What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Obesity (n=81). Intervention: Increasing BMI vs. Lower BMI. Primary outcome: Phosphocreatine-to-ATP ratio (p=< 0.006).

What does this research mean for the field?

Increasing BMI in healthy men is associated with a reduced left ventricular phosphocreatine-to-ATP ratio, indicating abnormal energy metabolism linked to insulin resistance despite preserved cardiac function. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 25, 2007Open Access

Abnormal Left Ventricular Energy Metabolism in Obese Men With Preserved Systolic and Diastolic Functions Is Associated With Insulin Resistance

Q: What are the key findings of this study?

Increasing BMI in healthy men was associated with a reduced left ventricular phosphocreatine-to-ATP ratio (P<0.006), indicating abnormal energy metabolism despite preserved cardiac function.

Q: What does this research mean for the field?

Increasing BMI in healthy men is associated with a reduced left ventricular phosphocreatine-to-ATP ratio, indicating abnormal energy metabolism linked to insulin resistance despite preserved cardiac function. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

GPGianluca PerseghinUniversity of Milan GNGeorgia NtaliUniversity Hospitals Birmingham NHS Foundation Trust FCFrancesco De CobelliCardiac Imaging

Key Result

Increasing BMI in healthy men was associated with a reduced left ventricular phosphocreatine-to-ATP ratio (P<0.006), indicating abnormal energy metabolism despite preserved cardiac function.

Study Design

Type

Cross-Sectional (n=81)

Structured PICO

Population

81 healthy men, aged 22-55 years, with BMI between 19 and 35 kg/m2

Outcome

Left ventricular structure/geometry, function, and energy metabolism (phosphocreatine-to-ATP ratio) measured by cardiac magnetic resonance imaging and 31P-magnetic resonance spectroscopysurrogate

Abnormal left ventricular energy metabolism is detectable in obese, insulin-resistant men prior to the onset of functional or structural remodeling and overt hyperglycemia.

Main Result

p-value: p=< 0.006

Abstract

OBJECTIVE: Perturbations in cardiac energy metabolism might represent early alterations in diabetes preceding functional and pathological changes. We evaluated left ventricular (LV) structure/geometry and function in relation to energy metabolism and cardiovascular risk factors in overweight/obese men using magnetic resonance techniques. RESEARCH DESIGN AND METHODS: We studied 81 healthy men (aged 22-55 years, with BMI between 19 and 35 kg/m2) by means of cardiac magnetic resonance imaging and 31P-magnetic resonance spectroscopy in the resting and fasted conditions and stratified them in quartiles of BMI (cut offs: 23.2, 25.5 and 29.0 kg/m2). RESULTS: LV mass increased across quartiles of BMI; meanwhile, the volumes did not differ. Parameters of LV systolic and diastolic function were not different among quartiles. The phosphocreatine-to-ATP ratio was reduced across increasing quartiles of mean +/- SD BMI (2.25 +/- 0.52, 1.89 +/- 0.26, 1.99 +/- 0.38, and 1.79 +/- 0.29; P < 0.006) in association with insulin sensitivity (computer homeostasis model assessment 2 model); this relation was independent of age, BMI, blood pressure, wall mass, HDL cholesterol, triglycerides, smoking habits, and metabolic syndrome. CONCLUSIONS: Abnormal LV energy metabolism was detectable in obese men in the presence of normal function, supporting the hypothesis that metabolic remodeling in insulin resistant states precedes functional and structural/geometrical remodeling of the heart regardless of the onset of overt hyperglycemia.

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