Pattern and Severity of Diastolic Dysfunction in Obese Hypertensive Patients in Rural Population in South India

Abstract

OBJECTIVES:To assess the effect of obesity and hypertension on left ventricular (LV) diastolic function. BACKGROUND: Obese and overweight individuals are at increased risk of heart failure. LV diastolic dysfunction is an asymptomatic condition associated with future heart failure. It is unclear whether obesity and overweight are independently associated with LV diastolic dysfunction. Obesity is associated with heart failure, but an effect of weight, independent of comorbidities, on cardiac structure and function is not well established. Severe prolonged obesity in adults results in increased plasma volume, eccentric LV hypertrophy, and diastolic dysfunction. Obese people are at increased risk for the development of heart failure. METHODS: A total of eighty subjects of either gender, coming from rural background admitted in a tertiary care hospital in South India, were enrolled in this cross sectional case control study. Patients were enrolled from March 2014 to May 2015. The study sample was divided into three groups: normal weight [body mass index (BMI) <25.0], overweight ) and obese (BMI≥30). Diastolic dysfunction in each category of patients was assessed with standard methods. RESULTS: BMI was independently associated with higher E, A, and E/E′, an indicator of LV filling pressure (all p≤0.01). Overweight and obese had lower E′ (both p<0.01) and higher E/E′ (both p<0.01) than normal weight participants. E/A was lower in obese than normal weight subjects (p<0.01). The risk of diastolic dysfunction was significantly higher in overweight and obese compared to normal weight individuals. Hypertensive patients were found to have worse diastolic function as compared to those having normal blood pressure. CONCLUSIONS: Increased BMI was associated with worse LV diastolic function. The increased risk of LV diastolic dysfunction in both overweight and obese individuals may partially account for the increased risk of heart failure associated with both conditions. Overweight subjects without overt heart disease have subclinical changes of LV structure and function. These abnormalities in LV function may have important implications for explaining the myocardial dysfunction that is associated with increased cardiovascular morbidity and mortality caused by obesity. Hypertension adds to the worsening of diastolic dysfunction.