Background In addition to hypertension, the constellation of metabolic abnormalities (diabetes mellitus, dyslipidemia and/or obesity) independently increases the incidence and severity of cardiovascular diseases, and this is compounded by the modern lifestyle and aging society. The prevalence of metabolic syndrome is high and non-hypertensive heart failure is common in Asians. Adverse cardiac remodeling is an important substrate for cardiac dysfunction in the onset and progression of heart failure and its amelioration improves outcomes and prognosis. Better understanding of metabolic-driven cardiac remodeling is warranted due to the rising prevalence and complexity of metabolic syndrome and strong interests in targeted therapy.

Methods and Analysis Response of the Myocardium to Hypertrophic Conditions in the Adult Population (REMODEL) is a prospective observational cohort study with an aim to establish the significance of cardiac remodeling by cardiovascular magnetic resonance (CMR). Expanding from the initial hypertension population, the study examines adults with cardiometabolic conditions including hypertension, diabetes, dyslipidemia, obesity and fatty liver disease. Cardiac remodeling features pertaining to hypertrophy, fibrosis and functional changes are assessed on CMR. Body adiposity is mapped by magnetic resonance imaging across the heart, liver and abdomen. Outcome data is adjudicated and follow-up assessment will be available in a subset of participants. Blood biomarkers will be investigated in relation to imaging findings. Cross-sectional analysis will establish the implication of cardiometabolic disease towards cardiac remodeling, while follow-up and outcome analysis will infer on disease progression and prognosis.

Ethics and Dissemination The study was approved by the SingHealth Centralised Institutional Review Board (2015/2603). Study outcomes will be published in peer-reviewed journals and scientific conferences.

Trial Registration Number NCT02670031

This prospective cohort study will allow targeted interrogation of the interplay between metabolic disorders and cardiac remodeling in a population-based multiethnic Asian cohort.

Longitudinal and biomarker analyses will elucidate cardiac remodeling progression and identify early and novel cardiometabolic risk markers.

Self-reporting data such as lifestyle habits and family history may be subject to recall bias.

The authors have declared no competing interest.

NCT02670031

The Ministry of Health Singapore and National Medical Research Council (MOH-CSAINV23jan-0001; NRMC/CG1/003/2021-NHCS).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the SingHealth Centralised Institutional Review Board (2015/2603).

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