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(Circulation Research. 2007;101:759.)
© 2007 American Heart Association, Inc.

Review

Forgotten but Not Gone

The Rediscovery of Fatty Heart, the Most Common Unrecognized Disease in America

Lidia S. Szczepaniak, Ronald G. Victor, Lelio Orci, Roger H. Unger

From the Department of Internal Medicine, Division of Hypertension (L.S.S., R.G.V.); Department of Radiology (L.S.S.); and Touchstone Center for Diabetes Research (R.H.U.), University of Texas Southwestern Medical Center, Dallas; Veterans Affairs Medical Center (R.H.U.), Dallas, Tex; and Department of Cell Physiology and Metabolism (L.O.), University Medical Center, Geneva, Switzerland.

Correspondence to Roger H. Unger, Touchstone Center for Diabetes Research, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8854. E-mail roger.unger{at}utsouthwestern.edu

This Review is part of a thematic series on the Pathobiology of Obesity, which includes the following articles:

Adipose-Derived Stem Cells for Regenerative Medicine

Cardiac Energy Metabolism in Obesity

Leptin Signaling and Obesity: Cardiovascular Consequences

Forgotten but Not Gone: The Rediscovery of Fatty Heart, the Most Common Unrecognized Disease in America

Adiponectin As a Cardiovascular Protectant
Gary Lopaschuk Guest Editor

Until 60 years ago, fatty heart was an accepted clinical entity. Since then, its very existence has been questioned, despite the fact that 2 of 3 Americans are now obese or overweight and obesity has been shown to be correlated with cardiac functional abnormalities. In 2000, a syndrome of "lipotoxic cardiomyopathy" resembling earlier pathologic descriptions of fatty human hearts was described in rodents, and fatty infiltration of cardiomyocytes was subsequently reported in patients with congestive failure. Now, magnetic resonance spectroscopy has been adapted to permit routine noninvasive screening for fatty heart. The use of this technique in human volunteers indicates that cardiomyocyte fat correlates well with body mass index and is elevated in uncomplicated obesity. It is more severe when glucose tolerance becomes abnormal or diabetes is present. It is associated with impaired diastolic filling, even in seemingly asymptomatic obese volunteers. Because fatty heart can be readily prevented by lifestyle modification and pharmacologic interventions that reduce caloric intake and increase fatty acid oxidation, it seems important to recognize its existence so as to intervene as early as possible.

Key Words: magnetic resonance spectroscopy • lipotoxic cardiomyopathy • fatty heart • obesity

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