Imaging-Derived Sarcopenic Obesity and Cardiovascular Outcomes: Insights Into Heart Failure Risk and Muscle Biology

Area of Science:

• Cardiology
• Genetics
• Biomedical Engineering

Background:

• The prognostic value of obesity in cardiovascular disease is complex and varies with measurement methods.
• Sarcopenic obesity, the combination of excess fat and low muscle mass, may offer clearer insights but is difficult to assess clinically.

Purpose of the Study:

• To develop a translatable method for assessing sarcopenic obesity using cardiovascular imaging.
• To evaluate the clinical relevance of this assessment using long-term follow-up, genomic, and transcriptomic data.

Main Methods:

• A deep learning pipeline quantified pectoralis major muscle mass from cardiac MRI scans.
• A novel sarcopenic obesity index was derived by combining muscle mass with body weight.
• Associations with cardiac remodeling, cardiovascular outcomes, and mortality were analyzed.
• Genome-wide association, colocalization, and transcriptomic analyses were performed.

Main Results:

• A higher sarcopenic obesity index correlated with adverse cardiac remodeling and increased risks of heart failure, cardiovascular death, and all-cause mortality.
• Genome-wide analysis identified 16 loci for sarcopenic obesity, including genes linked to heart failure.
• Transcriptomic profiling showed sarcopenic obesity loci are modulated during muscle atrophy, identifying ACVR2B as a potential therapeutic target.

Conclusions:

• Sarcopenic obesity is a clinically significant cardiovascular risk phenotype.
• The study identifies viable therapeutic targets for managing sarcopenic obesity and its cardiovascular consequences.