Myocardial Metabolics

*Visions of Cardiomyocyte - Fundamental Concepts of Heart Life and Disease*

node and its disease. Arrhythmia & Electrophysiology Review [Internet]. 2015;**4**(1):28. Available from: http:// www.radcliffecardiology.com/articles/ biology-sinus-node-and-its-disease

[117] Protze SI, Liu J, Nussinovitch U, Ohana L, Backx PH, Gepstein L, et al. Sinoatrial node cardiomyocytes derived from human pluripotent cells function as a biological pacemaker. Nature Biotechnology. 2017;**35**(1):56-68

[118] Shamis Y, Hewitt KJ, Bear SE, Addy AH, Qari H, Margvelashvilli M, et al. IPSC-derived fibroblasts demonstrate augmented production and assembly of extracellular matrix proteins. In Vitro Cellular & Developmental Biology—

Animal. 2012;**48**(2):112-122

2014;**9**(6):1514-1531

[119] Orlova VV, Van Den Hil FE,

[120] Granata A, Serrano F, Bernard WG, McNamara M, Low L, Sastry P, et al. An iPSC-derived vascular model of Marfan syndrome identifies key mediators of smooth muscle cell death. Nature Genetics. 2017;**49**(1):97-109

[121] Musunuru K. Genome editing of human pluripotent stem cells to generate human cellular disease models. Disease Models & Mechanisms [Internet]. 2013;**6**(4):896-904. Available from: http://dmm.biologists.org/cgi/

doi/10.1242/dmm.012054

Petrus-Reurer S, Drabsch Y, Ten Dijke P, Mummery CL. Generation, expansion and functional analysis of endothelial cells and pericytes derived from human pluripotent stem cells. Nature Protocols.

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**Chapter 6**

**Abstract**

Obesity-Related Myocardiopathy

Cardiovascular disease in populations with obesity is a major concern because of it is epidemic proportion. Obesity leads to the development of cardiomyopathy directly via inflammatory mediators and indirectly by obesity-induced hypertension, diabetes, and coronary artery diseases. Metabolic disturbances such as increased free fatty acid levels, insulin resistance, elevated levels of adipokines, myocardial remodeling, activation of the sympathetic nervous and renin-angiotensinaldosterone systems, and small-vessel disease are the most important mechanisms in the development of obesity cardiomyopathy. The myocardial changes related with obesity are increasingly recognized, and they are independent of classic risk factors as hypertension, coronary artery disease, and obstructive sleep apnea. There is a wide range of evidence: the association between heart failure and obesity shown in epidemiologic studies; the confirmation of the association of adiposity with left ventricular dysfunction, independent of hypertension, coronary artery disease, and other heart diseases; and experimental evidence of functional and structural changes in the myocardium in response to increased adiposity support the existence

During the past half-century, the advances in the prevention, diagnosis, and management of cardiovascular disease (CVD) have been spectacular. The cardiovascularrelated deaths have declined by about two-thirds in industrialized nations [1]. Heart failure is characterized by an increased rate of cell death, which has been attributed to a variety of conditions: oxidative stress; abnormal elevations in circulating neurohormones; toxins, such as alcohol or cancer chemotherapeutic drugs; excessive adrenergic activity; inflammation; and infiltrative processes. Apoptosis is a highly regulated type of cell death that normally increases with aging. It has been suggested that, over time, the resulting deletion of myocytes leads to heart failure [2, 3]. The metabolic demand is increased in obesity; this is due to different factors as increasing blood volume, greater adipose tissue and lean mass, and as such, increased preload to the heart. In addition, in obese patients there are vascular alterations impacting arterial stiffness, and resistance increases afterload to the heart. In adults with obesity, both eccentric and concentric hypertrophies have been

noted and are impacted by the duration and the degree of the obesity [4, 5].

*Marco Antonio Lopez Hernandez*

of a cardiomyopathy related to obesity.

**1. Introduction**

**Keywords:** heart failure, obesity, adipokines, myocardiopathy
