The Muscle Mass Paradox: Elevated Lean Mass Indices Impair Systolic Function via Myocardial Remodeling in Obesity

Objectives To explore the relationships between cardiac parameters and body composition indices, identifying predictors of subclinical cardiac systolic dysfunction. Methods Using anthropometric and serological parameters, echocardiography, and body composition analysis, this study evaluated metabolic profiles, cardiac remodeling patterns, and body composition characteristics in young adult obese patients, while quantifying the correlations between cardiac parameters and body composition indices. Subclinical left ventricular systolic dysfunction was defined as global longitudinal strain (GLS) < 18%. Results This study included 91 obese participants categorized as metabolically healthy obesity (MHO) group ( n = 25) and metabolically unhealthy obesity (MUO) group ( n = 66), with 20 healthy controls as reference. Compared with controls, both MUO and MHO groups showed reduced myocardial longitudinal strain (all p < 0.05), with greater impairment in MUO than MHO. Impaired GLS occurred in 31 obese participants (34.07%), who showed higher fat‐free mass index (FFMI), and skeletal muscle mass index (SMI) compared to those with preserved GLS (all p < 0.05). Correlation analysis revealed significant associations between body composition indices and cardiac parameters. Multivariate logistic regression identified SMI (OR 1.81, 95% CI 1.12–2.93, p < 0.001) and FFMI (OR 1.43, 95% CI 1.07–1.91, p < 0.001) as independent predictors of impaired GLS. Conclusion Impaired GLS commonly manifests in obese individuals. SMI and FFMI were established as independent predictors of this cardiac dysfunction.