Impact of Weight Reduction on Cardiac Structure in AF
Background Obesity and pericardial adipose tissue are independent risk factors for atrial fibrillation (AF) and adverse cardiac structural remodeling. The effect of weight reduction on pericardial adipose tissue and cardiac structure remains unknown.
Methods We prospectively performed cardiac magnetic resonance imaging on 87 participants with AF undergoing either structured weight management (intervention) or general lifestyle advice (control). We measured pericardial adipose tissue, atrial and ventricular volumes, and myocardial mass at baseline and 12 months.
Results In total, 69 participants underwent baseline and 12-month follow-up cardiac magnetic resonance imaging (intervention n = 36 and controls n = 33). From baseline to 12 months, weight loss (kg, mean [95% CI]) was greater in the intervention group from 101.5 kg (97.2–105.8 kg) to 86.5 kg (81.2–91.9 kg) as compared with controls from 102.6 kg (97.2–108.1 kg) to 98.7 kg (91.0–106.3 kg) (time-group interaction P < .001). The intervention group showed a reduction in left atrial volumes (mL) from 105.0 mL (98.9–111.1 mL) to 96.4 mL (91.6–101.1 mL), whereas the change in the control group was from 108.8 mL (99.6–117.9 mL) to 108.9 mL (99.8–118.0 mL) (time-group interaction P < .001). There was a decline in pericardial adipose tissue (cm) from 140.9 cm (129.3–152.4 cm) to 118.8 cm (108.1–129.6 cm) and myocardial mass (g) from 137.6 g (128.1–147.2 g) to 123.1 g (114.5–131.7 g) in the intervention group, whereas the change in the control group was from 143.2 cm (124.6–161.7 cm) to 147.2 cm (128.9–165.4 cm) for pericardial adipose tissue and 138.3 g (124.8–151.8 g) to 140.7 g (127.4–154.1 g) for myocardial mass (both variables, time-group interaction P < .001).
Conclusions Weight reduction results in favorable structural remodeling and a reduction in pericardial adipose tissue burden.
Obesity is a significant risk factor for the development and progression of atrial fibrillation (AF). We have recently demonstrated for the first time in a randomized trial that weight loss is associated with a reduction in AF burden in overweight and obese individuals. The mechanisms by which weight loss results in reduction in AF burden remain uncertain, however.
Pericardial adipose tissue has recently emerged as a risk factor for the development of AF independent of traditional metabolic risk factors including measures of systemic obesity, such as body mass index (BMI). Observations suggest that pericardial adipose tissue may be a unique metabolically active visceral adipose depot and an important source of inflammatory and profibrotic cytokines, thereby potentially influencing contiguous cardiac pathologic changes. In the ventricular chambers, autopsy studies have shown a strong correlation between myocardial mass and pericardial adipose volume, independent of the underlying ventricular pathology, suggesting myocardial structural remodeling may, in part, be influenced by overlying pericardial adipose tissue.
The aim of this current study was, therefore, to evaluate the effect of weight loss on pericardial adipose stores and cardiac structure in overweight/obese individuals with paroxysmal AF using cardiac magnetic resonance (CMR) imaging.
Abstract and Introduction
Abstract
Background Obesity and pericardial adipose tissue are independent risk factors for atrial fibrillation (AF) and adverse cardiac structural remodeling. The effect of weight reduction on pericardial adipose tissue and cardiac structure remains unknown.
Methods We prospectively performed cardiac magnetic resonance imaging on 87 participants with AF undergoing either structured weight management (intervention) or general lifestyle advice (control). We measured pericardial adipose tissue, atrial and ventricular volumes, and myocardial mass at baseline and 12 months.
Results In total, 69 participants underwent baseline and 12-month follow-up cardiac magnetic resonance imaging (intervention n = 36 and controls n = 33). From baseline to 12 months, weight loss (kg, mean [95% CI]) was greater in the intervention group from 101.5 kg (97.2–105.8 kg) to 86.5 kg (81.2–91.9 kg) as compared with controls from 102.6 kg (97.2–108.1 kg) to 98.7 kg (91.0–106.3 kg) (time-group interaction P < .001). The intervention group showed a reduction in left atrial volumes (mL) from 105.0 mL (98.9–111.1 mL) to 96.4 mL (91.6–101.1 mL), whereas the change in the control group was from 108.8 mL (99.6–117.9 mL) to 108.9 mL (99.8–118.0 mL) (time-group interaction P < .001). There was a decline in pericardial adipose tissue (cm) from 140.9 cm (129.3–152.4 cm) to 118.8 cm (108.1–129.6 cm) and myocardial mass (g) from 137.6 g (128.1–147.2 g) to 123.1 g (114.5–131.7 g) in the intervention group, whereas the change in the control group was from 143.2 cm (124.6–161.7 cm) to 147.2 cm (128.9–165.4 cm) for pericardial adipose tissue and 138.3 g (124.8–151.8 g) to 140.7 g (127.4–154.1 g) for myocardial mass (both variables, time-group interaction P < .001).
Conclusions Weight reduction results in favorable structural remodeling and a reduction in pericardial adipose tissue burden.
Introduction
Obesity is a significant risk factor for the development and progression of atrial fibrillation (AF). We have recently demonstrated for the first time in a randomized trial that weight loss is associated with a reduction in AF burden in overweight and obese individuals. The mechanisms by which weight loss results in reduction in AF burden remain uncertain, however.
Pericardial adipose tissue has recently emerged as a risk factor for the development of AF independent of traditional metabolic risk factors including measures of systemic obesity, such as body mass index (BMI). Observations suggest that pericardial adipose tissue may be a unique metabolically active visceral adipose depot and an important source of inflammatory and profibrotic cytokines, thereby potentially influencing contiguous cardiac pathologic changes. In the ventricular chambers, autopsy studies have shown a strong correlation between myocardial mass and pericardial adipose volume, independent of the underlying ventricular pathology, suggesting myocardial structural remodeling may, in part, be influenced by overlying pericardial adipose tissue.
The aim of this current study was, therefore, to evaluate the effect of weight loss on pericardial adipose stores and cardiac structure in overweight/obese individuals with paroxysmal AF using cardiac magnetic resonance (CMR) imaging.