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Map** the Unseen: In Vivo CEST-MRI of Creatine Reveals Improved Cardiac Energetics in Subjects with Obesity Following Bariatric Surgery

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Abstract

Background

Obesity is associated with derangement of cardiac metabolism and the development of subclinical cardiovascular disease. This prospective study examined the impact of bariatric surgery on cardiac function and metabolism.

Methods

Subjects with obesity underwent cardiac magnetic resonance imaging (CMR) at Massachusetts General Hospital before and after bariatric surgery between 2019 and 2021. The imaging protocol included Cine for global cardiac function assessment and creatine chemical exchange saturation transfer (CEST) CMR for myocardial creatine map**.

Results

Thirteen subjects were enrolled, and 6 subjects [mean BMI 40.5 ± 2.6] had completed the second CMR (i.e. post-surgery), with a median follow-up of 10 months. The median age was 46.5 years, 67% were female, and 16.67% had diabetes. Bariatric surgery led to significant weight loss, with achieved mean BMI of 31.0 ± 2.0. Additionally, bariatric surgery resulted in significant reduction in left ventricular (LV) mass, LV mass index, and epicardial adipose tissue (EAT) volume. This was accompanied by slight improvement in LV ejection fraction compared to baseline. Following bariatric surgery, there was a significant increase in creatine CEST contrast. Subjects with obesity had significantly lower CEST contrast compared to subjects with normal BMI (n = 10), but this contrast was normalized after the surgery, and statistically similar to non-obese cohort, indicating an improvement in myocardial energetics.

Conclusions

CEST-CMR has the ability to identify and characterize myocardial metabolism in vivo non-invasively. These results demonstrate that in addition to reducing BMI, bariatric surgery may favorably affect cardiac function and metabolism.

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Fig. 1

Data Availability

The data that support the findings of this study are available on request from the corresponding author.

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Funding

C.T.N is supported by grants from National Institute of Health (R01 HL151704, R01 HL159010, R01 HL135242). C.T.F is supported by grants from National Institute of Health (R01-EB031008 and R01-CA203873). S.D, E.D.A and C.T.N are supported by a grant from American Heart Association (SFRN 20SFRN35120267).

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Authors and Affiliations

  1. Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02124, USA

    Salva R. Yurista, Shi Chen, Robert A. Eder, Thomas Garrett, Saumya Das & Christopher T. Nguyen

  2. Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA

    Salva R. Yurista, Shi Chen, Robert A. Eder, Thomas Garrett, Christian T. Farrar & Christopher T. Nguyen

  3. Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Salva R. Yurista, Shi Chen, Thomas Garrett, W. H. Wilson Tang & Christopher T. Nguyen

  4. Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, JJ55 S, Cleveland, OH, 44195, USA

    Salva R. Yurista, Shi Chen, Thomas Garrett & Christopher T. Nguyen

  5. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    W. Scott Butsch & Ali Aminian

  6. MGH Weight Center, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Denise Gee

  7. Department of Medicine, David Geffen School of Medicine and UCLA Health, Los Angeles, CA, 90095, USA

    E. Dale Abel

  8. Division of Health Science Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA, 02139, USA

    Christopher T. Nguyen

  9. Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Christopher T. Nguyen

  10. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44106, USA

    Christopher T. Nguyen

Authors
  1. Salva R. Yurista
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  2. Shi Chen
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  3. Robert A. Eder
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  4. Thomas Garrett
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  5. W. Scott Butsch
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  6. Ali Aminian
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  7. W. H. Wilson Tang
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  8. Christian T. Farrar
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  9. Denise Gee
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  10. E. Dale Abel
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  11. Saumya Das
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  12. Christopher T. Nguyen
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Corresponding author

Correspondence to Christopher T. Nguyen.

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Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Key points

• This study examines the impact of bariatric surgery on cardiac function and metabolism.

• Subjects with obesity has lower cardiac creatine levels.

• Bariatric surgery reduces weight, BMI , LV mass index, and epicardial fat.

• These changes are accompanied improvement in LVEF and cardiac energetics.

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Yurista, S.R., Chen, S., Eder, R.A. et al. Map** the Unseen: In Vivo CEST-MRI of Creatine Reveals Improved Cardiac Energetics in Subjects with Obesity Following Bariatric Surgery. OBES SURG 33, 1944–1948 (2023). https://doi.org/10.1007/s11695-023-06589-0

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  • DOI: https://doi.org/10.1007/s11695-023-06589-0

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