EARLY-MYO-OBESITY-CMR is a prospective, three-center, cardiac imaging study to investigate cardiac morphology, function, and tissue phenotypes in a cohort of non-diabetic obese adults, and compare with metabolically healthy non-obese controls.

1. Transthoracic echocardiography was performed to analyze the LV morphology and function.
2. CMR was performed within 24 hours of the echocardiographic examination to assess the cardiac morphology , cardiac function, and myocardial tissue characteristics. Standard cine images were acquired to quantify LV function and volume. T1 mapping-derived ECV values were used to detect subtle diffuse fibrosis , and late gadolinium-enhanced (LGE) imaging was used to identify focal fibrosis. Native T2 values were obtained to quantify myocardial edema . Global longitudinal peak systolic strain (GLS) and e' SR were assessed by tissue tracking analysis to detect subclinical systolic and diastolic dysfunction.

Inclusion criteria:

• age 18-75 years without cardiac symptoms or known cardiac diseas;
• body mass index ≥25 kg/m2

Exclusion criteria:

• coronary artery disease (coronary artery stenosis >50% on angiography or coronary computed tomography, documented myocardial infarction, or a history of coronary artery bypass graft surgery or percutaneous coronary intervention)
• non-ischemic cardiovascular disease, such as idiopathic cardiomyopathy, valvular disease, congenital heart disease, or pulmonary heart diseas
• a left ventricular (LV) ejection fraction of<50% on echocardiography or a history of heart failure
• arrhythmia or the presence of bundle branch block on electrocardiography
• pacemaker or defibrillator implantation
• renal dysfunction with an estimated glomerular filtration rate of <60 mL/min/1.73 m2
• contraindications to cardiac magnetic resonance (CMR) imaging
• malignancy or life expectancy of less than 2 year
• inability to provide written informed consent

Adult obese participants without cardiac symptoms or known cardiac disease