Zhao Hang, Jiang Meng, Wang Wei, Tao Zhengyu, Wang Xu, Chai Yezi, Han Yuchi, Liu Qiming, Chen Yifan, Yue Jiang, Qi Yicheng, Li Xinli, Ma Jing, Pu Jun
Department of Cardiology, Ren Ji Hospital, State Key Laboratory for Oncogenes and Related Genes, School of Medicine, Shanghai Jiao Tong University; Shanghai 200127, China.
Department of Cardiology, Ren Ji Hospital, State Key Laboratory for Oncogenes and Related Genes, School of Medicine, Shanghai Jiao Tong University; Shanghai 200127, China.
Int J Cardiol. 2025 Aug 15;433:133321. doi: 10.1016/j.ijcard.2025.133321. Epub 2025 Apr 26.
Early detection of cardiac impairment in overweight and obesity is essential for early preventive strategies against heart failure. Myocardial work is a novel echocardiographic parameter that incorporates left ventricular afterload into global longitudinal strain analysis. This study aimed to: 1) assess subclinical alterations of myocardial work among non-diabetic overweight and obese individuals with normal left ventricular ejection fraction (LVEF); 2) investigate the impact of cardiometabolic traits on these alterations; and 3) determine the correlation between myocardial work and myocardial tissue characteristics.
In the prospective EARLY-MYO-OBESITY-II study (NCT04933188), we enrolled 150 non-diabetic participants, including 50 obese individuals (BMI ≥ 30 kg/m), 50 age- and gender-matched overweight individuals (BMI 25-30 kg/m), and 50 healthy lean controls (BMI < 25 kg/m). Non-invasive myocardial work was calculated from two-dimensional speckle-tracking echocardiography and cuff blood pressure, while myocardial fibrosis was assessed using extracellular volume fraction (ECV) and native T1 value from cardiac magnetic resonance imaging.
Global work index (GWI) and constructive work (GCW) were decreased in the obese participants compared with the overweight and control groups. Both overweight and obese groups exhibited elevated global wasted work (GWW) and reduced global work efficiency (GWE). In multivariate regression analysis, elevated Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values were independently associated with reduced GWI and GCW (β = -89.953 and -121.191, respectively). The overweight and obese groups showed elevated ECV and native T1 compared to the control group. GWW and GWE were significantly correlated with ECV (Spearman's Rho 0.516 and -0.547, respectively) and demonstrated superior predictive value for myocardial fibrosis (AUC = 0.86 and 0.82, respectively) compared to global longitudinal strain (AUC = 0.58).
Myocardial work is impaired in non-diabetic overweight and obese individuals, even with preserved LVEF. Insulin resistance is significantly and independently associated with myocardial work, highlighting the importance of targeting individuals with insulin resistance to reduce heart failure risk. Non-invasive myocardial work may serve as an image marker for detecting early cardiac fibrosis.
早期发现超重和肥胖人群的心脏功能损害对于心力衰竭的早期预防策略至关重要。心肌做功是一种新的超声心动图参数，它将左心室后负荷纳入整体纵向应变分析。本研究旨在：1）评估左心室射血分数（LVEF）正常的非糖尿病超重和肥胖个体中心肌做功的亚临床改变；2）研究心脏代谢特征对这些改变的影响；3）确定心肌做功与心肌组织特征之间的相关性。
在前瞻性EARLY-MYO-OBESITY-II研究（NCT04933188）中，我们纳入了150名非糖尿病参与者，包括50名肥胖个体（BMI≥30kg/m²）、50名年龄和性别匹配的超重个体（BMI 25-30kg/m²）以及50名健康瘦对照组（BMI<25kg/m²）。通过二维斑点追踪超声心动图和袖带血压计算无创心肌做功，同时使用心脏磁共振成像的细胞外容积分数（ECV）和固有T1值评估心肌纤维化。
与超重和对照组相比，肥胖参与者的整体做功指数（GWI）和建设性做功（GCW）降低。超重和肥胖组均表现出整体浪费做功（GWW）升高和整体做功效率（GWE）降低。在多变量回归分析中，胰岛素抵抗稳态模型评估（HOMA-IR）值升高与GWI和GCW降低独立相关（β分别为-８９.９５３和-１２１.１９１）。与对照组相比，超重和肥胖组的ECV和固有T1升高。GWW和GWE与ECV显著相关（Spearman相关系数分别为0.516和-0.547），并且与整体纵向应变（AUC=0.58）相比，对心肌纤维化具有更高的预测价值（AUC分别为0.86和0.82）。
即使LVEF保留，非糖尿病超重和肥胖个体的心肌做功也会受损。胰岛素抵抗与心肌做功显著且独立相关，突出了针对胰岛素抵抗个体以降低心力衰竭风险的重要性。无创心肌做功可能作为检测早期心脏纤维化的影像标志物。
