Cardiac steatosis and left ventricular function in men with metabolic syndrome
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RESEARCH
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Cardiac steatosis and left ventricular function in men with metabolic syndrome Kristofer Nyman4, Marit Granér2, Markku O Pentikäinen2, Jesper Lundbom4, Antti Hakkarainen4, Reijo Sirén3, Markku S Nieminen2, Marja-Riitta Taskinen2, Nina Lundbom4 and Kirsi Lauerma1*
Abstract Background: Ectopic accumulation of fat accompanies visceral obesity with detrimental effects. Lipid oversupply to cardiomyocytes leads to cardiac steatosis, and in animal studies lipotoxicity has been associated with impaired left ventricular (LV) function. In humans, studies have yielded inconclusive results. The aim of the study was to evaluate the role of epicardial, pericardial and myocardial fat depots on LV structure and function in male subjects with metabolic syndrome (MetS). Methods: A study population of 37 men with MetS and 38 men without MetS underwent cardiovascular magnetic resonance and proton magnetic spectroscopy at 1.5 T to assess LV function, epicardial and pericardial fat area and myocardial triglyceride (TG) content. Results: All three fat deposits were greater in the MetS than in the control group (p 3000 ms) did not fall below the respiratory cycle length. Navigator echoes were collected from the lungdiaphragm interface and the end-systole triggering was set at about 80% of the resting heart rate of the subject. The spectra were collected with and without water suppression, using 32 and 4 acquisitions, respectively, and analyzed with jMRUI v3.0 software [21] using the AMARES algorithm [22] to determine water (4.7 ppm), methylene (1.3 ppm) and methyl (0.9 ppm) resonance areas. The myocardial TG content was expressed as a ratio of fat to water (%). Correction for methylene T2 relaxation was not possible due to lack of reliable data for cardiac application. Quantification of epicardial and pericardial fat
The 4-chamber oriented cine images were applied for measuring the epicardial and pericardial adipose tissue area as described previously [23]. All phases of the cine images were inspected and the measurements were performed in the single end-diastolic image using a standard radiologic workstation (Impax 5.5 software, Agfa Healthcare, Mortsel, Belgium). The areas of high intensity fat layers between the myocardium and the visceral pericardium (epicardial fat) and outside the
Nyman et al. Journal of Cardiovascular Magnetic Resonance 2013, 15:103 http://jcmr-online.com/content/15/1/103
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Figure 2 Evaluation of diastolic function in left ventricular (LV) volume versus time curve. A) LV filling pattern in a normal subject. Early peak filling rate (PFR) is derived from the steepest gradient in the volume curve in the early filling phase. The horizontal white line demonstrates the diastolic diastasis phase (plateau) separating the early and late diastole. B) LV filling pattern in a metabolic syndrome patient with LV diastolic dysfunction demonstrating a depression of diastolic plateau and early PFR (arrow).
parietal pericardium (pericardial fat) were measured (Figure 3). Intra-thoracic adipos
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