The Relationship of Obesity with Subclinical Myocardial Injury and Heart Failure

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DESCRIPTION (provided by applicant): Chiadi E. Ndumele, MD, MHS is an Assistant Professor in the Division of Cardiology at Johns Hopkins University. Dr. Ndumele seeks a Mentored Patient-Oriented Research Career Development Award in order to obtain the skills, knowledge and research experience to provide the foundation for a career as an independent investigator in the field of cardiovascular disease prevention. Dr. Ndumele's career development plan includes the completion of a doctorate in Epidemiology at the Johns Hopkins Bloomberg School of Public Health, mentorship from Dr. Josef Coresh, MD, PhD and Dr. Gary Gerstenblith, M.D., and clinical research examining the relationship of obesity with subclinical myocardial injury, myocardial dysfunction and incident heart failure. The specific aims of the research agenda are to: 1) Evaluate the relationship of adult body weight history with the development of myocardial injury, myocardial dysfunction and incident heart failure; 2) Characterize the relationship of myocardial steatosis, evaluated by cardiac MRI spectroscopy, with myocardial injury and dysfunction; 3) To test the longitudinal effects of intentional weight loss before and after bariatric surgery on myocardial injury and dysfunction, and to identify novel risk factors fo myocardial injury in a new cohort of morbidly obese adults. The goals during the award period include developing expertise in the design, performance, analysis and presentation of clinical research, including leading data collection in a new cohort, through mentored research and tailored didactic coursework. Long term goals include developing a career as an independent clinical investigator and developing new approaches for preventing cardiovascular disease related to obesity. Obesity is strongly associated with the development of myocardial dysfunction and heart failure, but the mechanisms underlying this relationship are poorly understood and only partially explained by traditional risk factors. Recent studies demonstrate an independent, graded relationship between obesity and myocardial injury, as indexed by a novel high sensitivity assay for troponin T (hs-cTnT), among individuals without clinical cardiovascular disease that portends a markedly increased risk for the development of heart failure. The proposed research aims to elucidate the factors mediating the relationship of obesity with subclinical myocardial injury, myocardial dysfunction and incident heart failure, with the goal of informing future strategies for cardiovascular risk prediction and prevention among individuals with obesity.