Abstract Body (Do not enter title and authors here): Background: Higher body mass index (BMI) has been associated with worse echocardiographic parameters. Few studies have examined the influence of adiposity on cardiac function in South Asians (SA), a population with greater cardiovascular burden and visceral adiposity at a lower BMI than other race/ethnic groups.

Research Question: Which adiposity markers are more closely associated with echo measures of abnormal cardiac function?

Methods: We re-examined 675 participants in the Mediators of Atherosclerosis in SA Living in America (MASALA) study between 2021-2024. Participants completed echo (at rest and with legs up on a wedge pillow), 6-minute walk test (6MWD), anthropometry, and clinical data collection. We examined correlations and Loess plots of BMI, waist circumference (WC), and visceral abdominal fat area (VAT) with echo parameters overall and by gender. We calculated residuals of the linear regression between BMI and VAT to examine the discordance between VAT and BMI (T1: lower VAT for BMI; T2: concordant VAT and BMI; T3: greater VAT for BMI) and determined associated characteristics after adjusting for age and gender.

Results: Mean age was 66±9 years, 53% were male, mean BMI was 26.2±4.2 kg/m². BMI was poorly correlated to most echo parameters and modestly correlated with average E/e’ ratio (r=0.11) and with LV EDV (r=0.09). WC had a stronger correlation with LVEF (r=-0.17) and LV EDV (r=0.27). VAT had more consistent correlations with resting and legs up echo measures (r=0.09 to 0.20). Those with VAT greater than BMI were older and more frequently male; had lower exercise; lower 6MWD; higher hypertension and diabetes prevalence; higher Hba1c and triglycerides; and lower HDL. The Table shows the age, gender, eGFR, and hypertension adjusted echo parameters across the three VAT and BMI groups. Those with higher VAT than BMI had evidence of increase LV filling pressures with higher E/e’ ratio at rest and with legs up. Those with greater VAT than BMI who also had BMI<30 kg/m² were more likely to be men with diabetes and hypertension.

Conclusions: Visceral adiposity was better associated with echo parameters than BMI in older SA, especially among those with greater VAT than BMI. Nonobese SA men with hypertension and diabetes with significant visceral adiposity may benefit from targeted treatments such as GLP1 receptor agonists to reduce adiposity and improve cardiac function.