Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study

Karason, Kristjan; Wallentin, I; Larsson, Bo; Sjöström, Lars

doi:10.1136/bmj.315.7113.912

Cited by 159 publications

(115 citation statements)

References 27 publications

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“…So far several studies after bariatric surgery could show an improvement of diastolic function after successful weight reduction. [36][37][38][39] One found an increase in the E/A ratio in obese patients after gastric bypass 7 months after surgery. 39) However, bariatric surgery is not a first line approach and risks of surgical procedures in obese patients should not be neglected.…”

Section: Discussionmentioning

confidence: 99%

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

et al. 2015

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SummaryObesity and the metabolic syndrome (MetS) are risk factors for left ventricular diastolic dysfunction (LVDD). However, little is known about the impact of successful weight reduction (WR) on diastolic function and physical performance.Obese subjects (øBMI 40.2 ± 8.6 kg/m 2 ) underwent a 1-year WR program comprising diet and lifestyle components. Echocardiography and exercise capacity (6-minute walk) were performed at baseline and after 1 year. The distribution of weight reduction was split at the sample median and subjects were dichotomized in "successful WR" (% WR ≥ median, corresponding to a weight loss of 8%) and "failed-WR" (% WR < median).From a total of 188 obese subjects, 71 had LVDD at baseline. Obese patients with successful WR improved their MetS alterations, including fasting glucose, insulin, lipids, adipokines, blood pressure levels, and epicardial fat thickness. (-28 [-54, -4], P < 0.01), and 6-minute walk distance (65 [19, 135], P < 0.01). Improvement of ≥ 2 LVDD criteria was accomplished in 30% of subjects with WR versus 10% without (P = 0.009). Using multivariable regression analysis, reduction of epicardial fat thickness was particularly predictive for the improvement of diastolic function.In summary, in severe obesity, successful long-term WR was associated with improved LV diastolic function and exercise capacity. (Int Heart J 2015; 56: 196-202) Key words: Adiposity, Metabolic syndrome, Diastolic dysfunction, Weight loss O besity and metabolic syndrome (MetS) are increasing in global prevalence. Accompanying these trends there is a concerning shift in the population weight distribution toward the more extreme ends of obesity, given an increased risk for cardiovascular morbidity and mortality that is associated with excess adiposity.1-4) One associated finding is an impairment of cardiac performance leading to myocardial systolic and diastolic dysfunction and clinical symptoms often indistinguishable from heart failure. In fact, evidence of left ventricular diastolic dysfunction (LVDD) is a common finding in the obese, and consequently, obesity is considered a risk factor for diastolic heart failure. 5-9)Although lifestyle modification and weight reduction are routinely recommended to improve symptoms and to reduce cardiovascular risk in the obese with metabolic disorders, their effects on diastolic function and physical performance have been studied only rudimentarily, particularly in adults with severe obesity. Thus, the aim of the present study was to assess the effect of long-term lifestyle and weight reduction programs on these measures in severely obese subjects with varying degrees of MetS.Notably, there is considerable variation in biological determinants, encompassing metabolic and endocrine factors and in the degree of weight loss per se achieved by individuals in response to caloric restriction and physical activity. 10,11) In this regard, it is of interest that several of these biological determinants may independently influence diastolic function or modify the effect of...

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Section: Discussionmentioning

confidence: 99%

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

et al. 2015

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“…There is experimental and clinical evidence for the salutary effect of weight loss on cardiac morphology and function [26,[29][30][31][32][33][34][35]. Irrespective of the means of weight loss (surgical, pharmacological, dietary or physical training) [8-10, 25, 33, 34], small clinical studies have shown left ventricular mass reduction, improvement in left ventricular diastolic function and a minor increase in left ventricular systolic function [7,10,36].…”

Section: Clinical Effects Of Improved Myocardial Functionmentioning

confidence: 99%

Improvement of left ventricular function by lifestyle intervention in obesity: contributions of weight loss and reduced insulin resistance

et al. 2009

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Aims/hypothesis Weight excess and insulin resistance mediate the link between obesity and left ventricular dysfunction. We investigated the effect and mechanisms of lifestyle modification on left ventricular function changes in obese patients. Methods Reduction of body weight and insulin resistance was sought using a behavioural intervention programme including dietary restrictions and exercise training in 261 patients (age 45±13 years) with BMI ≥30 kg/m 2 , no history of cardiac disease and a normal stress echocardiogram. Each patient underwent echocardiographic measurement of myocardial deformation and velocity at baseline and at 6 month follow-up. Results Improvements in left ventricular systolic and diastolic function were demonstrated only in patients with significant reduction of weight and/or insulin resistance. Left ventricular improvement was less frequent in patients with diabetes than in those without (52% vs 82% for strain, 50% vs 81% for strain rate and 59% vs 80% for peak early diastolic myocardial velocity). The independent predictors of improved left ventricular systolic function (increase in strain) were: weight reduction (β=0.14, p<0.05), decrease in the HOMA insulin resistance index (β=0.20, p<0.005) and absence of diabetes (β=0.18, p<0.02). A decrease in HbA 1c also predicted improvement of left ventricular diastolic function (β=0.26, p<0.001). There was a parallel increment in exercise capacity with intervention and increase in strain was independently correlated with increase in Á VO 2 (β=0.13, p<0.04). Conclusions/interpretation Effective lifestyle modifications in obese patients improve left ventricular systolic and diastolic function, but appear less effective with coexisting diabetes. The reversal of left ventricular function abnormalities is associated with reduction of both weight and insulin resistance, and is accompanied by an increase in cardiorespiratory fitness.

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“…14 participants were not randomly assigned to groups, and no between-groups analyses were performed. In obese adolescents, a weight-and %BF-reducing diet intervention did not elicit any changes in LV structure and function.…”

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confidence: 99%

“…14,15 Other weight-reducing interventions, such as gastric surgery, have resulted in favorable improvements in LVM and RWT. A recent 13-week training study in nonobese children found favorable improvements in LV structure 16 ; limitations of this study are that the participants were not randomly assigned to groups, and no between-groups analyses were performed.…”

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confidence: 99%

Left Ventricular Structure and Function in Obese Adolescents: Relations to Cardiovascular Fitness, Percent Body Fat, and Visceral Adiposity, and Effects of Physical Training

et al. 2002

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ABSTRACT. Objective. Little is known about the relations of fitness and fatness to left ventricular structure and function in obese adolescents. This project had 2 purposes: 1) to determine the correlations of cardiovascular fitness and adiposity to left ventricular parameters in obese adolescents; and 2) to see the effect of 8 months of physical training (PT) at low and high intensities.Design. Obese 13-to 16-year-olds (N ‫؍‬ 81) were tested at baseline and then randomly assigned to lifestyle education (LSE) alone, LSE plus moderate-intensity PT, or LSE plus high-intensity PT. Follow-up testing was conducted 8 months later. Because no significant differences were found between moderate-intensity and high-intensity PT, the groups were combined to form a LSE ؉ PT group.Intervention. Eight months of PT, offered 5 days per week with the target energy expenditure for all PT participants being 250 kcal/session, and LSE every 2 weeks.Outcome Measures. Left ventricular mass divided by height to the 2.7th power (LVM/Ht 2.7 ), midwall fractional shortening (MFS), and relative wall thickness (RWT) were measured using M-mode echocardiography. Cardiovascular fitness was measured by a maximal multistage treadmill test; percent body fat (%BF) with dualenergy radiograph absorptiometry; and visceral adipose tissue (VAT) with magnetic resonance imaging.Results. At baseline, high levels of VAT were associated with higher RWT (r ‫؍‬ 0.30) and lesser MFS (r ‫؍‬ ؊0.29). Compared with the LSE-alone group, the LSE ؉ PT group significantly improved in cardiovascular fitness and decreased in %BF and VAT. However, there were no significant differences between groups on changes in LVM/Ht 2.7 , MFS, or RWT. Individual changes in cardiovascular fitness, %BF, and VAT did not correlate significantly with interindividual changes in left ventricular structure and function.Conclusions. High levels of VAT were associated with unfavorable left ventricular structure and function. However, no evidence was provided that an 8-month PT program, which improved cardiovascular fitness and reduced general and visceral adiposity, improved left ventricular structure and function. Future studies consisting of longer training programs and/or greater weight reductions are needed to see whether the adverse left ventricular effects of obesity can be ameliorated by exercise training. O besity and physical inactivity are modifiable lifestyle factors associated with cardiovascular disease, one of the major killers in the United States. 1 The prevalence of obesity in American children is on the rise and presents a major public health concern. 2 Unfavorable cardiovascular risk profiles are already present in children with low levels of cardiovascular fitness (CVF) and high levels of percent body fat (%BF) and visceral adipose tissue (VAT). [3][4][5][6][7] In addition, adolescent obesity is strongly associated with adult obesity and may lead to type 2 diabetes, hypertension, or stroke. 2 Left ventricular mass (LVM) and relative wall thickness (RWT), measures of left ve...

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Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study

Cited by 159 publications

References 27 publications

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

Improvement of left ventricular function by lifestyle intervention in obesity: contributions of weight loss and reduced insulin resistance

Left Ventricular Structure and Function in Obese Adolescents: Relations to Cardiovascular Fitness, Percent Body Fat, and Visceral Adiposity, and Effects of Physical Training

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