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  • Review Article
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Obesity cardiomyopathy: diagnosis and therapeutic implications

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 480–490 (2007)Cite this article

Abstract

Obesity is associated with an increased risk of heart failure. Apparently healthy obese individuals can, however, exhibit subclinical left ventricular dysfunction. The use of myocardial imaging techniques to detect this subclinical change could have important management implications with respect to initiating prophylactic therapy. In this Review, we evaluate possible pharmacologic and nonpharmacologic strategies for treating obesity cardiomyopathy in the context of currently understood mechanisms, including myocardial remodeling and small vessel disease, and more speculative mechanisms such as insulin resistance, and activation of the renin–angiotensin–aldosterone and sympathetic nervous systems.

Key Points

  • Obesity is associated with an increased risk of heart failure

  • Subclinical left ventricular dysfunction can be detected with noninvasive cardiac imaging techniques such as echocardiography (including tissue Doppler imaging, backscatter and strain imaging), MRI, CT and nuclear ventriculography

  • Therapeutic approaches include weight control by dietary intervention and exercise, and bariatric surgery for the morbidly obese

  • Renin–angiotensin–aldosterone system antagonists, β-blockade and insulin sensitizers are potential therapeutic options for individuals with obesity cardiomyopathy

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Figure 1: Tissue Doppler imaging curves showing improvement in diastolic tissue velocity from (A) 5.2 cm/s at baseline, to (B) 6.9 cm/s after weight loss
Figure 2: Reduced NT-proBNP (mean and SE) in obese patients and nonobese patients with ischemic and dilated cardiomyopathy17
Figure 3: Mean changes in diastolic mitral annular velocity as a function of weight change in tertiles (lowest tertile showing minor weight gain, middle tertile showing stable weight and highest tertile showing weight loss) in obese patients12

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Acknowledgements

The authors would like to acknowledge the National Health and Medical Research Council, Canberra, Australia for a Centers of Clinical Research Excellence Award and postgraduate research scholarship.

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Authors and Affiliations

  1. C Wong is a Cardiologist and Postgraduate Research Fellow, and TH Marwick is Professor of Medicine, at the School of Medicine, University of Queensland, Brisbane, Australia.,

    Chiew Wong & Thomas H Marwick

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  1. Chiew Wong
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Correspondence to Thomas H Marwick.

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Competing interests

C Wong declared no competing interests.

TH Marwick receives grant support from GE Healthcare and Philips Medical Systems, but unrelated to this topic.

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Wong, C., Marwick, T. Obesity cardiomyopathy: diagnosis and therapeutic implications. Nat Rev Cardiol 4, 480–490 (2007). https://doi.org/10.1038/ncpcardio0964

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