Syndrome - pathology; Myocarditis. Cardiomyopathies; Obesity; Obesity - complications; Obesity - metabolism; Obesity - physiopathology; Overweight - physiology; United States; Vertebrates: cardiovascular system; Heart; Obesity; Cardiomyopathy; lipotoxic cardiomyopathy; Magnetic resonance; Nutrition disorder; Cardiovascular disease; magnetic resonance spectroscopy; Myocardial disease; Vertebrata; Mammalia; Heart disease; fatty heart; Circulatory system; Nutritional status
• ISSN: 0009-7330; 1524-4571
• DOI: 10.1161/CIRCRESAHA.107.160457

Until 60 years ago, fatty heart was an accepted clinical entity. Since then, its very existence has been questioned, despite the fact that 2 of 3 Americans are now obese or overweight and obesity has been shown to be correlated with cardiac functional abnormalities. In 2000, a syndrome of “lipotoxic cardiomyopathy” resembling earlier pathologic descriptions of fatty human hearts was described in rodents, and fatty infiltration of cardiomyocytes was subsequently reported in patients with congestive failure. Now, magnetic resonance spectroscopy has been adapted to permit routine noninvasive screening for fatty heart. The use of this technique in human volunteers indicates that cardiomyocyte fat correlates well with body mass index and is elevated in uncomplicated obesity. It is more severe when glucose tolerance becomes abnormal or diabetes is present. It is associated with impaired diastolic filling, even in seemingly asymptomatic obese volunteers. Because fatty heart can be readily prevented by lifestyle modification and pharmacologic interventions that reduce caloric intake and increase fatty acid oxidation, it seems important to recognize its existence so as to intervene as early as possible.