Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study

Background: Obesity is associated with cardiac steatosis in healthy adults and is independently associated with increased left ventricular (LV) mass and could contribute to the progression of heart failure-related composite events in patients with hypertrophic cardiomyopathy (HCM). However, it is un...

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Main Authors: Jie Wang, Lutong Pu, Jinquan Zhang, Ruihao Xu, Yang Li, Mengdi Yu, Yangjie Li, Jiajun Guo, Yuanwei Xu, Yu Kang, Yuchi Han, Yucheng Chen
Format: Article
Language:English
Published: Elsevier 2025-01-01
Series:Journal of Cardiovascular Magnetic Resonance
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Online Access:http://www.sciencedirect.com/science/article/pii/S1097664725000651
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author Jie Wang
Lutong Pu
Jinquan Zhang
Ruihao Xu
Yang Li
Mengdi Yu
Yangjie Li
Jiajun Guo
Yuanwei Xu
Yu Kang
Yuchi Han
Yucheng Chen
author_facet Jie Wang
Lutong Pu
Jinquan Zhang
Ruihao Xu
Yang Li
Mengdi Yu
Yangjie Li
Jiajun Guo
Yuanwei Xu
Yu Kang
Yuchi Han
Yucheng Chen
author_sort Jie Wang
collection DOAJ
description Background: Obesity is associated with cardiac steatosis in healthy adults and is independently associated with increased left ventricular (LV) mass and could contribute to the progression of heart failure-related composite events in patients with hypertrophic cardiomyopathy (HCM). However, it is unclear whether the increased LV mass is accompanied by increased fibrosis. We aimed to assess the impact of increased body mass index (BMI) on myocardial tissue characteristics in patients with HCM. Methods: A total of 737 patients with HCM (99 obese, 298 overweight, and 340 normal-weight patients) who underwent cardiovascular magnetic resonance (CMR) imaging were prospectively included. We assessed the relationship between BMI and LV mass, global native T1, extracellular volume, and late gadolinium enhancement (LGE) using CMR. Myocardial tissues from one patient each with obstructive HCM who underwent septal myectomy of the obese, overweight, and normal-weight groups were obtained and stained with red oil O, hematoxylin, and Masson’s trichrome. Results: LV mass index (87.2, interquartile range [IQR]: 71.3 to 113.8, 89.4, IQR:75.5 to 111.5, and 104.7, IQR: 86.4 to 123.4 g/m2, P < 0.001) was higher in obese and overweight patients with HCM than those with normal weight, but the native T1 was decreased in obese patients with HCM (1324±67 ms, 1308±63 ms, and 1298±67 ms, P < 0.001). In addition, there was no significant difference in LGE extent among the three subgroups (normal weight: 3.7%, IQR: 0 to 9.5%, overweight: 2.7%, IQR: 0 to 7.7%, obese: 3.8%, IQR: 0 to 7.2%, P = 0.194). Multivariable linear regression analyses found that BMI was independently associated with global native T1 (β = −1.918, P = 0.005). Furthermore, myocardial tissues stained with oil red O from three patients showed an increasing extent of fat deposits with BMI, whereas collagen volume fractions were similar. Conclusion: In HCM patients, obesity is associated with increased myocardial mass and decreased native T1, likely reflecting cardiac steatosis in addition to fibrosis. This distinction underscores the potential reversibility of obesity-related myocardial changes through targeted weight management. Trial registration: This prospective cohort study was registered in the Chinese Clinical Trial Registry (URL: http://www.chictr.org.cn; Registry number: ChiCTR1900024094).
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spelling doaj-art-658e59f3f59c4cddbae8b8592a4641a32025-08-20T03:46:05ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472025-01-0127110190310.1016/j.jocmr.2025.101903Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based studyJie Wang0Lutong Pu1Jinquan Zhang2Ruihao Xu3Yang Li4Mengdi Yu5Yangjie Li6Jiajun Guo7Yuanwei Xu8Yu Kang9Yuchi Han10Yucheng Chen11Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Cardiac Imaging and Target Therapy Lab, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, ChinaWest China School of Medicine, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Cardiac Imaging and Target Therapy Lab, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Cardiac Imaging and Target Therapy Lab, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Cardiac Imaging and Target Therapy Lab, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaCardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USADepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Cardiac Imaging and Target Therapy Lab, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Corresponding author.Background: Obesity is associated with cardiac steatosis in healthy adults and is independently associated with increased left ventricular (LV) mass and could contribute to the progression of heart failure-related composite events in patients with hypertrophic cardiomyopathy (HCM). However, it is unclear whether the increased LV mass is accompanied by increased fibrosis. We aimed to assess the impact of increased body mass index (BMI) on myocardial tissue characteristics in patients with HCM. Methods: A total of 737 patients with HCM (99 obese, 298 overweight, and 340 normal-weight patients) who underwent cardiovascular magnetic resonance (CMR) imaging were prospectively included. We assessed the relationship between BMI and LV mass, global native T1, extracellular volume, and late gadolinium enhancement (LGE) using CMR. Myocardial tissues from one patient each with obstructive HCM who underwent septal myectomy of the obese, overweight, and normal-weight groups were obtained and stained with red oil O, hematoxylin, and Masson’s trichrome. Results: LV mass index (87.2, interquartile range [IQR]: 71.3 to 113.8, 89.4, IQR:75.5 to 111.5, and 104.7, IQR: 86.4 to 123.4 g/m2, P < 0.001) was higher in obese and overweight patients with HCM than those with normal weight, but the native T1 was decreased in obese patients with HCM (1324±67 ms, 1308±63 ms, and 1298±67 ms, P < 0.001). In addition, there was no significant difference in LGE extent among the three subgroups (normal weight: 3.7%, IQR: 0 to 9.5%, overweight: 2.7%, IQR: 0 to 7.7%, obese: 3.8%, IQR: 0 to 7.2%, P = 0.194). Multivariable linear regression analyses found that BMI was independently associated with global native T1 (β = −1.918, P = 0.005). Furthermore, myocardial tissues stained with oil red O from three patients showed an increasing extent of fat deposits with BMI, whereas collagen volume fractions were similar. Conclusion: In HCM patients, obesity is associated with increased myocardial mass and decreased native T1, likely reflecting cardiac steatosis in addition to fibrosis. This distinction underscores the potential reversibility of obesity-related myocardial changes through targeted weight management. Trial registration: This prospective cohort study was registered in the Chinese Clinical Trial Registry (URL: http://www.chictr.org.cn; Registry number: ChiCTR1900024094).http://www.sciencedirect.com/science/article/pii/S1097664725000651Hypertrophic cardiomyopathy (HCM)ObesityCardiovascular magnetic resonanceLate gadolinium enhancementT1 mapping
spellingShingle Jie Wang
Lutong Pu
Jinquan Zhang
Ruihao Xu
Yang Li
Mengdi Yu
Yangjie Li
Jiajun Guo
Yuanwei Xu
Yu Kang
Yuchi Han
Yucheng Chen
Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study
Journal of Cardiovascular Magnetic Resonance
Hypertrophic cardiomyopathy (HCM)
Obesity
Cardiovascular magnetic resonance
Late gadolinium enhancement
T1 mapping
title Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study
title_full Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study
title_fullStr Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study
title_full_unstemmed Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study
title_short Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study
title_sort effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy a cardiovascular magnetic resonance based study
topic Hypertrophic cardiomyopathy (HCM)
Obesity
Cardiovascular magnetic resonance
Late gadolinium enhancement
T1 mapping
url http://www.sciencedirect.com/science/article/pii/S1097664725000651
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