. 2023 Jun;33(6):1944-1948.

doi: 10.1007/s11695-023-06589-0. Epub 2023 Apr 14.

Mapping the Unseen: In Vivo CEST-MRI of Creatine Reveals Improved Cardiac Energetics in Subjects with Obesity Following Bariatric Surgery

Salva R Yurista^{1

2

3

4}, Shi Chen^{1

2

3

4}, Robert A Eder^{1

2}, Thomas Garrett^{1

2

3

4}, W Scott Butsch⁵, Ali Aminian⁵, W H Wilson Tang³, Christian T Farrar², Denise Gee⁶, E Dale Abel⁷, Saumya Das¹, Christopher T Nguyen^{8

9

10

11

12

13

14}

Affiliations

¹ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02124, USA.
² Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
³ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
⁴ Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, JJ55 S, Cleveland, OH, 44195, USA.
⁵ Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
⁶ MGH Weight Center, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA.
⁷ Department of Medicine, David Geffen School of Medicine and UCLA Health, Los Angeles, CA, 90095, USA.
⁸ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02124, USA. nguyenc6@ccf.org.
⁹ Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA. nguyenc6@ccf.org.
¹⁰ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. nguyenc6@ccf.org.
¹¹ Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, JJ55 S, Cleveland, OH, 44195, USA. nguyenc6@ccf.org.
¹² Division of Health Science Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. nguyenc6@ccf.org.
¹³ Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. nguyenc6@ccf.org.
¹⁴ Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44106, USA. nguyenc6@ccf.org.

PMID: 37058265
PMCID: PMC11100502
DOI: 10.1007/s11695-023-06589-0

Mapping the Unseen: In Vivo CEST-MRI of Creatine Reveals Improved Cardiac Energetics in Subjects with Obesity Following Bariatric Surgery

Salva R Yurista et al. Obes Surg. 2023 Jun.

. 2023 Jun;33(6):1944-1948.

doi: 10.1007/s11695-023-06589-0. Epub 2023 Apr 14.

Authors

Affiliations

¹ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02124, USA.
² Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
³ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
⁴ Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, JJ55 S, Cleveland, OH, 44195, USA.
⁵ Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
⁶ MGH Weight Center, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA.
⁷ Department of Medicine, David Geffen School of Medicine and UCLA Health, Los Angeles, CA, 90095, USA.
⁸ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02124, USA. nguyenc6@ccf.org.
⁹ Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA. nguyenc6@ccf.org.
¹⁰ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. nguyenc6@ccf.org.
¹¹ Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, JJ55 S, Cleveland, OH, 44195, USA. nguyenc6@ccf.org.
¹² Division of Health Science Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. nguyenc6@ccf.org.
¹³ Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. nguyenc6@ccf.org.
¹⁴ Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44106, USA. nguyenc6@ccf.org.

PMID: 37058265
PMCID: PMC11100502
DOI: 10.1007/s11695-023-06589-0

Abstract

Background: Obesity is associated with derangement of cardiac metabolism and the development of subclinical cardiovascular disease. This prospective study examined the impact of bariatric surgery on cardiac function and metabolism.

Methods: Subjects with obesity underwent cardiac magnetic resonance imaging (CMR) at Massachusetts General Hospital before and after bariatric surgery between 2019 and 2021. The imaging protocol included Cine for global cardiac function assessment and creatine chemical exchange saturation transfer (CEST) CMR for myocardial creatine mapping.

Results: Thirteen subjects were enrolled, and 6 subjects [mean BMI 40.5 ± 2.6] had completed the second CMR (i.e. post-surgery), with a median follow-up of 10 months. The median age was 46.5 years, 67% were female, and 16.67% had diabetes. Bariatric surgery led to significant weight loss, with achieved mean BMI of 31.0 ± 2.0. Additionally, bariatric surgery resulted in significant reduction in left ventricular (LV) mass, LV mass index, and epicardial adipose tissue (EAT) volume. This was accompanied by slight improvement in LV ejection fraction compared to baseline. Following bariatric surgery, there was a significant increase in creatine CEST contrast. Subjects with obesity had significantly lower CEST contrast compared to subjects with normal BMI (n = 10), but this contrast was normalized after the surgery, and statistically similar to non-obese cohort, indicating an improvement in myocardial energetics.

Conclusions: CEST-CMR has the ability to identify and characterize myocardial metabolism in vivo non-invasively. These results demonstrate that in addition to reducing BMI, bariatric surgery may favorably affect cardiac function and metabolism.

Keywords: Bariatric surgery; Cardiac function; Chemical saturation exchange transfer; Magnetic resonance imaging; Myocardial energetics; Obesity.

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Conflict of interest statement

Conflict of Interest All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Fig. 1**
The impact of bariatric surgery on cardiac function and metabolism. Changes in body weight (A), body mass index (B), LV mass (C), LV mass index (D), epicardial fat (E), LV ejection fraction (F), T1 value (G) and T2 value (H) after bariatric surgery. (**I-K**) Representative images of fat–water content, cine CMR, and T1 and T2 maps, respectively. (L) Graphs shows creatine signal (MTR_asym) for each concentration obtained from CEST-CMR phantom experiment. (M) Representative masked images of cardiac CEST-CMR at 1.8 ppm. (N) Myocardial creatine content before and after bariatric surgery. **(O)** Comparison of CEST contrast between subjects with normal BMI and subjects with obesity. LV indicates left ventricle; CMR indicates cardiac magnetic resonance imaging. *p < 0.05, **p < 0.01, ***p < 0.001

See this image and copyright information in PMC

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Mapping the Unseen: In Vivo CEST-MRI of Creatine Reveals Improved Cardiac Energetics in Subjects with Obesity Following Bariatric Surgery

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Mapping the Unseen: In Vivo CEST-MRI of Creatine Reveals Improved Cardiac Energetics in Subjects with Obesity Following Bariatric Surgery

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