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Combined associations of obesity and metabolic health with subclinical left ventricular dysfunctions: Danyang study

Ye Wang¹, Junya Liang¹, Shasha Zheng¹

¹Institute of Hypertension, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.

ESC Heart Failure

|May 3, 2021

Insights

Metabolically healthy obese individuals, despite appearing healthy, show signs of subclinical cardiac dysfunction. This study reveals that metabolic healthy obesity (MHO) is linked to worse systolic function and increased risk of left ventricular systolic dysfunction.

Area of Science:

Cardiology
Metabolic Health
Obesity Research

Background:

The association between metabolically healthy obesity (MHO) and subclinical cardiac dysfunction is not well understood.
Defining metabolic health and obesity is crucial for assessing cardiovascular risk.

Purpose of the Study:

To investigate the relationship between MHO and subclinical cardiac dysfunction in a Chinese population.
To assess systolic and diastolic cardiac function in individuals categorized by BMI and metabolic health status.

Main Methods:

Recruited 2757 participants, categorizing them into six groups based on BMI and metabolic health.
Assessed preclinical systolic function using global longitudinal strain (GLS) and diastolic function via transmitral and tissue Doppler imaging.
Adjusted for covariates to analyze trends in cardiac function across groups.

Main Results:

Metabolically healthy obese (MHO) participants exhibited significantly worse GLS and e' compared to controls.
MHO individuals showed a higher risk of subclinical left ventricular systolic dysfunction (OR=3.44).
Metabolically unhealthy individuals, regardless of obesity status, had poorer diastolic function.

Conclusions:

Metabolically healthy obesity (MHO) is associated with impaired subclinical systolic cardiac function.
Early diastolic dysfunction appears more pronounced in metabolically unhealthy obese individuals (MUO).
MHO status independently contributes to increased risk of subclinical cardiac dysfunction.

Read full analysis

Abstract

Aims:

The association of strictly defined metabolic healthy obese (MHO) with subclinical cardiac function was unclear. Our study aims to examine the role of MHO in subclinical cardiac dysfunction in a Chinese population.

Methods And Results:

The study subjects were recruited from Danyang from 2017 to 2019. Obesity was defined by body mass index (BMI) categories (normal weight, overweight and obesity). Metabolic health was strictly defined as having neither any of the guidelines recommended metabolic syndrome components nor insulin resistance. Thus, subjects were grouped by BMI categories and metabolic health status as six groups. Preclinical systolic (global longitudinal strain [GLS]) and diastolic function were assessed by 2D speckle tracking, and transmitral and tissue Doppler imaging, respectively. The 2757 participants (mean age ± standard deviation, 52.7 ± 11.7 years) included 1613 (58.5%) women, 999 (36.2%) obese, 2080 (75.4%) metabolically unhealthy and 93 (3.4%) MHO participants. After adjustment for covariates, the trend was similar for left ventricular (LV) ejection fraction (P_trend ≥ 0.07) but significantly worse for GLS, e' and E/e' (P_trend ≤ 0.02) across the six groups or passing from normal weight to obese individuals irrespective of metabolic status. MHO participants had lower GLS (20.4 vs. 21.4%) and e' (9.6 vs. 10.6 cm/s) compared with controls (P < 0.0001) but had similar GLS (P = 0.47) compared with metabolically unhealthy obese (MUO). Regardless of obesity status, metabolically unhealthy participants had worse diastolic function compared with their metabolically healthy counterparts (P ≤ 0.0004). Compared with controls, MHO individuals were at higher risk of subclinical LV systolic dysfunction (OR = 3.44, 95% CI = 1.25-9.49, P = 0.02). These results were robust to sensitivity analysis.

Conclusions:

MHO was substantially associated with worse subclinical systolic function although early diastolic dysfunction seemed to be more accentuated in MUO.

Keywords:

Insulin resistance Metabolic status Obesity Subclinical myocardial abnormalities

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