Adverse right ventricular remodelling, function, and stress responses in obesity: insights from cardiovascular magnetic resonance

Figures

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  Figure 1. Cardiac phenotype in class III obesity assessed using CMR. (A) Participants of healthy weight and with class III obesity underwent 1.5T and 3T CMR and a subgroup underwent 31P MRS. (B) Assessment of cardiac volumes and systolic function using CMR (red—LV endocardium, green—LV epicardium, orange—left atrium, and yellow—right ventricular endocardium) including feature tracking strain analysis and representative 31P spectrum. (C) Class III obesity was associated with RV dilatation and systolic dysfunction which was associated with impairment of cardiac energetics. (D) Class III obesity was associated with LV remodelling and impairment of systolic but not diastolic function. Unless otherwise stated data are presented as mean ± standard deviation, *P < 0.05, **P < 0.01, ***P < 0.001. Hollow circles denote participants with healthy weight, black circles those with class III obesity.

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  Figure 2. Abnormal RV systolic and diastolic stress response in obesity. Study participants (n = 27) with class I–II obesity or healthy weight underwent cine CMR before and during dobutamine stress; a subgroup also underwent 31P MRS for energetics. Participants with obesity had a delayed peak of diastolic RV filling at rest consistent with diastolic dysfunction, an attenuated stress inducible increase in RV ejection fraction, and an impaired stress inducible change in peak RV filling rate (a measure of stress RV diastolic dysfunction). There was a non-significant numerical trend to greater cardiac energetic deficit during stress in obesity. Data are presented as mean ± standard deviation, *P < 0.05, **P < 0.01, ***P < 0.001.

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  Figure 3. Beneficial effects of weight loss on RV remodelling and function. A subgroup of patients with class III obesity from Study 1 underwent follow-up imaging after weight loss surgery. Weight loss was associated with significant improvements in RV volume and systolic function. One pre-operative 31P spectrum was not evaluable due to poor spectral quality. Data are presented as mean ± standard deviation, *P < 0.05, **P < 0.01, ***P < 0.001.