Relationship between epicardial/visceral obesity and features of myocardial remodeling in patients with acquired mitral valve disease
https://doi.org/10.15829/1728-8800-2025-4301
EDN: OCMQUJ
Abstract
Aim. To study the relationship between epicardial/visceral obesity and cardiac remodeling characteristics in patients with acquired mitral valve (MV) disease and indications for surgical treatment of the defect.
Material and methods. The study included 49 patients hospitalized for surgery of non-infectious acquired MV defect. Patients were divided into groups according to computed tomography as follows: group 1 — with visceral obesity (visceral adipose tissue ≥130 cm2 (n=28)), and group 2 — without visceral obesity (n=21).
Results. Patients with visceral obesity had more impaired left ventricular (LV) global longitudinal strain compared to the group without visceral obesity (-15,65 [-18,8; -11,6] vs -19,4 [-21,3; -16,9]%, p=0,020). Right ventricular ejection fraction (3D echocardiography) in group 1 was lower compared to patients in group 2 as follows: median 46 [40,6; 48,9] vs 53 [45,8; 54,2]% (p=0,042). Increase in epicardial adipose tissue (EAT) volume by 1 cm3 according to multislice computed tomography was associated with left atrial increase by a B-coefficient of 0,009 (p=0,001) and LV end-systolic volume by a B-coefficient of 0,1224 (p=0,046). The visceral adipose tissue/subcutaneous adipose tissue index >0,4 is associated with an increase in the LV mass index by a B-coefficient of 44,7 (p=0,001). According to the ROC analysis, the EAT volume >115,1 cm3 is associated with arrhythmias such as atrial fibrillation (AUC=0,714 (p=0,003)).
Conclusion. Visceral obesity is associated with a more pronounced structural and functional impairment of heart ventricles, while EAT volume >115,1 cm3 — with atrial fibrillation before MV defect surgery.
Supporting agencies: The study was conducted at the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” with the support of the Russian Science Foundation Grant No. 24-75-10031 "Epicardial and visceral obesity as a factor influencing the remodeling of the myocardium and pulmonary vessels after surgical correction of acquired valvular heart diseases"
About the Authors
E. V. Dren'
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Elena Vladimirovna Dren', PhD student, junior researcher of laboratory of rehabilitation
Kemerovo
I. N. Lyapina
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Irina Nikolaevna Lyapina, senior researcher at the Rehabilitation Laboratory, the Department of Clinical Cardiology, Cardiologist of pulmonary arterial hypertension center
Kemerovo
A. N. Stasev
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Aleksandr Nikolaevich Stasev, PhD, Senior Researcher at the Laboratory of Heart Defects, Department of Cardiovascular Surgery
Kemerovo
I. N. Mamchur
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Irina Nikolaevna Mamchur, PhD, Physician at the Department of Functional and Ultrasonic Diagnostics
Kemerovo
N. K. Brel
Limited Liability Company “SM-clinic”
Russian Federation
Russian Federation
Natalia Kirillovna Brel, MD, 1st category doctor, Radiologist, Head of the Department of Radiology of the Hospital No. 2
Moscow
A. I. Kareeva
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Anastasia Ilyasovna Kareeva, junior researcher of laboratory of radiation diagnostic methods
Kemerovo
O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Olga Leonidovna Barbarash, Academician of RAS, MD, professor, Head of Research Institute for Complex Issues of Cardiovascular Diseases
Kemerovo
References
1. Mihl C, Dassen WR, Kuipers H. Cardiac remodelling: concentric versus eccentric hypertrophy in strength and endurance athletes. Neth Heart J. 2008;16(4):129-33. doi:10.1007/BF03086131.
2. D'Elia N, D'hooge J, Marwick TH. Association Between Myocardial Mechanics and Ischemic LV Remodeling. JACC Cardiovasc Imaging. 2015;8(12):1430-43. doi:10.1016/j.jcmg.2015. 10.005.
3. Semenova YeI, Zheleznev SI, Semenov II, et al. Cardiac valves’prosthetics in elderly patients. Risk factors: associated morbidity. Sibirskij zhurnal klinicheskoj i eksperimental'noj mediciny. 2007;22(3):97-100. (In Russ.).
4. Gritsenko OV, Chumakova GA, Elchaninova SA, et al. Lipotoxicity damage of myocardium in obesity. Cardiosomatics. 2017;8(4):36-40. (In Russ.). doi:10.26442/CS45386.
5. Guler S, Varol E. The relation between echocardiographic epicardial fat thickness and mitral annular calcification. Afr Health Sci. 2019;19(1):1657-64. doi:10.4314/ahs.v19i1.41.
6. Brel NK, Gruzdeva OV, Kokov AN, et al. Relationship of visceral obesity and coronary calcinosis in ischemic heart disease. Terapevticheskii Arkhiv. 2021;93(12):1428-34. (In Russ.). doi:10.26442/00403660.2021.12.201277.
7. Brel NK, Gruzdeva OV, Kokov AN, et al. Relationship of coronary calcinosis and local fat deposts in patients with coronary artery disease. Complex Issues of Cardiovascular Diseases. 2022;11(3): 51-63. (In Russ.). doi:10.17802/2306-1278-2022-11-3-51-63.
8. Van der Heijden CAJ, Verheule S, Olsthoorn J, et al. Postoperative atrial fibrillation and atrial epicardial fat: Is there a link? Int J Cardiol Heart Vasc. 2022;39:100976. doi:10.1016/j.ijcha.2022. 100976.
9. Varghese B, Swamy S, Srilakshmi MA, et al. Visceral adiposity in young patients with coronary artery diseasea case control study. Indian Heart J. 2012;64(3):284-9. doi:10.1016/S0019-4832(12)60088-1.
10. Galderisi M, Cosyns B, Edvardsen T, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J-Cardiovasc Imaging. 2017;18(12):1301-10. doi:10.1093/ehjci/jex244.
11. Islamova MR, Safarova AF, Kobalava ZhD, et al. Prognostic Value of Right Ventricular Dysfunction in Patients With Decompensated Chronic Heart Failure. Kardiologiia. 2023;63(3):13-20. (In Russ.). doi:10.18087/cardio.2023.3.n2071.
12. Fragasso G, Sanvito F, Monaca G, et al. Myocardial fibrosis in asymptomatic patients undergoing surgery for mitral and aortic valve regurgitation. J Cardiovasc Med. 2022;23(8):505-12. doi:10.2459/JCM.0000000000001347.
13. Marsan NA, Delgado V, J Shah D, et al. Valvular heart disease: shifting the focus to the myocardium. Eur Heart J. 2023;44(1): 28-40. doi:10.1093/eurheartj/ehac504.
14. Wong CY, O'Moore-Sullivan T, Leano R. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol. 2006;4(3):611-6. doi:10.1016/j.jacc.2005.11.015.
15. Nazare JA, Smith J, Borel A-L, et al. Usefulness of measuring both body mass index and waist circumference for the estimation of visceral adiposity and related cardiometabolic risk profile (from the INSPIRE ME IAA study). Am J Cardiol. 2015;115(3):307-15. doi:10.1016/j.amjcard.2014.10.039.
16. Druzhilov MA, Beteleva YuE, Druzhilova OYu, et al. The role of epicardial obesity in the development of structural and functional remodeling of the heart. Russian Journal of Cardiology. 2017;(4):35-9. (In Russ.). doi:10.15829/1560-4071-2017-4-35-39.
17. Zain S, Shamshad T, Kabir A, et al. Epicardial Adipose Tissue and Development of Atrial Fibrillation (AFIB) and Heart Failure With Preserved Ejection Fraction (HFpEF). Cureus. 2023;15(9):46153. doi:10.7759/cureus.46153.
18. Dzhioeva ON, Timofeev YuS, Metelskaya VA, et al. Role of epicardial adipose tissue in the pathogenesis of chronic inflammation in heart failure with preserved ejection fraction. Cardiovascular Therapy and Prevention. 2024;23(3):3928. (In Russ.). doi:10.15829/1728-8800-2024-3928.
19. Chumakova GA, Veselovskaya NG. Methods of visceral obesity assessment in clinical practice. Russian Journal of Cardiology. 2016;(4):89-96. (In Russ.). doi:10.15829/1560-4071-2016-4-89-96.
20. Sinitsky MY, Ponasenko AV, Gruzdeva OV. Genetic profile and secretome of adipocytes from visceral and subcutaneous adipose tissue in patients with cardiovascular diseases. Complex Issues of Cardiovascular Diseases. 2017;6(3):155-65. (In Russ.). doi:10.17802/2306-1278-2017-6-3-155-165.
21. Chumakova GA, Gritsenko OV, Gruzdeva OV, et al. Predicting the risk of left ventricular diastolic dysfunction in obesity. Russian Journal of Cardiology. 2022;27(4):4811. (In Russ.). doi:10.15829/1560-4071-2022-4811.
22. Dren’ EV, Lyapina IN, Pecherina TB, et al. Phenotype of a patient with valvular heart disease: literature review. CardioSomatics. 2023;14(4):269-82. (In Russ.). doi:10.17816/CS601825.
23. Göçer K, Öztürk B, Kaniyolu M, et al. Epicardial Fat Thickness as a Predictor of Ventricular Extrasystoles. Kardiologiia. 2024; 64(6):65-71. (In Russ.). doi:10.18087/cardio.2024.6.n2540.
24. Druzhilov MA, Kuznetsova TYu. Epicardial fat thickness as a tool for predicting complicated obesity. J Biomed Technol. 2015;2:49-58. doi:10.15393/j6.art.2015.3261.
25. Miklishanskaya SV, Mazur NA, Chapurnykh AV, et al. Contribution of epicardial adipose tissue to atrial fibrillation development in patients with arterial hypertension: a pilot study. Russian Journal of Cardiology. 2024;29(5):5659. (In Russ.). doi:10.15829/1560-4071-2024-5659.
26. Ionin VA, Listopad OV, Nifontov SE, et al. Role of galectin 3 and epicardial fat thickness in the development of atrial fibrillation in patients with metabolic syndrome. The Scientific Notes of the Pavlov University. 2015;22(1):43-6. (In Russ.). doi:10.24884/1607-4181-2015-22-1-43-46.
27. Haemers P, Hamdi H, Guedj K, et al. Atrial fibrillation is associated with the fibrotic remodelling of adipose tissue in the subepicardium of human and sheep atria. Eur Heart J. 2017;38(1): 53-61. doi:10.1093/eurheartj/ehv625.21.
28. Coisne A, Ninni S, Ortmans S, et al. Epicardial fat amount is associated with the magnitude of left ventricular remodeling in aortic stenosis. Int J Cardiovasc Imaging. 2019;35(2):267-73. doi:10.1007/s10554-018-1477-z.
29. Song XT, Zhang PY, Fan L, et al. Epicardial adipose tissue and right ventricular function in type 2 diabetes mellitus using two-dimensional speckle tracking echocardiography. Diab Vasc Dis Res. 2022;19(4):14791641221118622. doi:10.1177/14791641221118622.
30. Chen Y, Li J, Li F, et al. Impact of Epicardial Adipose Tissue on Right Cardiac Function and Prognosis in Pulmonary Arterial Hypertension. Chest. 2024;165(5):1211-23. doi:10.1016/j.chest.2023.11.039.
31. Vavilov AV, Skopin II. Pathogenesis, diagnostics and surgical treatment of ischemic mitral valve insufficiency. Thoracic and cardiovascular surgery. 2018;60(3):185-93. (In Russ.). doi:10.24022/0236-2791-2018-60-3-185-193.
32. Averina II, Mironenko MYu, Bokeria LA. Prognostic value of global longitudinal deformation of the left atrium in the development of heart failure in patients with valvular heart disease. Creative cardiology. 2021;15(4):510-23. (In Russ.). doi:10.24022/1997-3187-2021-15-4-510-523.
Supplementary files
What is already known about the subject?
- Current data on the relationship between visceral adipose tissue and structural and functional heart characteristics have been studied mainly in patients with coronary artery disease and in individuals with heart failure with preserved ejection fraction.
What might this study add?
- The study demonstrated that visceral obesity is associated with more pronounced structural and functional remodeling of the heart, affecting the volume and size of the cavities, worsening the left ventricular myocardial strain and right ventricular systolic function in patients with acquired mitral valve disease. Epicardial adipose tissue value >115,1 cm3is associated with atrial fibrillation in patients before the surgical intervention for mitral valve disease.
Review
For citations:
Dren' E.V., Lyapina I.N., Stasev A.N., Mamchur I.N., Brel N.K., Kareeva A.I., Barbarash O.L. Relationship between epicardial/visceral obesity and features of myocardial remodeling in patients with acquired mitral valve disease. Cardiovascular Therapy and Prevention. 2025;24(2):4301. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4301. EDN: OCMQUJ
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