PT  - JOURNAL ARTICLE
AU  - Jennifer J Rayner
AU  - William T Clarke
AU  - Mark A Peterzan
AU  - Christopher T Rodgers
AU  - Stefan Neubauer
AU  - Oliver J Rider
TI  - 15 Obesity is linked to increased ATP delivery rates in heart failure
AID  - 10.1136/heartjnl-2018-BCVI.30
DP  - 2018 May 01
TA  - Heart
PG  - A11--A11
VI  - 104
IP  - Suppl 5
4099  - http://heart.bmj.com/content/104/Suppl_5/A11.2.short
4100  - http://heart.bmj.com/content/104/Suppl_5/A11.2.full
SO  - Heart2018 May 01; 104
AB  - Introduction Obesity is associated with improved prognosis in heart failure, despite diminished myocardial energetic stores. It has been shown that reduced ATP transfer from the mitochondrion to the myofibril via creatine kinase is related to increased mortality. Given that the creatine kinase rate constant (k f CK) is elevated in obesity in the absence of cardiovascular disease, we hypothesised that the rate of ATP transfer would also be raised in obese heart failure.Methods 43 individuals (14 normal weight (BMI <25 kg/m2); 29 obese (BMI >30 kg/m2)) with DCM (EF 25%–45%) underwent MR imaging (3 T Siemens) of visceral, hepatic and myocardial lipid, and cardiac structure and function. They also underwent Triple Repetition time Saturation Transfer (TRiST) 31P magnetic resonance spectroscopy, to calculate apical myocardial k f CK.Results Obese DCM participants had greater BMI (37±5 kg/m2 compared to 23±3 kg/m2, p<0.001), and fat mass (46±13 kg compared to 17±8 kg, p<0.001). There were no significant differences in LV EDV (obese 227±58 ml, normal weight 210±48 ml, p=0.349), mass (obese 164±38 g, normal weight 145±42 g, p=0.165) or ejection fraction (obese 41%±6%, normal weight 37%±5%, p=0.119).However, k f CK was significantly higher in the obese group compared to normal weight (0.17±0.08s-1 compared to 0.08±0.07s-1, p=0.002). k f CK was significantly correlated with visceral fat volume (r=0.473, p=0.008).Conclusion Here we demonstrate that myocardial k f CK is higher in obese DCM, despite identical cardiac parameters to the control group. It has previously been shown that low k f CK is associated with heart failure events and mortality. Utilising multinuclear MRS to demonstrate the reverse in obesity, we propose this as a novel energetic basis underlying the obesity paradox.