Skip to main content

Cardiac steatosis and left ventricular remodeling in heart failure with reduced and preserved ejection fraction

Background

Heart failure (HF) is characterised by alterations in fatty acid and glucose metabolism. We aimed to determine if myocardial lipid is increased in HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction (EF), and assess whether it is related to cardiac structure and function.

Methods

25 HFrEF due to dilated cardiomyopathy (DCM), 18 HFpEF (defined by EF >50%, abnormal diastolic function, maximum oxygen consumption <80% predicted for age, height and gender, with a cardiac limitation in exercise) and 28 normal volunteers were prospectively recruited. All subjects underwent cardiovascular magnetic (MR) resonance at 3T for the determination of left ventricular (LV) volumes and function, and cardiac 1H MR spectroscopy to quantify myocardial lipid/water (%).

Results

As expected DCM patients had significantly increased LV volumes and reduced EF, whilst HFpEF patients had significantly increased LV mass to end-diastolic volume ratio (LV mass/EDV). Importantly, cardiac lipid was increased in both HFrEF and HFpEF when compared to normal controls (cardiac lipid/water 0.67±0.42% in HFrEF; 1.06±0.83% in HFpEF versus normal controls 0.44±0.17, all p<0.05), with HFpEF group having the highest level of cardiac lipid (Table 1, Figure 1). In DCM patients, cardiac lipid negatively correlated with LVEF (r=-0.33, p=0.03) and positively correlated with LV size (r=0.54, p<0.001). In HFpEF, cardiac lipid positively correlated with age (r=0.41, p=0.008) and LV mass/EDV (r=0.37, p=0.02). Although HFpEF patients were significantly older, with age positively correlated with cardiac lipid, multiple regression analysis showed that age is not an independent predictor of cardiac lipid.

Table 1 Clinical characteristics of patients with reduced (HFrEF), preserved (HFpEF) ejection fraction and normal controls.
Figure 1
figure1

Cardiac lipid content in HFrEF, HFpEF and normal subjects. *p<0.05 vs HFpEF and normal; **p<0.05 vs normal.

Conclusions

This is the first study to demonstrate that myocardial steatosis occurs in both HFrEF and HFpEF and is related to parameters of LV remodeling. This suggests that myocardial lipid may play a role in the pathophysiological processes of LV remodeling in both HFrEF and HFpEF. Cardiac lipid accumulation may be a potential therapeutic target in these conditions.

Funding

N/A.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Masliza Mahmod.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mahmod, M., Pal, N., Holloway, C. et al. Cardiac steatosis and left ventricular remodeling in heart failure with reduced and preserved ejection fraction. J Cardiovasc Magn Reson 17, P309 (2015). https://doi.org/10.1186/1532-429X-17-S1-P309

Download citation

Keywords

  • Dilate Cardiomyopathy
  • Left Ventricular Mass
  • Left Ventricular Volume
  • Left Ventricular Remodel
  • Maximum Oxygen Consumption