Table 2

Imaging Characteristics of Metabolic Heart Disease

DomainFindings
Cardiac morphologyLV concentric or eccentric hypertrophy
Myocardial tissue characterizationHigher cIB and shorter post-contrast CMR-derived T1 time, both indicative of enhanced myocardial fibrosis
LV diastolic functionUsually delayed relaxation, evidence of LV filling pressure elevation less common in preclinical phase
LV systolic functionEF and FS usually normal or even supranormal in obesity
Decrease in longitudinal function (strain or myocardial systolic velocities)
Circumferential and radial deformations unchanged, decreased, or increased (radial)
LV rotational functionIncreased LV torsion and untwisting rate
RV functionSystolic and diastolic abnormalities evidenced by longitudinal strain and myocardial velocities
LA functionImpaired LA deformation (reduced function)
LV response to stressUsually reduced systolic and diastolic reserve, as evidenced by tissue velocities, longitudinal strain and strain rate, E/e′ ratio, EF, FS, stroke volume, and ventriculoarterial coupling
Coronary microvascular functionReduced coronary flow reserve and diminished endothelium-dependent and independent vasodilation, as demonstrated by myocardial contrast echocardiography, distal coronary Doppler flow, and PET, usually with a vasodilating stressor agent (dipyridamole, adenosine, regadenoson) or with dobutamine

cIB = calibrated integrated backscatter; CMR = cardiac magnetic resonance; E/e′ ratio = peak early diastolic mitral flow velocity/peak early diastolic mitral annular velocity; EF = ejection fraction; FS = fractional shortening; LA = left atrial; LV = left ventricular; PET = positron emission tomography; RV = right ventricular.