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Introduction: Accumulation of excess intra-peritoneal fat is associated with left ventricular (LV) dysfunction in those not receiving treatment for cancer. We sought to determine if increases in intra-peritoneal fat were associated with declines in LV ejection fraction (LVEF) after receipt of potentially cardio-toxic chemotherapy. Methods: In 61 patients (32 lymphoma, 23 breast cancer, 6 sarcoma) we obtained magnetic resonance imaging (MRI) assessments of abdominal fat (intra-peritoneal [IP], retroperitoneal [RP] and subcutaneous [SQ]) at the level of the L2 vertebra, as well as LVEF prior to and 24 months after initiating cardio-toxic chemotherapy (70% doxorubicin, 1% trastuzumab, 5% taxol, 26% docetaxel, and 67% cyclophosphamide). Correlations between 24-month change in LVEF and baseline measures of body mass index (BMI), IP, RP & SQ fat were identified after accounting for baseline LVEF, height, gender, anthracycline use, and time. Results: A total of 61 participants (age 53 ± 15 yrs; 32% men, 78% Caucasian) exhibited an average baseline BMI of 30 ± 6 kg/m2, height of 170 ± 11cm, and a baseline LVEF of 62 ± 8%. After accounting for height, baseline LVEF, anthracycline use, gender and time between visits, baseline IP fat volume was associated with a LVEF decline (r=-0.27, p=0.047) while BMI, RP and SC fat were not (p= 0.09 to 0.41 for all). Those older than median age of 52 yrs. with high IP fat trended toward greater declines in LVEF (r=0.31, p=0.082) when compared to younger individuals (<52 yrs.) (r=0.24, p=0.346). Within the entire cohort, those with high IP/low SQ fat experienced marked declines in LVEF (p= 0.026). Conclusions: Pre-chemotherapy intra-peritoneal fat (not necessarily reflected in an assessment of BMI) is associated with declines in LVEF 2 years after receipt of cardio-toxic chemotherapy. These findings suggest those with larger amounts of intra-peritoneal fat are at higher risk for developing left ventricular dysfunction upon receipt of cardio-toxic chemotherapy. [ABSTRACT FROM AUTHOR]