Intra-thoracic adiposity is associated with impaired contractile function in patients with coronary artery disease: a cardiovascular magnetic resonance imaging study

  • Anna Todd
  • Alessandro Satriano
  • Kate Fenwick
  • Naeem Merchant
  • Carmen P. Lydell
  • Andrew G. Howarth
  • Matthias G. Friedrich
  • Todd J. Anderson
  • Nowell M. Fine
  • James A. WhiteEmail author
Original Paper


The influence of visceral adiposity on left ventricular remodeling following coronary artery disease (CAD)-related events has not been examined to date. Using magnetic resonance imaging (MRI) we explored intra-thoracic fat volume (ITFV) and strain-based markers of adverse remodeling in patients with CAD. Forty-seven patients with known CAD (25 with prior MI, 22 without prior MI) were studied. ITFV was quantified using previously validated imaging techniques. Myocardial strain was derived from cine MRI using a validated 3D feature-tracking (FT) software. Segmental LGE quantification was performed and was used to incrementally constrain strain analyses to non-infarcted (i.e. remote) segments. Remote myocardial strain was compared to the non-MI control cohort and was explored for associations with ITFV. Mean age was 57 ± 13 years with a mean BMI of 30.0 ± 6.2 kg/m2 (range 20.3–38.4 kg/m2). Patients with versus without prior MI had similar demographics and BMI (29.4 ± 4.4 vs. 30.4 ± 7.9 kg/m2, p = 0.62). Patients with prior MI had lower mean peak strain than non-MI patients (p = 0.02), consistent with remote tissue contractile dysfunction. Inverse associations were identified between ITFV and mean peak strain in both the MI group (circumferential: r = 0.43, p = 0.03; radial: − 0.41, p = 0.04; minimum principal: r = 0.41, p = 0.04; maximum principal: r = − 0.43, p = 0.03) and non-MI group (circumferential: r = 0.42, p = 0.05; minimum principal: r = 0.45, p = 0.03). In those with prior MI higher ITFV was associated with a greater reduction in remote tissue strain. ITFV is associated with contractile dysfunction in patients with CAD. This association is prominent in the post-MI setting suggesting relevant influence on remote tissue health following ischemic injury. Expanded study of intra-thoracic adiposity as a modulator of myocardial health in patients with CAD is warranted.


Intra-thoracic fat volume ITFV Strain Late gadolinium enhancement Adiposity Adaptive remodeling 



Body mass index


Body surface area


Coronary artery bypass graft


Coronary artery disease


Cardiac magnetic resonance


High density lipoproteins


Intra-class correlation


Intra-thoracic fat volume


Glomerular filtration rate


Low density lipoproteins


Late gadolinium enhancement


Left ventricle


Left ventricular end-diastolic volume


Left ventricular end-diastolic volume index


Left ventricular ejection fraction


Left ventricular mass


Left ventricular mass index


Left ventricular end-systolic volume index


Myocardial infarction


Magnetic resonance imaging


Percutaneous coronary intervention



Dr. White received salary support from the Heart and Stroke Foundation of Alberta during this study, receives research grant support from the Circle Cardiovascular Inc. and is a shareholder of Cohesic Inc. Dr. Howarth receives consulting fees from Amgen. Dr. Matthias G. Friedrich is Chief Medical Officer of Circle Cardiovascular Inc. Dr. Fine receives consulting fees from Novartis and Pfizer.


This study was funded by Heart and Stroke Foundation of Alberta.

Compliance with Ethical Standards

Conflict of interest

Dr. Anna Todd has no conflict of interest. Dr. Alessandro Satriano declares that he has no conflict of interest. Ms. Kate Fenwick declares that she has no conflict of interest. Dr. Naeem Merchant declares that he has no conflict of interest. Dr. Carmen P. Lydell declares that she has no conflict of interest. Dr. Andrew G. Howarth receives consulting fees from Amgen. Dr. Matthias G. Friedrich is Chief Medical Officer of Circle Cardiovascular Inc. Dr. Todd J. Anderson declares that he has no conflict of interest. Dr. Nowell M. Fine receives consulting fees from Novartis and Pfizer. Dr. James A. White received salary support from the Heart and Stroke Foundation during this study, received research grants from Circle Cardiovascular Inc., and is a shareholder of Cohesic Inc.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involved in human or animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10554_2018_1430_MOESM1_ESM.docx (47 kb)
Supplementary material 1 (DOCX 46 KB)


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Anna Todd
    • 1
    • 2
  • Alessandro Satriano
    • 1
    • 2
  • Kate Fenwick
    • 1
  • Naeem Merchant
    • 3
  • Carmen P. Lydell
    • 3
  • Andrew G. Howarth
    • 1
    • 2
  • Matthias G. Friedrich
    • 4
  • Todd J. Anderson
    • 2
  • Nowell M. Fine
    • 2
  • James A. White
    • 1
    • 2
    Email author
  1. 1.Stephenson Cardiac Imaging CentreCalgaryCanada
  2. 2.Division of Cardiology, Department of Cardiac SciencesLibin Cardiovascular Institute of AlbertaCalgaryCanada
  3. 3.Department of Diagnostic ImagingUniversity of CalgaryCalgaryCanada
  4. 4.McGill University Health CentreMontrealCanada

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