Abstract
BackgroundObesity and visceral adiposity are increasingly recognized risk factors for cardiovascular disease. Visceral fat may reduce myocardial perfusion by impairing vascular endothelial function. Women experience more anginal symptoms compared to men despite less severe coronary artery stenosis, as assessed by angiography. Women and men have different fat storage patterns which may account for the observed differences in cardiovascular disease. Therefore, our objective was to evaluate the relationship between visceral adipose tissue distributions and myocardial perfusion in men and women.MethodsVisceral and subcutaneous fat distributions and myocardial perfusion were measured in 69 men and women without coronary artery disease using magnetic resonance imaging techniques. Myocardial perfusion index was quantified after first-pass perfusion with gadolinium contrast at peak dose dobutamine stress.ResultsWe observed inverse relationships between female gender (r = -0.35, p = 0.003), pericardial fat (r = -0.36, p = 0.03), intraperitoneal fat (r = -0.37, p = 0.001), and retroperitoneal fat (r = -0.36, p = 0.002) and myocardial perfusion index. Visceral fat depots were not associated with reduced myocardial perfusion at peak dose dobutamine in men. However, in women, BMI (r = -0.33, p = 0.04), pericardial fat (r = -0.53, p = 0.02), subcutaneous fat (r = -0.39, p = 0.01) and intraperitoneal fat (r = -0.30, p = 0.05) were associated with reduced myocardial perfusion during dobutamine stress.ConclusionsHigher visceral fat volumes are associated with reduced left ventricular myocardial perfusion at peak dose dobutamine stress in women but not in men. These findings suggest that visceral fat may contribute to abnormal microcirculatory coronary artery perfusion syndromes, explaining why some women exhibit more anginal symptoms despite typically lower grade epicardial coronary artery stenoses than men.
Highlights
Obesity is associated with multiple cardiovascular and metabolic derangements including hypertension, diabetes, dyslipidemia, endothelial dysfunction, and inflammation that have been linked to the development of coronary artery disease and heart failure
Visceral fat depots were not associated with reduced myocardial perfusion at peak dose dobutamine in men
Higher visceral fat volumes are associated with reduced left ventricular myocardial perfusion at peak dose dobutamine stress in women but not in men
Summary
Obesity is associated with multiple cardiovascular and metabolic derangements including hypertension, diabetes, dyslipidemia, endothelial dysfunction, and inflammation that have been linked to the development of coronary artery disease and heart failure. Visceral adiposity is recognized to play an important role in the development of many of the metabolic disorders which increase the risk for developing coronary artery disease (CAD). Visceral abdominal adiposity is associated with markers of peripheral vascular endothelial dysfunction whereas subcutaneous fat is not [4]. From these studies it appears that accumulation of fat in compartments other than subcutaneous tissues has adverse effects on the vasculature the effects on coronary artery blood flow and left ventricular myocardial perfusion have not been extensively studied. Our objective was to evaluate the relationship between visceral adipose tissue distributions and myocardial perfusion in men and women
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