Prevalence and determinants of left ventricular diastolic dysfunction in obese subjects and the role of left ventricular global longitudinal strain and mass normalized to height

Dini, Frank Lloyd; Fabiani, Iacopo; Miccoli, Mario; Galeotti, Gian Giacomo; Pugliese, Nicola Riccardo; D’Agostino, Andreina; Scartabelli, Alessandra; Conte, Lorenzo; Salvetti, Guido; Santini, Ferruccio; Pedrinelli, Roberto

doi:10.1111/echo.13890

Cited by 20 publications

(19 citation statements)

References 42 publications

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“…Obesity and MetS are also associated with LV diastolic dysfunction. [11, 13, 15] We found that indices of diastolic function were impaired in both obese and metabolically unhealthy subjects, and poor metabolic health status was more strongly associated with impaired diastolic function than high BMI, which is consistent with results of previous studies. [33, 34, 36] Among metabolic factors, SBP was found to show the strongest association with E/e´.…”

Section: Discussionsupporting

confidence: 91%

“…[7–9] Obesity has been reported to be associated with LV dilatation, LV hypertrophy, LV diastolic dysfunction as well as worse LV strain, though LVEF is typically preserved or only mildly impaired. [10–13] MetS has also been associated with LV hypertrophy, LV diastolic dysfunction and subtle LV systolic dysfunction with preserved LVEF. [14–17]…”

Section: Introductionmentioning

confidence: 99%

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Subclinical alterations in left ventricular structure and function according to obesity and metabolic health status

et al. 2019

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BackgroundObesity and metabolic syndrome (MetS) are associated with high risk of cardiac dysfunction and heart failure. We assessed the effect of obesity and metabolic health status on left ventricular (LV) structure and function in subjects without overt heart disease.MethodsIn 789 subjects (58.8±13.0 years, 50.7% males) without overt heart disease, LV morphology and function were compared among 6 groups stratified by body mass index (BMI) (normal weight, overweight and obese) and metabolic health status (meeting ≤1 criterion of MetS excluding waist circumference defined as metabolically healthy; otherwise, metabolically unhealthy).ResultsLV ejection fraction (LVEF) was not different among the 6 groups (P>0.05). However, high BMI and poor metabolic health were associated with poorer global longitudinal strain (GLS), higher LV mass index (LVMI) and higher E/e′ (P<0.001). Poor metabolic health status was associated with greater adverse changes in LV structure and function than obesity, and among MetS components, high systolic blood pressure (SBP) showed the greatest impact. Higher SBP, BMI and triglycerides were independently associated with worse GLS, and higher SBP was also associated with worse LVMI and E/e´. GLS, LVMI and E/e´ worsened in proportion to the number of MetS criteria or continuous MetS scores. Adverse myocardial changes associated with obesity were significant in the metabolically healthy group, but not in the metabolically unhealthy group.ConclusionsObesity and poor metabolic health status were associated with subclinical decrement in LV systolic and diastolic function, and higher LV mass, but not with LVEF, in subjects without overt heart disease.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Subclinical alterations in left ventricular structure and function according to obesity and metabolic health status

et al. 2019

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“…However the accuracy of these measurements is likely to be lower for echography-Doppler compared to CMR. Echography-Doppler nevertheless has the advantage of an easier evaluation of the LV diastolic function, an additional prognostic indicator (41), which is frequently affected in obese subjects (42). Unfortunately, the LV diastolic function could not be assessed in the present CMR study, which constitutes an additional limitation.…”

Section: Discussionmentioning

confidence: 88%

Arterial and Cardiac Remodeling Associated With Extra Weight Gain in an Isolated Abdominal Obesity Cohort

Mandry

Girerd

Lamiral

et al. 2021

Front. Cardiovasc. Med.

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Introduction: This study aims to assess the changes in cardiovascular remodeling attributable to bodyweight gain in a middle-aged abdominal obesity cohort. A remodeling worsening might explain the increase in cardiovascular risk associated with a dynamic of weight gain.Methods: Seventy-five middle-aged subjects (56 ± 5 years, 38 women) with abdominal obesity and no known cardiovascular disease underwent MRI-based examinations at baseline and at a 6.1 ± 1.2-year follow-up to monitor cardiovascular remodeling and hemodynamic variables, most notably the effective arterial elastance (Ea). Ea is a proxy of the arterial load that must be overcome during left ventricular (LV) ejection, with increased EA resulting in concentric LV remodeling.Results: Sixteen obese subjects had significant weight gain (>7%) during follow-up (WG+), whereas the 59 other individuals did not (WG–). WG+ and WG– exhibited significant differences in the baseline to follow-up evolutions of several hemodynamic parameters, notably diastolic and mean blood pressures (for mean blood pressure, WG+: +9.3 ± 10.9 mmHg vs. WG–: +1.7 ± 11.8 mmHg, p = 0.022), heart rate (WG+: +0.6 ± 9.4 min−1 vs. −8.9 ± 11.5 min−1, p = 0.003), LV concentric remodeling index (WG: +0.08 ± 0.16 g.mL−1 vs. WG−: −0.02 ± 0.13 g.mL−1, p = 0.018) and Ea (WG+: +0.20 ± 0.28 mL mmHg−1 vs. WG−: +0.01 ± 0.30 mL mmHg−1, p = 0.021). The evolution of the LV concentric remodeling index and Ea were also strongly correlated in the overall obese population (p < 0.001, R2 = 0.31).Conclusions: A weight gain dynamic is accompanied by increases in arterial load and load-related concentric LV remodeling in an isolated abdominal obesity cohort. This remodeling could have a significant impact on cardiovascular risk.

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“…Diastolic function is also affected in patients with obesity with abnormal pulsed mitral inflow, abnormal tissue Doppler velocities, and decreased longitudinal strain [ 54 , 55 ]. The prevalence of diastolic dysfunction may reach 19% in obese patients [ 56 ]. Furthermore, obesity affects left atrial (LA) size, LA reservoir, and conduit [ 57 ], with a significant correlation between LA size and LV mass [ 58 ].…”

Section: Heart Health In the Context Of Covid-19 And Obesitymentioning

confidence: 99%

Cardiopulmonary Pathophysiological Aspects in the Context of COVID-19 and Obesity

Fayssoil

Carnavalet

Mansencal

et al. 2021

SN Compr. Clin. Med.

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Obesity is a significant public health concern associated with high morbidity. Obese patients are at risk of severe COVID-19 infection, and obesity is a high-risk factor for admission to the intensive care unit. We aimed to write a narrative review of cardiac and pulmonary pathophysiological aspects of obese patients in the context of COVID-19 infection. Obesity affects lung volume, with a decrease in expiratory reserve volume, which is associated with a decrease in lung and chest wall compliance, an increase in airway resistance, and an increase in work of breathing. Obesity affects cardiac structure and hemodynamics. Obesity is a risk factor for hypertension and cardiovascular disorders. Moreover, obesity is associated with a low-grade inflammatory state, endothelial dysfunction, hyperinsulinemia, and metabolic disorders. Obesity is associated with severe COVID-19 and invasive mechanical ventilation. These previous cardiopulmonary pathological aspects may explain the clinical severity in obese patients with COVID-19. Obese patients are at risk of severe COVID-19 infection. Understanding cardiorespiratory pathophysiological aspects may help physicians manage patients in hospitals.

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Prevalence and determinants of left ventricular diastolic dysfunction in obese subjects and the role of left ventricular global longitudinal strain and mass normalized to height

Abstract: These results show that DD is highly prevalent among obese subjects and impairment of longitudinal systolic mechanics, as reflected by GLS reduction, and LV mass normalized to height are major independent predictors of DD in this patients' population.

Cited by 20 publications

References 42 publications

Subclinical alterations in left ventricular structure and function according to obesity and metabolic health status

Subclinical alterations in left ventricular structure and function according to obesity and metabolic health status

Arterial and Cardiac Remodeling Associated With Extra Weight Gain in an Isolated Abdominal Obesity Cohort

Cardiopulmonary Pathophysiological Aspects in the Context of COVID-19 and Obesity

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