Жировая кардиомиопатия у больных с тяжелой степенью ожирения. Клиническое наблюдение

Миклишанская С.В., Стукалова О.В., Соломасова Л.В., Мазур Н.А. Жировая кардиомиопатия у больных с тяжелой степенью ожирения. Клиническое наблюдение. Терапевтический архив. 2021; 93 (9): 1073–1077. DOI: 10.26442/00403660.2021.09.201038

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Miklishanskaya SV, Stukalova OV, Solomasova LV, Mazur NA. Fat cardiomyopathy in patients with severe degree of obesity. Case report. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (9): 1073–1077. DOI: 10.26442/00403660.2021.09.201038

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Аннотация

В настоящее время в мире наблюдается постоянный рост числа лиц с ожирением. Как показано во Фремингемском исследовании, ожирение является фактором риска многих сердечно-сосудистых заболеваний. Влияние ожирения на сердце проявляется в виде его ремоделирования, воздействия на энергетический метаболизм, а также в виде инфильтрации липидами миокарда и увеличения накопления жировой ткани в околосердечной сумке. Ремоделирование сердца в первую очередь происходит за счет утолщения стенок левого желудочка (ЛЖ) и увеличения массы миокарда ЛЖ. Нарушение систолической функции сердца реже наблюдается у лиц с ожирением по сравнению с диастолической дисфункцией. Однако современные методы (тканевой допплер, визуализация деформации миокарда – strain imaging) выявляют субклиническое снижение систолической функции у лиц с ожирением. Окончательно неизвестно, ассоциируется ли ожирение с систолической дисфункцией независимо от других факторов риска. В качестве иллюстрации мы приводим пример, когда ожирение и сопутствующая патология (артериальная гипертония, сахарный диабет, для которых характерно развитие нарушений диастолической функции) привели к развитию систолической дисфункции со снижением фракции выброса ЛЖ до 35% (жировая кардиопатия), что иллюстрирует потенциальную опасность развития выраженной систолической сердечной недостаточности вследствие как изолированного ожирения, так и комбинации его с сопутствующими заболеваниями.

Ключевые слова: сердечная недостаточность, жировая кардиопатия, ремоделирование сердца, энергетический метаболизм, инфильтрация липидами

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Currently, the world is constantly increasing the number of people with obesity. As was shown by the Framingham study, obesity is a risk factor for many cardiovascular diseases. The effect of obesity on the structure and function of the heart is manifested in the form of cardiac remodeling, the effect on energy metabolism in the heart and infiltration of both myocardium with lipids, and an increase in the accumulation of adipose tissue in the pericardium, imbalance of adipokines and activation of inflammatory markers. Cardiac remodeling occurs primarily due to thickening of the left ventricle (LV) walls and an increase in the LV myocardium mass. Systolic dysfunction of the heart is less common in obese individuals compared with diastolic dysfunction. However, more modern methods (tissue Doppler, visualization of the deformation of the chambers of the heart – strain imaging) reveal a subclinical decrease in systolic function in people with obesity. It is not fully known whether obesity is associated with systolic dysfunction, regardless of other risk factors. In any case, it has been proven that heart failure in people with obesity can develop independently of other risk factors. As an illustration, we give an example when the presence of obesity and concomitant pathology (arterial hypertension, diabetes) led to the development of systolic dysfunction with a decrease in the LV ejection fraction to 35% (fat cardiopathy), which show the potential for the influence of both obesity itself and in combination with concomitant diseases to lead to severe systolic heart failure.

Keywords: heart failure, fat cardiopathy, cardiac remodeling, energy metabolism, lipid infiltration

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Список литературы

1. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008;88:389-419. DOI:10.1152/physrev.00017.2007
2. Lavie CJ, Alpert MA, Arena R, et al. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail. 2013;1:93-102. DOI:10.1016/j.jchf.2013.01.006
3. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. New Engl J Med. 2002;347:305-13. DOI:10.1056/NEJMoa020245
4. Ashrafian H, Athanasiou T, le Roux CW. Heart remodelling and obesity: the complexities and variation of cardiac geometry. Heart. 2011;97(3):171-2. DOI:10.1136/hrt.2010.207092
5. Sletten AC, Peterson LR, Schaffer JE. Manifestations and mechanisms of myocardial lipotoxicity in obesity. J Intern Med. 2018;284:478-91. DOI:10.1111/joim.12728
6. Миклишанская С.В., Соломасова Л.В., Мазур Н.А. Ожирение и механизм его отрицательного влияния на структуру и функцию сердца. Рацион. фармакотерапия в кардиологии. 2020;16:108-17 [Miklishanskaya SV, Solomasova LV, Mazur NA. Obesity and the mechanism of its negative impact on the structure and function of the heart. Rational pharmacotherapy in cardiology. 2020;16:108-17 (in Russian)]. DOI:10.20996/1819-6446-2020-02-09
7. Rider OJ, Lewis AJ, Neubauer S. Structural and metabolic effects of obesity on the myocardium and the aorta. Obes Facts. 2014;7(5):329-38. DOI:10.1159/000368429
8. De la Maza MP, Estevez A, Bunout D, et al. Ventricular mass in hypertensive and normotensive obese subjects. Int J Obes Relat Metab Disord. 1994;18:193-7.
9. Alpert MA, Lambert CR, Terry BE, et al. Interrelationship of left ventricular mass, systolic function and diastolic filling in normotensive morbidly obese patients. Int J Obes Relat Metab Disord. 1995;19:550-7.
10. Otto ME, Belohlavek M, Khandheria B, et al. Comparison of right and left ventricular function in obese and nonobese men. Am J Cardiol. 2004;93:1569-72. DOI:10.1016/j.amjcard.2004.02.073
11. Morricone L, Malavazos AE, Coman C, et al. Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res. 2002;10:489-98. DOI:10.1038/oby.2002.67
12. Iacobellis G, Ribaudo MC, Leto G, et al. Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes Res. 2002;10:767-73. DOI:10.1038/oby.2002.104
13. Pascual M, Pascual DA, Soria F, et al. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart. 2003;89:1152-6. DOI:10.1136/heart.89.10.1152
14. Crendal E, Walther G, Vinet A, et al. Myocardial deformation and twist mechanics in adults with metabolic syndrome: impact of cumulative metabolic burden. Obesity. 2013;21(12):E679-86. DOI:10.1002/oby.20537
15. Lee HJ, Kim HL, Lim WH, et al. Subclinical alterations in left ventricular structure and function according to obesity and metabolic health status. PLoS One. 2019;14(9):e0222118. DOI:10.1371/journal.pone.0222118
16. Blomstrand P, Sjöblom P, Nilsson M, et al. Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovasc Diabetol. 2018;17:113-25. DOI:10.1186/s12933-018-0756-2
17. Wong C, Marwick T. Obesity cardiomyopathy: diagnosis and therapeutic implications. Nat Clin Pract Cardiovasc Med. 2007;4:480-90. DOI:10.1038/ncpcardio0964
18. Alexander JK. The cardiomyopathy of obesity. Prog Cardiovasc Dis. 1985;27:325-34. DOI:10.1016/s0033-0620(85)80002-5
19. Glenn DJ, Wang F, Nishimoto M, et al. A Murine Model of Isolated Cardiac Steatosis Leads to Cardiomyopathy. Hypertension. 2011;57:216-22. DOI:10.1161/HYPERTENSIONAHA.110.160655;13
20. Alpert A, Lambert CR, Panayiotou H, et al. Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol. 1995;76:1194-7. DOI:10.1016/S0002-9149(99)80338-5
21. Khan MF, Movahed MR. Obesity cardiomyopathy and systolic function: Obesity is not independently associated with dilated cardiomyopathy. Heart Fail Rev. 2013;18:207-17. DOI:10.1007/s10741-012-9320-4
22. Дедов И.И., Александров А.А., Кухаренко С.С. Сердце и ожирение. Ожирение и метаболизм. 2006;1:14-20 [Dedov II, Aleksandrov AA, Kyharenko SS. Heart and obesity. Obesity and metabolism. 2006;1:14-20 (in Russian)]. DOI:10.14341/2071-8713-4938
23. Ebong IA, Goff DC, Rodriguez CJ, et al. Mechanisms of Heart Failure in Obesity. Obes Res Clin Pract. 2014;8:e540-8. DOI:10.1016/j.orcp.2013.12.005
24. Ávila-Vanzzini N, Leyva C, Castellanos L, et al. Excessive Weight and Obesity Are Associated to Intra-Ventricular Asynchrony: Pilot Study.
J Cardiovasc Ultrasound. 2015;23(2):86-90. DOI:10.4250/jcu.2015.23.2.86
25. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-52. DOI:10.1161/CIRCULATIONAHA.105.169404
26. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. J Am Coll Cardiol. 2009;53(17):1475-87. DOI:10.1016/j.jacc.2009.02.007
27. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48. DOI:10.1093/eurheartj/eht210

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1. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008;88:389-419. DOI:10.1152/physrev.00017.2007
2. Lavie CJ, Alpert MA, Arena R, et al. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail. 2013;1:93-102. DOI:10.1016/j.jchf.2013.01.006
3. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. New Engl J Med. 2002;347:305-13. DOI:10.1056/NEJMoa020245
4. Ashrafian H, Athanasiou T, le Roux CW. Heart remodelling and obesity: the complexities and variation of cardiac geometry. Heart. 2011;97(3):171-2. DOI:10.1136/hrt.2010.207092
5. Sletten AC, Peterson LR, Schaffer JE. Manifestations and mechanisms of myocardial lipotoxicity in obesity. J Intern Med. 2018;284:478-91. DOI:10.1111/joim.12728
6. Miklishanskaya SV, Solomasova LV, Mazur NA. Obesity and the mechanism of its negative impact on the structure and function of the heart. Rational pharmacotherapy in cardiology. 2020;16:108-17 (in Russian). DOI:10.20996/1819-6446-2020-02-09
7. Rider OJ, Lewis AJ, Neubauer S. Structural and metabolic effects of obesity on the myocardium and the aorta. Obes Facts. 2014;7(5):329-38. DOI:10.1159/000368429
8. De la Maza MP, Estevez A, Bunout D, et al. Ventricular mass in hypertensive and normotensive obese subjects. Int J Obes Relat Metab Disord. 1994;18:193-7.
9. Alpert MA, Lambert CR, Terry BE, et al. Interrelationship of left ventricular mass, systolic function and diastolic filling in normotensive morbidly obese patients. Int J Obes Relat Metab Disord. 1995;19:550-7.
10. Otto ME, Belohlavek M, Khandheria B, et al. Comparison of right and left ventricular function in obese and nonobese men. Am J Cardiol. 2004;93:1569-72. DOI:10.1016/j.amjcard.2004.02.073
11. Morricone L, Malavazos AE, Coman C, et al. Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res. 2002;10:489-98. DOI:10.1038/oby.2002.67
12. Iacobellis G, Ribaudo MC, Leto G, et al. Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes Res. 2002;10:767-73. DOI:10.1038/oby.2002.104
13. Pascual M, Pascual DA, Soria F, et al. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart. 2003;89:1152-6. DOI:10.1136/heart.89.10.1152
14. Crendal E, Walther G, Vinet A, et al. Myocardial deformation and twist mechanics in adults with metabolic syndrome: impact of cumulative metabolic burden. Obesity. 2013;21(12):E679-86. DOI:10.1002/oby.20537
15. Lee HJ, Kim HL, Lim WH, et al. Subclinical alterations in left ventricular structure and function according to obesity and metabolic health status. PLoS One. 2019;14(9):e0222118. DOI:10.1371/journal.pone.0222118
16. Blomstrand P, Sjöblom P, Nilsson M, et al. Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovasc Diabetol. 2018;17:113-25. DOI:10.1186/s12933-018-0756-2
17. Wong C, Marwick T. Obesity cardiomyopathy: diagnosis and therapeutic implications. Nat Clin Pract Cardiovasc Med. 2007;4:480-90. DOI:10.1038/ncpcardio0964
18. Alexander JK. The cardiomyopathy of obesity. Prog Cardiovasc Dis. 1985;27:325-34. DOI:10.1016/s0033-0620(85)80002-5
19. Glenn DJ, Wang F, Nishimoto M, et al. A Murine Model of Isolated Cardiac Steatosis Leads to Cardiomyopathy. Hypertension. 2011;57:216-22. DOI:10.1161/HYPERTENSIONAHA.110.160655;13
20. Alpert A, Lambert CR, Panayiotou H, et al. Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol. 1995;76:1194-7. DOI:10.1016/S0002-9149(99)80338-5
21. Khan MF, Movahed MR. Obesity cardiomyopathy and systolic function: Obesity is not independently associated with dilated cardiomyopathy. Heart Fail Rev. 2013;18:207-17. DOI:10.1007/s10741-012-9320-4
22. Dedov II, Aleksandrov AA, Kyharenko SS. Heart and obesity. Obesity and metabolism. 2006;1:14-20 (in Russian). DOI:10.14341/2071-8713-4938
23. Ebong IA, Goff DC, Rodriguez CJ, et al. Mechanisms of Heart Failure in Obesity. Obes Res Clin Pract. 2014;8:e540-8. DOI:10.1016/j.orcp.2013.12.005
24. Ávila-Vanzzini N, Leyva C, Castellanos L, et al. Excessive Weight and Obesity Are Associated to Intra-Ventricular Asynchrony: Pilot Study.
J Cardiovasc Ultrasound. 2015;23(2):86-90. DOI:10.4250/jcu.2015.23.2.86
25. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-52. DOI:10.1161/CIRCULATIONAHA.105.169404
26. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. J Am Coll Cardiol. 2009;53(17):1475-87. DOI:10.1016/j.jacc.2009.02.007
27. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48. DOI:10.1093/eurheartj/eht210

Авторы

С.В. Миклишанская*1, О.В. Стукалова1,2, Л.В. Соломасова1, Н.А. Мазур1

1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*kvant83@list.ru

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Sofia V. Miklishanskaya*1, Olga V. Stukalova1,2, Lilia V Solomasova1, Nikolai A. Mazur1

1 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2 National Medical Research Center of Cardiology, Moscow, Russia
*kvant83@list.ru

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