Obesity Effects on Cardiac Structure and Function

Obesity imposes a multifaceted burden on the heart by promoting both anatomical remodelling and functional impairment. Chronically elevated body mass leads to increased blood volume and cardiac output, driving adaptive enlargement of the left ventricle. Over time this may progress from physiological eccentric dilation to pathological concentric hypertrophy, characterised by increased wall thickness and relative wall thickness. Metabolic dysregulation, low-grade inflammation and adipokine imbalance further stimulate myocardial fibrosis and impair microvascular density, compromising oxygen delivery at the cellular level. Functionally, these changes manifest as subclinical diastolic dysfunction with elevated filling pressures and impaired relaxation, as well as reductions in systolic performance detectable by strain imaging despite preserved ejection fraction. Atrial remodelling and enlargement increase susceptibility to atrial fibrillation, while impaired aortic distensibility and elevated systemic vascular resistance compound the cardiac load. Early identification of these alterations through echocardiographic and magnetic resonance techniques enables risk stratification and informs interventions such as weight management, metabolic modulation and, in selected cases, surgical reduction of adiposity to reverse or attenuate adverse remodelling.

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Research from all publishers

Recent longitudinal analyses have demonstrated that higher body mass index (BMI) and waist-to-hip ratio across adulthood are independently associated with greater left ventricular mass, increased chamber dimensions and poorer diastolic indices by the age of 60–64 years, emphasising the cumulative impact of adiposity on myocardial structure and function. Advanced magnetic resonance studies in adults free of overt cardiovascular disease have shown that visceral and ectopic fat—particularly hepatic and pancreatic fat fractions—correlate with subclinical reductions in global myocardial strain and elevations in left ventricular end-diastolic volume, highlighting the role of fat distribution beyond general obesity measures. A large community-based cohort integrating BMI and waist-to-hip ratio with cardiovascular magnetic resonance phenotyping and outcome data revealed that adverse remodelling—higher left ventricular mass, concentricity and left atrial enlargement—mediates a substantial proportion of the increased risk of heart failure and atrial fibrillation attributable to obesity, underscoring the importance of combined anthropometric measures and imaging biomarkers in cardiovascular risk assessment.

Obesity Effects on Cardiac Structure and Function publication trend

The graph below shows the total number of articles in obesity effects on cardiac structure and function across all publications each year (not limited to Nature Index journals).

Technical terms

Left ventricular mass: The total weight of the myocardium in the left ventricle, indicative of hypertrophic remodelling.

Concentric remodelling: A pattern of cardiac adaptation in which wall thickness increases relative to chamber size, often in response to pressure overload or metabolic stress.

Global longitudinal strain (GLS): A sensitive echocardiographic measure of myocardial deformation, reflecting systolic function beyond ejection fraction.

Diastolic dysfunction: Impaired relaxation or increased stiffness of the ventricular myocardium, leading to elevated filling pressures.

Ectopic fat deposition: Accumulation of fat within non-adipose tissues (e.g. liver, pancreas, epicardium) that can trigger local inflammation and metabolic dysfunction.

Relative wall thickness: A ratio comparing wall thickness to chamber radius, used to distinguish between concentric and eccentric remodelling patterns.

References

1. Adulthood adiposity affects cardiac structure and function in later life. European Heart Journal (2024).
2. Association of abdominal adiposity, hepatic shear stiffness with subclinical left-ventricular remodeling evaluated by magnetic resonance in adults free of overt cardiovascular diseases: a prospective study. Cardiovascular Diabetology (2023).
3. The role of obesity-related cardiovascular remodelling in mediating incident cardiovascular outcomes: a population-based observational study. European Heart Journal - Cardiovascular Imaging (2023).
4. Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovascular Diabetology (2018).
5. Weight Loss with Sleeve Gastrectomy in Obese Type 2 Diabetes Mellitus: Impact on Cardiac Function. Obesity Surgery (2015).
6. Obesity Is Associated with Lower Coronary Microvascular Density. PLOS ONE (2013).
7. Remodeling and Fibrosis of the Cardiac Muscle in the Course of Obesity—Pathogenesis and Involvement of the Extracellular Matrix. International Journal of Molecular Sciences (2022).
8. Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction. Nutrition & Diabetes (2012).