Myocardial Triglyceride Content and Epicardial Fat Mass in Human Obesity: Relationship to Left Ventricular Function and Serum Free Fatty Acid Levels

• Published in: The journal of clinical endocrinology and metabolism Vol. 91; no. 11; pp. 4689 - 4695
• Main Authors: Kankaanpää, Mikko, Lehto, Hanna-Riikka, Pärkkä, Jussi P., Komu, Markku, Viljanen, Antti, Ferrannini, Ele, Knuuti, Juhani, Nuutila, Pirjo, Parkkola, Riitta, Iozzo, Patricia
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-11-2006; Copyright by The Endocrine Society
• Subjects: Adipose Tissue - anatomy & histology; Adult; Alanine Transaminase - analysis; Biological and medical sciences; Cardiovascular Diseases - etiology; Choristoma - etiology; Endocrinopathies; Fatty Acids, Nonesterified - blood; Fundamental and applied biological sciences. Psychology; Heart - diagnostic imaging; Humans; Liver - chemistry; Liver - enzymology; Liver - metabolism; Medical sciences; Middle Aged; Myocardium - chemistry; Obesity - blood; Obesity - complications; Obesity - diagnostic imaging; Pericardium - anatomy & histology; Radiography; Thinness - blood; Triglycerides - analysis; Ventricular Function, Left - physiology; Vertebrates: endocrinology; Waist-Hip Ratio; Human; Obesity; Nutrition disorder; Epicardium; Lipids; Free fatty acid; Triglyceride; Fat mass; Myocardium; Serum; Circulatory system; Left ventricle performance; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2006-0584

Context and Objective: Ectopic fat accumulation within and around the myocardial wall has been implicated in the pathogenesis of heart disease in obesity. We evaluated myocardial and epicardial fat, left ventricular (LV) function, and metabolic risk factors in nine (five lean, four moderately obese) men.
Methods: Myocardial fat percent was quantified in the septum by proton magnetic resonance spectroscopy. Reproducibility was assessed by triplicate systolic and diastolic measurements. LV parameters and epicardial fat were determined by magnetic resonance imaging. Waist-to-hip ratio and liver enzymes (alanine transaminase) were used as surrogate markers of visceral and liver fat contents.
Results: Myocardial fat (2.1 ± 0.5 vs. 0.8 ± 0.1, P = 0.03) and epicardial fat (120 ± 33 vs. 55 ± 12 g, P = 0.08) were higher in obese than lean subjects. Individuals with above-median alanine transaminase values had a 4-fold elevation in myocardial fat. The coefficient of variation of repeated myocardial fat percent determinations was 17 ± 3 and 23 ± 3% in systole and diastole, respectively. Myocardial fat was correlated with free fatty acid (FFA) levels (r = 0.76; P = 0.017), epicardial fat (r = 0.69; P = 0.042), and waist-to-hip ratio (r = 0.70; P = 0.035), and it showed a tendency to associate positively with LV work. Epicardial fat was associated with peripheral vascular resistance (positively) and the cardiac index (negatively). FFA levels were significantly correlated with LV mass (r = 0.72; P = 0.030) and forward work (r = 0.74; P = 0.023).
Conclusions/Interpretation: The accumulation of triglyceride in and around the myocardium of moderately obese individuals is significant, and it is related to FFA exposure, generalized ectopic fat excess, and peripheral vascular resistance. These changes precede LV overload and hypertrophy.