Cardiac Remodeling with Excessive Visceral Adiposity beyond Anthropometrics in Asymptomatic Asians

Abstract Purpose: Visceral Adipose Tissue (VAT) as a source of proinflammatory and biological mediators is implicated in adverse cardiac structure remodeling, functional alternations, and results in Heart Failure (HF) in central obese patients. However, the impact of different distributions of visceral fat on cardiac structural/functional changes still remains unclear. Methods: This retrospective analysis includes 354 subjects free from previous myocardial infarction, coronary arterial disease, stroke, or clinical HF. Regional VAT including Pericardial Fat (PCF) and Thoracic Periaortic Fat (TAT) volumes, fatty liver grades were all measured by Multi-Detector Computed Tomography (MDCT) (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA) and abdominal sonography (Toshiba Nemio SSA-550A). We measured Left ventricular mass/mass index (LVM/LVMI), LV Mass to Volume ratio (LVMVI), Left Atrium (LA) diameter represented as cardiac remodeling, and analyzed their association with adiposity measures. Results: All VAT are significantly associated with worsening cardio-metabolic profiles (hs-CRP, metabolic scores, coronary calcium score) (all P<0.05). Excess PCF/TAT wassignificantly associated with larger LVM/LVMI, LVMVI, and LA diameter (all P<0.05); presented in LV concentric remodeling, it further worsens LV diastolic function. In multivariate models, this effect on LA remodeling was attenuated in TAT after adjusting for the clinical variable (P=0.052). However, there was no correlation between hepatic fat and LV/LA structural/functional alternations. Conclusion: Accumulated visceral adiposity, especially PCF deposits, was associated with certain cardiac structural/functional remodeling characterized by impaired LV diastolic function. PCF may exhibit a local effect on adjacent cardiac structure more than TAT and hepatic fat. Our data suggested that PCF may serve as an independent predictor to screen subclinical heart failure in asymptomatic population.