Regional fat distribution as a determinant of mortality in populations with left ventricular systolic dysfunction: challenging the obesity paradox

AIMS: Obesity and regional fat distribution are associated with adverse cardiovascular outcomes, yet the prognostic significance of specific adiposity phenotypes in individuals with left ventricular systolic impairment remains incompletely defined. Body mass index (BMI) incompletely captures fat distribution and may underestimate metabolically adverse adiposity. METHODS AND RESULTS: Participants from the community-based UK Biobank Imaging Enhancement Programme who underwent cardiac magnetic resonance (CMR) imaging were evaluated. Individuals with CMR-defined left ventricular systolic impairment [left ventricular ejection fraction