Characteristics of heart changes in overweight and obese patients

Background. The visceral adipose tissue has the greatest influence on disorders of the structure and function of the heart. Discrepancies in studies assessing the impact of obesity on the structure and function of the heart are apparently related to the heterogeneity of obesity and the fact that patients with varying degrees of visceral obesity were included and compared in the study. The effect of obesity on the heart in most cases is associated with thickening of the LV myocardial wall due to lipid infiltration and mild cardiomyocyte hypertrophy. In addition to fat infiltration of the intercellular space of the myocardium, with visceral obesity, intracellular accumulation of fatty acids occurs, which combine into triglycerides, which leads to steatosis of the heart. Intracellular accumulation of lipids, which in publications is called myocardial fat, ultimately leads to the death of a cardiomyocyte (lipotoxicity). These changes further lead to diastolic dysfunction with the possible subsequent development of heart failure, regardless of the influence of concomitant diseases such as arterial hypertension, diabetes and coronary heart disease. In a smaller number of cases, the predominance of LV dilation over wall thickening contributes to the development of systolic dysfunction. In the presence of diastolic dysfunction, subclinically pronounced systolic dysfunction may also be present. The presence of concomitant diseases repeatedly accelerates and aggravates the heart damage that occurs in obesity up to the development of dilated cardiopathy and severe heart failure, which should be called fatty cardiopathy. Thanks to a better understanding of the mechanisms of the development of fatty cardiopathy, it became obvious that this is a preventable and potentially reversible process associated with overweight, but more pronounced in people with severe obesity and the presence of concomitant diseases.

Conclusion. Given the reversibility of heart changes in obesity, it is necessary to detect and combat visceral obesity and concomitant diseases as early as possible.

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