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. Author manuscript; available in PMC: 2019 Mar 27.
Published in final edited form as: Circulation. 2018 Mar 27;137(13):1391–1406. doi: 10.1161/CIRCULATIONAHA.117.029617

Figure 3. Mechanistic Model for Effects of Obesity on Cardiac Dysfunction and Heart Failure.

Figure 3

Model for adiposity-related cardiac dysfunction integrates our understanding of body fat distribution into a potential etiologic pathway leading from obesity to heart failure. Excessive fat accumulation in visceral and ectopic sites result in increasing circulating blood volume and local and systemic pro-atherogenic inflammatory factors which act to increased stroke volume, cardiac wall stress, and myocardial injury leading to concentric left ventricular hypertrophy, left ventricular remodeling, and ultimately diastolic and systolic cardiac failure. Natriuretic peptides released by cardiomyocytes may exert differential effects on fat metabolism in a positive feedback loop modified by factors such as exercise, sex hormones, and insulin resistance. LBAT=lower body subcutaneous adipose tissue; VAT=visceral adipose tissue