Abnormal myocardial deformation properties in obese, non-hypertensive children: an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study

Salvo, Giovanni Di; Pacileo, Giuseppe; Giudice, Emanuele Miraglia del; Natale, Francesco; Limongelli, Giuseppe; Verrengia, Marina; Rea, Alessandra; Fratta, Fiorella; Castaldi, Biagio; D’Andrea, Antonello; Calabrò, Paolo; Miele, Tiziana; Coppola, Filomena; Russo, Maria Giovanna; Caso, Pio; Perrone, Laura; Calabrò, Raffaele

doi:10.1093/eurheartj/ehl163

Cited by 143 publications

(132 citation statements)

References 49 publications

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“…These findings are in agreement with those of other authors studying obese subjects; 4,11,12,22,23 in particular, they are consistent with the results reported by Ballo et al 24 in obese hypertensive patients with normal left-ventricular ejection fraction. Moreover, our data add to the evidence reported by Mureddu et al 25 that obesity does not significantly increase the prolonged isovolumic relaxation found in non-obese hypertensive patients.…”

Section: Left-ventricular Diastolic Functionsupporting

confidence: 93%

“…This relationship was particularly highlighted by the evaluation of the early-diastolic mitral inflow/mitral annular velocity and the mitral annulus E m /A m ratios, in agreement with the findings of most other authors. 4,11,12,22,23 Notably, in our study, the variation was quite similar in terms of significance for both of these parameters. This finding, confirmed in two other studies, 4,12 may suggest that the mitral annulus E m /A m ratio, which is more feasible and practical to obtain in routine echocardiographic practice and is equal in sensitivity to the early-diastolic mitral inflow/mitral annular velocity ratio, could be helpful in evaluating diastolic function in these patients.…”

Section: Left-ventricular Diastolic Functionsupporting

confidence: 73%

“…These results challenge previous findings 7,9,26 and support more recent literature, 4,11,12,22,24 probably because of the use of newer and more sensitive echocardiographic techniques rather than conventional echocardiographic measurements, such as left-ventricular ejection fraction and fractional shortening, which are relatively insensitive, and thus unable to detect early preclinical changes in left-ventricular function.…”

Section: Left-ventricular Morphology and Systolic Functioncontrasting

confidence: 60%

“…4,11,12,[22][23][24] Even if left-ventricular ejection fraction values were completely normal with no significant differences between the subgroups, mitral annulus S m , and more impressively basal interventricular septum peak strain and peak strain rate values, showed a significant reduction; consequently, these measurements were able to identify and assess the obesity-related sub-clinical left-ventricular systolic dysfunction.…”

Section: Left-ventricular Morphology and Systolic Functionmentioning

confidence: 98%

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Obesity-related adjunctive systo–diastolic ventricular dysfunction in patients with hypertension: echocardiographic assessment with tissue Doppler velocity and strain imaging

et al. 2011

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Very few data exist regarding the effect of obesity on both left and right systo-diastolic ventricular function in hypertensive patients. Therefore, the aim of this study was to determine the existence and extent of an obesity-related adjunctive depressive effect on left-and right-ventricular systo-diastolic dysfunction. This study compared non-obese with obese hypertensive patients and evaluated left-and right-ventricular morphological and functional parameters by means of conventional echocardiography and by two new sensitive echocardiographic techniques: tissue Doppler velocity and strain imaging. We selected 248 hypertensive patients and divided them into four groups according to increasing body mass index (BMI). All patients underwent a clinical history and examination and transthoracic echocardiography, including conventional echocardiographic evaluation and tissue Doppler velocity and strain imaging measurements. Conventional echocardiographic evaluation did not reveal an association between ventricular systo-diastolic dysfunction and increasing BMI. In contrast, tissue Doppler velocity and strain imaging measurements emphasized the negative influence of obesity. For measurements in both the left and right ventricle, myocardial early peak diastolic velocities (E m ), the ratio of myocardial early-to-late peak diastolic velocity (E m /A m ), myocardial peak systolic velocities (S m ), and peak strain and strain rate values significantly decreased with increasing BMI (Po0.01 for all parameters measured), even after adjusting for potential confounding variables. In conclusion, by means of new more sensitive echocardiographic techniques, our study clearly demonstrated the negative impact of obesity on both left-and right-ventricular systo-diastolic function, in terms of adjunctive sub-clinical worsening, in hypertensive patients.

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Section: Left-ventricular Diastolic Functionsupporting

confidence: 93%

Section: Left-ventricular Diastolic Functionsupporting

confidence: 73%

Section: Left-ventricular Morphology and Systolic Functioncontrasting

confidence: 60%

Section: Left-ventricular Morphology and Systolic Functionmentioning

confidence: 98%

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Obesity-related adjunctive systo–diastolic ventricular dysfunction in patients with hypertension: echocardiographic assessment with tissue Doppler velocity and strain imaging

et al. 2011

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“…The sample size was calculated using the indexed LV mass from a previous study [23]. A sample of 45 patients in each group was calculated to provide a 90% power to detect a clinical effect (increase equal or greater than 30%) in LV mass, with a significance level (alpha) of 0.05 (two-tailed) [24].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Right Atrial Function in Obese Pediatric Patients

Barbosa¹,

Damião²,

P³

et al. 2013

J Obes Weight Loss Ther

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IntroductionObesity has become an epidemic in both developed and developing countries. Statistics from the United States of America reveal a 32.2% rate of obesity among adult men and 25.5% among adult women [1]. It is estimated that Five to 10 million adult individuals in the United States alone have severe obesity (body mass index ≥ 40 kg/m 2 ) [2]. In developing countries, the prevalence of obesity has reached more than 20% of the population. Reports on the pediatric population (children and adolescents aged two to 19 years) reveal that 11.9% are at or above the 97 th percentile of the body mass index (BMI) for age, 16.9% are at or above the 95 th percentile and 31.7% are at or above the 85 th percentile [3]. Ten percent of children starting school in the United Kingdom are already obese [4]. Cardiovascular complications associated with obesity contribute to high rates of morbidity and mortality. Structural and functional alterations in the heart, such as left ventricular hypertrophy, diastolic/systolic dysfunction and atrial enlargement, are well established in adult and pediatric patients with obesity [5][6][7][8][9][10]. Left atrial dysfunction with left ventricular diastolic dysfunction in subjects with preserved systolic function is well established in patients with hypertension [11,12]. There is strong evidence that left atrial enlargement and dysfunction are associated with an increase in morbidity and mortality rates in patients with cardiovascular disease and present clinical relevance with respect to the rate of long-term events, survival and the risk of developing atrial fibrillation [13]. Using Doppler-derived strain and strain rate (SR) MethodsObese pediatric patients six to 18 years of age with a BMI above the 95 th percentile were prospectively recruited from the nutrition clinic of a university hospital (Universidade Federal de Minas Gerais) in Belo Horizonte, Brazil. The control group was formed by children aged six to 18 years with a BMI below the 85 th percentile recruited from the general pediatrics clinic of the same institution. Patients with a history of hypertension, diabetes mellitus, endocrinological disorders, hereditary or inflammatory systemic diseases, sleep apnea (according to parents' information) and athletes were excluded in both groups. This study received approval from the Human Research Ethics Committee of the institution and written informed consent was obtained from all participants and/or parents. The participants were weighed in light clothing without shoes using a Welmy ® scale with a capacity of 300 Kg and accuracy of 100 g. Height was measured with a stadiometer (accuracy of 0.5 cm). BMI was calculated using the conventional formula of weight in kilograms divided by the square of height in AbstractBackground : Left atrial enlargement and right and left ventricular dysfunction have been described in obese Patients. A number of studies have also described atrial dysfunction in obese children and adolescents.

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