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Published on: May 16, 2020
Obesity cardiomyopathy and systolic function: obesity is not independently associated with dilated cardiomyopathy
Muhammad Fahad Khan1, Mohammad Reza Movahed
1Department of Medicine, The Southern Arizona VA Health Care System and University of Arizona, 3610 S. 6th Avenue, Tucson, AZ 85723, USA.
Insights
Obesity increases heart failure risk through multifactorial mechanisms, primarily causing diastolic dysfunction. Evidence does not support obesity-related cardiomyopathy leading to severe systolic dysfunction.
Area of Science:
- Cardiology
- Obesity Medicine
- Heart Failure Research
Background:
- Obesity is a global health concern, with rising heart failure prevalence.
- Obesity is an independent risk factor for heart failure, with multifactorial causes.
- Hemodynamic changes in obesity include increased blood volume and decreased systemic resistance, leading to high-output state adaptations.
Purpose of the Study:
- To review the literature on obesity's impact on cardiac structure and function.
- To determine if obesity causes significant systolic dysfunction or obesity-related cardiomyopathy.
- To clarify the relationship between obesity, hemodynamic changes, and heart failure development.
Main Methods:
- Extensive literature review of studies investigating obesity and heart function.
- Analysis of findings from Multi Gated Acquisition (MUGA) scans and echocardiogram studies.
- Evaluation of evidence for obesity-related cardiomyopathy and dilated cardiomyopathy criteria.
Main Results:
- Obesity-induced hemodynamic changes primarily lead to diastolic dysfunction.
- Previous findings of mild systolic dysfunction in obese individuals were not consistently confirmed by recent echocardiogram studies.
- No substantial evidence was found for obesity-related cardiomyopathy causing significant systolic dysfunction (LVEF <35%).
Conclusions:
- Obesity is linked to diastolic dysfunction and cardiac structural adaptations.
- Severe left ventricular dysfunction in obese patients warrants investigation for other underlying causes.
- Obesity-related cardiomyopathy leading to dilated cardiomyopathy is not supported by current evidence.
Abstract:
Obesity is a growing worldwide problem and the prevalence of heart failure is also on the rise. Obesity itself is an independent risk factor for the development of heart failure and the case of obesity-related heart failure is thought to be multifactorial. Obesity leads to increased central and total blood volumes along with decreased systemic arterial resistance resulting in high cardiac output state related adaptations in the cardiac structure. Persistence of these hemodynamic changes ultimately results in diastolic dysfunction, however, whether these changes progress to significant systolic dysfunction or not is doubtful. Some MUGA (Multi Gated Acquisition) scan-based studies had shown mild degree of left ventricular systolic dysfunction in the obese, however, these findings could not be confirmed with recent echocardiogram-based studies. Using extensive literature review, we found no evidence of obesity-related cardiomyopathy leading to significant systolic dysfunction fulfilling criterion for the diagnosis of dilated cardiomyopathy (LVEF <35 %). Therefore, any obese patient presenting with severe LV dysfunction should prompt further investigations to evaluate for the underlying etiology.
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