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Pape DJ, Falls-Hubert KC, Merrill RA, Ahmed A, Qian Q, McGivney GR, Sobieralski P, Rauckhorst AJ, Yang L, Taylor EB. The mitochondrial dicarboxylate carrier mediates in vivo hepatic gluconeogenesis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.12.612761. [PMID: 39314408 PMCID: PMC11419125 DOI: 10.1101/2024.09.12.612761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Hepatic gluconeogenesis (GNG) is essential for maintaining euglycemia during prolonged fasting. However, GNG becomes pathologically elevated and drives chronic hyperglycemia in type 2 diabetes (T2D). Lactate/pyruvate is a major GNG substrate known to be imported into mitochondria for GNG. Yet, the subsequent mitochondrial carbon export mechanisms required to supply the extra-mitochondrial canonical GNG pathway have not been genetically delineated. Here, we evaluated the role of the mitochondrial dicarboxylate carrier (DiC) in mediating GNG from lactate/pyruvate. We generated liver-specific DiC knockout (DiC LivKO) mice. During lactate/pyruvate tolerance tests, DiC LivKO decreased plasma glucose excursion and 13C-lactate/-pyruvate flux into hepatic and plasma glucose. In a Western diet (WD) feeding model of T2D, acute DiC LivKO after induction of obesity decreased lactate/pyruvate-driven GNG, hyperglycemia, and hyperinsulinemia. Our results show that mitochondrial carbon export through the DiC mediates GNG and that the DiC contributes to impaired glucose homeostasis in a mouse model of T2D.
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Affiliation(s)
- Daniel J Pape
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Kelly C Falls-Hubert
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Ronald A Merrill
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Adnan Ahmed
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Qingwen Qian
- Department of Anatomy and Cell Biology, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Gavin R McGivney
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Paulina Sobieralski
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Adam J Rauckhorst
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- FOEDRC Metabolomics Core Research Facility, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Ling Yang
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Department of Anatomy and Cell Biology, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Eric B Taylor
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- FOEDRC Metabolomics Core Research Facility, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
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Otowa‐Suematsu N, Sakaguchi K, Kaneko A, Ito J, Morita Y, Miura H, Yamada T, So A, Komada H, Okada Y, Hirota Y, Tamori Y, Ogawa W. Relation of cardiac function to insulin resistance as evaluated by hyperinsulinemic-euglycemic clamp analysis in individuals with type 2 diabetes. J Diabetes Investig 2021; 12:2197-2202. [PMID: 34081831 PMCID: PMC8668073 DOI: 10.1111/jdi.13608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023] Open
Abstract
AIMS Whereas homeostasis model assessment of insulin resistance (HOMA-IR), an easily measured but limited index of insulin resistance, has been shown to correlate with impairment of cardiac function in individuals without diabetes, the pathological relevance of insulin resistance to the development of cardiac dysfunction in individuals with type 2 diabetes has remained unclear. Here we investigated the relation between left ventricular (LV) function as assessed by echocardiography and insulin resistance as evaluated by hyperinsulinemic-euglycemic clamp analysis, the gold standard for measurement of this parameter, in individuals with type 2 diabetes. METHODS This retrospective study included 34 individuals with type 2 diabetes who underwent both hyperinsulinemic-euglycemic clamp analysis and echocardiography. Both the insulin sensitivity index (ISI) as determined by glucose clamp analysis as well as HOMA-IR were determined as measures of insulin resistance. The ratio of the peak early- to late-diastolic mitral inflow velocities (E/A) and the LV ejection fraction (LVEF) were determined as measures of diastolic and systolic function, respectively. RESULTS The ISI was significantly correlated with both the E/A ratio and LVEF (correlation coefficients of 0.480 and 0.360, respectively), whereas HOMA-IR was not correlated with either cardiac parameter. Multivariate analysis revealed that ISI was an independent predictor for both a high log [E/A] (P = 0.031) and a high LVEF (P = 0.045). CONCLUSIONS Insulin resistance as evaluated by hyperinsulinemic-euglycemic clamp analysis may be causally related to LV diastolic and systolic dysfunction in individuals with type 2 diabetes.
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Affiliation(s)
- Natsu Otowa‐Suematsu
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Kazuhiko Sakaguchi
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
- Division of General Internal MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Akihiro Kaneko
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Jun Ito
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yasuko Morita
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Hiroshi Miura
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Tomoko Yamada
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Anna So
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Hisako Komada
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yuko Okada
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yushi Hirota
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yoshikazu Tamori
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
- Division of Creative Health PromotionDepartment of Social/Community Medicine and Health ScienceKobe University Graduate School of MedicineKobeJapan
| | - Wataru Ogawa
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
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Adlakha H, Malik P, Donthula R, Rajagopal H, Kan A, Srivastava S, Karnik R, Shenoy RU. Systemic ventricular strain is abnormal with elevated BMI in adults with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Özden G, Kibar Gül AE, Mengen E, Ucaktürk A, Gürsu HA, Çetin İİ, Kızılgün M. Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography. J Pediatr Endocrinol Metab 2021; 34:885-896. [PMID: 33901387 DOI: 10.1515/jpem-2020-0597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/04/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity. METHODS A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated. RESULTS The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m2) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index. CONCLUSIONS LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.
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Affiliation(s)
- Güzin Özden
- Department of Pediatrics, Clinic of University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Esin Kibar Gül
- Department of Pediatric Cardiology, Clinic of University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Eda Mengen
- Department of Pediatric Endocrinology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Ucaktürk
- Department of Pediatric Endocrinology, Ankara City Hospital, Ankara, Turkey
| | - Hazım Alper Gürsu
- Department of Pediatric Cardiology, Clinic of University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - İbrahim İlker Çetin
- Department of Pediatric Cardiology, Clinic of Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Murat Kızılgün
- Department of Biochemistry, Clinic of University of Health Sciences, Gülhane Hospital, Ankara, Turkey
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Zhang X, Kong S, Wu M, Niu Y, Wang K, Zhu H, Yuan J. Impact high fat diet on myocardial strain in mice by 2D speckle tracking imaging. Obes Res Clin Pract 2021; 15:133-137. [PMID: 33640277 DOI: 10.1016/j.orcp.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND High-fat diet (HFD) had a complex impact on the myocardium and resulted in diastolic dysfunction and hypertension on left ventricular (LV) hypertrophy, which can cause cardiac remodeling. Two-dimensional speckle tracking echocardiography (2D-STE) provided deformation information of the LV, which had been reported to be valuable in identifying preclinical or subtle myocardial dysfunction. This study assessed whether 2D-STE can investigate the effect of HFD on cardiac function in mice. METHODS Animals were grouped into HFD group and normal diet group according to whether they were feeding with HFD. We acquired the echocardiographic image and the mice weight before feeding, at 12th week and 20th week during feeding periods, compared the strain values and traditional echocardiographic measurements in both groups. RESULTS There was a stepwise increase in body weight both HFD group and normal group over time. There was a distinct statistics difference in body weight at the end of 12th and 20th week between the two groups (all P<0.05). There was no significant change in traditional echocardiographic measurements of left ventricle in the feeding periods. There was no obvious statistical difference in the strain values of the HFD mice compared to normal mice at 12th week (P>0.05); however, a significant decrease was observed in longitudinal strain (LS) and circumferential strain (CS) levels (P<0.05) at 20th week between the two groups. CONCLUSIONS Compared to the normal group, LS and CS values in the HFD mice were evidently decreased despite normal ejection fractions in both groups. 2D STE is sensitive to detect the LV altered cardiac mechanics associated with HFD and can provide valuable information for clinical intervention.
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Affiliation(s)
- Xijun Zhang
- Department of Ultrasonography, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Sha Kong
- Department of Ultrasonography, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Ming Wu
- Department of Ultrasonography, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Yulin Niu
- Department of Ultrasonography, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China
| | - Ke Wang
- Department of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan, China
| | - Haohui Zhu
- Department of Ultrasonography, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China.
| | - Jianjun Yuan
- Department of Ultrasonography, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China.
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Mavrogeni SI, Bacopoulou F, Markousis-Mavrogenis G, Chrousos G, Charmandari E. Cardiovascular Imaging in Obesity. Nutrients 2021; 13:744. [PMID: 33652678 PMCID: PMC7996902 DOI: 10.3390/nu13030744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Obesity represents one of the most challenging public health problems of our century. It accounts for approximately 5% of deaths worldwide, mostly owing to cardiovascular disease and its associated complications. Cardiovascular noninvasive imaging may provide early accurate information about hypertrophy and ischemia/fibrosis in obese subjects. Echocardiography and nuclear cardiology have serious limitations in obese subjects owing to poor acoustic window and attenuation artifacts, respectively. Coronary computed tomography angiography can provide information about obstructive coronary disease; however, the use of radiation is a serious disadvantage. Finally, cardiac magnetic resonance (CMR) holds the promise of an "all in one" examination by combining evaluation of function, wall motion/thickness, stress rest/perfusion, replacement and diffuse fibrosis without radiation. Future studies are required to document the cost/benefit ratio of the CMR in the evaluation of cardiovascular risk in overweight/obese children and adolescents.
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Affiliation(s)
- Sophie I. Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (S.I.M.); (G.M.-M.)
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (F.B.); (G.C.)
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (F.B.); (G.C.)
| | | | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (F.B.); (G.C.)
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Νational and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Νational and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
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Steggerda JA, Mahendraraj K, Todo T, Noureddin M. Clinical considerations in the management of non-alcoholic steatohepatitis cirrhosis pre- and post-transplant: A multi-system challenge. World J Gastroenterol 2020; 26:4018-4035. [PMID: 32821068 PMCID: PMC7403794 DOI: 10.3748/wjg.v26.i28.4018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/07/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is the most common chronic liver disease worldwide, and the fastest growing indication for liver transplantation in the United States. NASH is now the leading etiology for liver transplantation in women, the second leading indication for men, and the most common cause amongst recipients aged 65 years and older. Patients with end-stage liver disease related to NASH represent a unique and challenging patient population due the high incidence of associated comorbid diseases, including obesity, type 2 diabetes (T2D), and hypertension. These challenges manifest in the pre-liver transplantation period with increased waitlist times and waitlist mortality. Furthermore, these patients carry considerable risk of morbidity and mortality both before after liver transplantation, with high rates of T2D, cardiovascular disease, chronic kidney disease, poor nutrition, and disease recurrence. Successful transplantation for these patients requires identification and management of their comorbidities in the face of liver failure. Multidisciplinary evaluations include a thorough pre-transplant workup with a complete cardiac evaluation, control of diabetes, nutritional support, and even, potentially, consultation with a bariatric surgeon. This article provides a comprehensive review of the conditions and challenges facing patients with NASH cirrhosis undergoing liver transplantation and provides recommendations for evaluation and management to optimize them before liver transplantation to produce successful outcomes.
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Affiliation(s)
- Justin A Steggerda
- Department of Surgery, Division of Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Krishnaraj Mahendraraj
- Department of Surgery, Division of Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Tsuyoshi Todo
- Department of Surgery, Division of Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Mazen Noureddin
- Division of Digestive and Liver Diseases, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
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El Hajj MC, Litwin SE. Echocardiography in the Era of Obesity. J Am Soc Echocardiogr 2020; 33:779-787. [PMID: 32359803 DOI: 10.1016/j.echo.2020.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/29/2022]
Abstract
Patients with obesity are at increased risk for coronary artery disease and heart failure and often present with symptoms of dyspnea, fatigue, edema, or chest pain. Echocardiography is frequently used to help distinguish whether these symptoms are due to cardiac disease. Unfortunately, obesity has a significant impact on image quality because of signal attenuation. Ultrasound-enhancing agents may improve the detection of structural remodeling and subclinical left ventricular dysfunction in patients with obesity. Assessment of chamber sizes and cardiac remodeling in severely obese subjects must be interpreted with caution, however, as the current recommendations for indexing cardiac chamber sizes to body size may lead to false conclusions about chamber volumes or mass, particularly in settings in which weight is changing. As a result of increases in stroke volume and cardiac output, obesity may exacerbate hemodynamic compromise in obstructive structural or valvular disease. With regard to assessment of ischemic heart disease, stress echocardiography can effectively risk-stratify patients with obesity and may have advantages over other noninvasive modalities. In general, transesophageal echocardiography is safe in patients with obesity, although some precautions should be observed. Stress echocardiography using the transesophageal approach is an alternative for preoperative or ischemia evaluation in patients with suboptimal transthoracic views.
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Affiliation(s)
- Milad C El Hajj
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sheldon E Litwin
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.
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Magnetic Resonance–based Assessment of Myocardial 2-Dimensional Strain Using Feature Tracking. J Thorac Imaging 2020; 35:49-55. [DOI: 10.1097/rti.0000000000000380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Homsi R, Yuecel S, Schlesinger-Irsch U, Meier-Schroers M, Kuetting D, Luetkens J, Sprinkart A, Schild HH, Thomas DK. Epicardial fat, left ventricular strain, and T1-relaxation times in obese individuals with a normal ejection fraction. Acta Radiol 2019; 60:1251-1257. [PMID: 30727747 DOI: 10.1177/0284185119826549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rami Homsi
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Seyrani Yuecel
- Department of Cardiology, University of Rostock, Rostock, Germany
| | | | | | | | | | | | - Hans H. Schild
- Department of Radiology, University of Bonn, Bonn, Germany
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Accardo G, Amoresano Paglionico V, Di Fraia R, Cittadini A, Salzano A, Esposito D, De Bellis A, Pasquali D. Management of cardiovascular complications in Klinefelter syndrome patients. Expert Rev Endocrinol Metab 2019; 14:145-152. [PMID: 30793993 DOI: 10.1080/17446651.2019.1584036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Klinefelter syndrome (KS), also known as 47, XXY, shows increased mortality when compared with mortality rates among the general population. Cardiovascular, hemostatic, metabolic diseases are implicated. Moreover, cardiac congenital anomalies in KS can contribute to the increase in mortality. AREAS COVERED In this study, we have systematically reviewed the relationships between KS and the cardiovascular system and the management of cardiovascular complication. In summary, patients with KS display increased cardiovascular risk profile, characterized by increased prevalence of metabolic alterations including dyslipidemia, diabetes mellitus (DM), and abnormalities in biomarkers of cardiovascular disease. KS subjects are characterized by subclinical abnormalities in endothelial function and in left ventricular (LV) systolic and diastolic function, which - when associated with chronotropic incompetence - may negatively influence cardiopulmonary performance. Moreover, KS patients appear to be at a higher risk for cardiovascular disease, due to thromboembolic events with high prevalence of recurrent venous ulcers, venous insufficiency, recurrent venous and arterial thromboembolism leading to deep venous thrombosis or pulmonary embolism. EXPERT OPINION Considering the unequivocal finding of increased mortality of KS patients, we suggest a periodic cardiovascular follow up in specialized centers with multidisciplinary care teams that comprise endocrinologists and cardiologists dedicated to KS syndrome.
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Affiliation(s)
- Giacomo Accardo
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Vanda Amoresano Paglionico
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Rosa Di Fraia
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Antonio Cittadini
- b Department of Translational Medical Sciences , Federico II University School of Medicine , Naples , Italy
| | - Andrea Salzano
- b Department of Translational Medical Sciences , Federico II University School of Medicine , Naples , Italy
| | - Daniela Esposito
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
- c Department of Endocrinology Institute of Medicine , Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Annamaria De Bellis
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Daniela Pasquali
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
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Abstract
BACKGROUND P-wave dispersion is a new and simple electrocardiographic marker that has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we evaluated P-wave dispersion in obese adolescents and investigated the relationship between P-wave dispersion, cardiovascular risk factors, and echocardiographic parameters. METHODS We carried out a case-control study comparing 150 obese adolescents and 50 healthy controls. Maximum and minimum P-wave durations were measured using a 12-lead surface electrocardiogram, and P-wave dispersion was calculated as the difference between these two measures. Echocardiographic examination was also performed for each subject. Multivariate linear regression analysis with stepwise variable selection was used to evaluate parameters associated with increased P-wave dispersion in obese subjects. RESULTS Maximum P-wave duration and P-wave dispersion were significantly higher in obese adolescents than control subjects (143±19 ms versus 117±20 ms and 49±15 ms versus 29±9 ms, p<0.0001 for both). P-wave dispersion was positively correlated with body mass index, waist and hip circumferences, systolic and diastolic blood pressures, total cholesterol, serum levels of low-density lipoprotein cholesterol, triglycerides, glucose, and insulin, homoeostasis model assessment for insulin resistance score, left ventricular mass, and left atrial dimension. P-wave dispersion was negatively correlated with high-density lipoprotein cholesterol levels. By multiple stepwise regression analysis, left atrial dimension (β: 0.252, p=0.008) and homoeostasis model assessment for insulin resistance (β: 0.205; p=0.009) were independently associated with increased P-wave dispersion in obese adolescents. CONCLUSIONS Insulin resistance is a significant, independent predictor of P-wave dispersion in obese adolescents.
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13
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Assessment of abnormal LV myocardial deformation properties in obese patients by 2D based strain and strain rate imaging. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wang YC, Liang CS, Gopal DM, Ayalon N, Donohue C, Santhanakrishnan R, Sandhu H, Perez AJ, Downing J, Gokce N, Colucci WS, Ho JE. Preclinical Systolic and Diastolic Dysfunctions in Metabolically Healthy and Unhealthy Obese Individuals. Circ Heart Fail 2015; 8:897-904. [PMID: 26175540 DOI: 10.1161/circheartfailure.114.002026] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 07/01/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite the substantial overlap of obesity and metabolic disease, there is heterogeneity with respect to cardiovascular risk. We sought to investigate preclinical differences in systolic and diastolic function in obesity, and specifically compare obese individuals with and without metabolic syndrome (MS). METHODS AND RESULTS Obese individuals without cardiac disease with (OB/MS+, n=124) and without (OB/MS-, n=37) MS were compared with nonobese controls (n=29). Diastolic function was assessed by transmitral and tissue Doppler. Global longitudinal strain (LS) and time-based dyssynchrony were assessed by speckle tracking. Both OB/MS- and OB/MS+ groups had similar ejection fraction but worse systolic mechanics as assessed by LS and dyssynchrony when compared with nonobese controls. Specifically, OB/MS- had 2.5% lower LS (SE, 0.7%; P=0.001 in multivariable-adjusted analyses) and 10.8 ms greater dyssynchrony (SE, 3.3 ms; P=0.002), and OB/MS+ had 1.0% lower LS (SE, 0.3%; P<0.001) and 7.8 ms greater dyssynchrony (SE, 1.5 ms; P<0.001) when compared with controls. Obesity was associated with impaired diastolic function regardless of MS status, as evidenced by greater left atrial diameter and left ventricular mass although diastolic dysfunction was more pronounced in OB/MS+ than in OB/MS- individuals. CONCLUSIONS Obesity is associated with subclinical differences in both systolic and diastolic function regardless of the presence or absence of MS although MS seems to be associated with worse diastolic dysfunction. When compared with controls, metabolically healthy obese had lower LS, greater dyssynchrony, and early diastolic dysfunction, supporting the notion that obesity per se may have adverse cardiovascular effects regardless of metabolic disease.
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Affiliation(s)
- Yi-Chih Wang
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Chang-Seng Liang
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Deepa M Gopal
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Nir Ayalon
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Courtney Donohue
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Rajalakshmi Santhanakrishnan
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Harpaul Sandhu
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Alejandro J Perez
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Jill Downing
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Noyan Gokce
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Wilson S Colucci
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Jennifer E Ho
- From the Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.-C.W.); the Cardiovascular Medicine Section (C.-s.L., N.A., C.D., R.S., A.J.P., J.D., N.G., W.S.C., J.E.H.), Department of Medicine (H.S.), Boston University School of Medicine, MA; and the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.).
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Kibar AE, Pac FA, Ece İ, Oflaz MB, Ballı Ş, Bas VN, Aycan Z. Effect of obesity on left ventricular longitudinal myocardial strain by speckle tracking echocardiography in children and adolescents. Balkan Med J 2015; 32:56-63. [PMID: 25759773 DOI: 10.5152/balkanmedj.2015.15136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/30/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Impaired subclinical ventricular function may contribute to the risk of cardiovascular disease in obesity. AIMS The aim of this study was to determine the influence of obesity on left ventricular (LV) longitudinal myocardial function in normotensive obese children using two-dimensional (2D) speckle tracking echocardiography (STE). STUDY DESIGN Case-control study. METHODS Sixty normotensive obese children aged 10-16 years (mean age, 13.9±2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)≥95(th) percentile. Regional strain/strain rate (SR) values were compared with left ventricular (LV) parameters. The correlation was studied by linear regression analysis. RESULTS Obese subjects exhibited a significantly higher LV end-diastolic diameter, left atrium/aortic diameter ratio, and LV mass/index when compared to controls (p<0.001). Left ventricular ejection fraction and regional systolic myocardial velocities were similar in the obese and control groups. By 2D STE, regional strain of both the septal wall (average strain: -16.0±3.9% vs -21.9±2.4%, p<0.001) and lateral wall (average strain: -15.6±2.3% vs -22.9±3.5%, p<0.001); regional SR of both the septal wall (average SRsys: -0.7±0.22 s(-1) vs -1.3±0.32 s(-1), p<0.001) and lateral wall (average SRsys: -0.67±0.19 s(-1) vs -1.33±0.31 s(-1), p<0.001); regional SRE/A of both the septal wall (average SRE/A: 1.8±0.83 vs. 2.2±0.91, p: 0.004) and lateral wall (average SRE/A: 1.4±0.43 vs. 2.4±1.21, p<0.001); and global strain (-14.6±7.34% vs -20.9±3.24%, p<0.001) were lower in the obese group compared with the controls. These strain imaging parameters appear to be related to the severity of obesity and can contribute to increased BMI. Left ventricular mass was found to be correlated with a decrease in global LV strain. CONCLUSION Our study showed that childhood obesity is associated with an alteration in the longitudinal LV function. Segmental analysis of the LV can provide subtle markers for the emergence of future obesity-related cardiac disease.
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Affiliation(s)
- Ayşe Esin Kibar
- Department of Pediatric Cardiology, Mersin Women's and Children's Hospital, Mersin, Turkey
| | - Feyza Ayşenur Pac
- Department of Pediatric Cardiology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - İbrahim Ece
- Department of Pediatric Cardiology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Mehmet Burhan Oflaz
- Department of Pediatric Cardiology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Şevket Ballı
- Department of Pediatric Cardiology, Balıkesir Hospital, Balıkesir, Turkey
| | - Veysel Nejat Bas
- Department of Pediatric Endocrinology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
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Carvajal K, Balderas-Villalobos J, Bello-Sanchez MD, Phillips-Farfán B, Molina-Muñoz T, Aldana-Quintero H, Gómez-Viquez NL. Ca(2+) mishandling and cardiac dysfunction in obesity and insulin resistance: role of oxidative stress. Cell Calcium 2014; 56:408-15. [PMID: 25168907 DOI: 10.1016/j.ceca.2014.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 12/12/2022]
Abstract
Obesity and insulin resistance (IR) are strongly connected to the development of subclinical cardiac dysfunction and eventually can lead to heart failure, which is the main cause of morbidity and death in patients having these metabolic diseases. It has been considered that excessive fat tissue may play a critical role in producing systemic IR and enhancing reactive oxygen species (ROS) generation. This oxidative stress (OS) may elicit or exacerbate IR. On the other hand, evidence suggests that some of the cellular mechanisms involved in the pathophysiology of obesity and IR-related cardiomyopathy are excessive myocardial ROS production and abnormal Ca(2+) homeostasis. In addition, emerging evidence suggests that augmented ROS production may contribute to Ca(2+) mishandling by affecting the redox state of key proteins implicated in this process. In this review, we focus on the role of Ca(2+) mishandling in the development of cardiac dysfunction in obesity and IR and address the evidence suggesting that OS might also contribute to cardiac dysfunction by affecting Ca(2+) handling.
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Affiliation(s)
- Karla Carvajal
- Laboratorio de Nutrición Experimental, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Jaime Balderas-Villalobos
- Laboratorio de Nutrición Experimental, Instituto Nacional de Pediatría, Mexico City, Mexico; Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados-Instituto Politécnico Nacional, Mexico City, Mexico
| | - Ma Dolores Bello-Sanchez
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados-Instituto Politécnico Nacional, Mexico City, Mexico
| | - Bryan Phillips-Farfán
- Laboratorio de Nutrición Experimental, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Tzindilu Molina-Muñoz
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados-Instituto Politécnico Nacional, Mexico City, Mexico
| | - Hugo Aldana-Quintero
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados-Instituto Politécnico Nacional, Mexico City, Mexico
| | - Norma L Gómez-Viquez
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados-Instituto Politécnico Nacional, Mexico City, Mexico.
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17
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Zehir R, Karabay CY, Kocabay G, Kalayci A, Kaymaz O, Aykan AC, Karabay E, Kirma C. Assessment of atrial conduction time in patients with polycystic ovary syndrome. J Interv Card Electrophysiol 2014; 41:137-43. [PMID: 25005453 DOI: 10.1007/s10840-014-9925-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is closely related to increased cardiovascular risk in women of reproductive age. Atrial conduction abnormalities in these patients have not been investigated in terms of atrial electromechanical delay measured by tissue Doppler imaging (TDI) as an early predictor of atrial fibrillation development. The aim of this study was to evaluate whether TDI-derived atrial conduction time is prolonged in PCOS. METHODS The study included 51 patients with PCOS and 48 age-matched healthy controls. P-wave dispersion (PWD) was calculated on the 12-lead surface electrocardiogram. Systolic and diastolic left ventricular (LV) functions, atrial electromechanical coupling, intraatrial and interatrial electromechanical delays were measured with conventional echocardiography and TDI. RESULTS PWD was higher in PCOS women (50.45 ± 3.7 vs 34.73 ± 6.7 ms, p = 0.008). Interatrial and intraatrial electromechanical delay were found longer in patients with PCOS compared to controls (41.9 ± 9.0 vs 22.2 ± 6.6 ms, p < 0.001; 22.6 ± 5.8 vs 5.9 ± 4.7 ms, p < 0.001, respectively). Left atrial (LA) volume index and LV diastolic parameters were significantly different between the groups. PWD was correlated with interatrial electromechanical delay (r = 0.54, p < 0.01). Interatrial electromechanical delay was strongly correlated with homeostatic model assessment insulin resistance index and high-sensitivity C-reactive protein levels (r = 0.68, p < 0.001; r = 0.53, p < 0.001, respectively). Interatrial electromechanical delay was positively correlated with LA volume index and deceleration time (r = 0.31, p = 0.04; r = 0.37, p = 0.021, respectively) and negatively correlated with flow propagation velocity (r = -0.38, p = 0.014). CONCLUSION This study shows that atrial electromechanical delay is prolonged in PCOS patients. Atrial electromechanical delay prolongation is related to low-grade inflammation, insulin resistance, and LV diastolic dysfunction in PCOS.
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Affiliation(s)
- Regayip Zehir
- Kartal Kosuyolu Heart and Research Hospital, Cardiology Department, Istanbul, Turkey
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18
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Antonini-Canterin F, Pellegrinet M, Marinigh R, Favretto G. Role of Cardiovascular Ultrasound in the Evaluation of Obese Subjects. J Cardiovasc Echogr 2014; 24:67-71. [PMID: 28465908 PMCID: PMC5353449 DOI: 10.4103/2211-4122.143961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Obesity represents a worldwide increasing health problem. Obesity, through complex and not fully understood pathogenetic mechanisms, induces different structural and functional changes of left heart chambers, right heart chambers, and arteries. Ultrasound techniques are the first choice for a comprehensive assessment of the cardiovascular adaptation to obesity. This review summarizes the up-to-date literature on the topic, with particular focus on the main clinical studies, which range over different cardiovascular adaptations to obesity, namely left ventricular mass, diastolic function, right ventricle structure and function, arterial stiffness, and intima-media thickness. Also, the importance of epicardial fat and of the degree of obesity is described. Finally, the role of weight loss and bariatric surgery and the study of cardiovascular obesity-induced abnormalities in children and adolescent are discussed.
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Affiliation(s)
| | | | - Ricarda Marinigh
- Rehabilitative and Preventive Cardiology, Motta di Livenza (TV), Italy
| | - Giuseppe Favretto
- Rehabilitative and Preventive Cardiology, Motta di Livenza (TV), Italy
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19
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Antonini-Canterin F, Mateescu AD, Vriz O, La Carrubba S, Di Bello V, Carerj S, Zito C, Sparacino L, Marzano B, Usurelu C, Ticulescu R, Ginghină C, Nicolosi GL, Popescu BA. Cardiac Structure and Function and Insulin Resistance in Morbidly Obese Patients: Does Superobesity Play an Additional Role? Cardiology 2013; 127:144-51. [DOI: 10.1159/000355260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/15/2013] [Indexed: 11/19/2022]
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Obert P, Gueugnon C, Nottin S, Vinet A, Gayrard S, Rupp T, Dumoulin G, Tordi N, Mougin F. Impact of diet and exercise training-induced weight loss on myocardial mechanics in severely obese adolescents. Obesity (Silver Spring) 2013; 21:2091-8. [PMID: 23625623 DOI: 10.1002/oby.20495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/01/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Recent findings indicated silent incipient myocardial dysfunction in juvenile obesity despite normal global cardiac function. The present study investigated whether lifestyle intervention is able to favorably impact these obesity-related myocardial abnormalities and whether improvements are related to changes in insulin resistance and cardiac remodeling. DESIGN AND METHODS Twenty-eight severe obese adolescents (OB) participated in a 9 month lifestyle intervention program (LIP) based on aerobic exercise and diet. Twenty healthy adolescents (CG) served as controls. Conventional echocardiography and myocardial mechanics were obtained at baseline and follow-up along with insulin resistance. RESULTS Insulin sensitivity improved (P < 0.001) and body weight decreased (P < 0.001) consecutive to LIP. At baseline, OB had depressed longitudinal (L) strain (CG: -18.3 ± 2.6, OB: -14.2 ± 3.6%, P < 0.001) and enhanced twist compared to controls. The LIP in OB restored L strain to normal values (-16.9 ± 3.5%, NS), whereas it did not affect twist mechanics. From stepwise multiple regression analysis, only baseline L strain and changes in BMI Z-score (r(2) -adjusted = 0.49, P < 0.001) emerged as independent predictors of L strain changes. CONCLUSIONS Juvenile obesity is associated with myocardial mechanic abnormalities that can be partly corrected by lifestyle intervention. Restoration of longitudinal myocardial function occurs in the absence of left ventricular remodeling changes and is not associated with insulin resistance improvements.
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Affiliation(s)
- Philippe Obert
- EA 4278, Laboratoire de Pharm-Ecologie Cardiovasculaire, University of Avignon, F-84000, Avignon, France
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Abstract
Cardiorespiratory fitness (CRF) is one of the most important health metrics in apparently healthy individuals, those at increased risk for cardiovascular (CV) disease and virtually all patient populations. In addition to CRF, a host of other variables obtained from aerobic exercise testing provides clinically valuable information. Individuals classified as obese (i.e. a body mass index ≥30 kg/m(2)) have varying degrees of CV, pulmonary and skeletal muscle dysfunction that impact CRF and other key aerobic exercise testing variables. Moreover, there is now evidence indicating inspiratory and expiratory respiratory muscle function, even in the absence of interstitial lung disease, is potentially compromised as a result of obesity. When obesity-induced respiratory muscle dysfunction is present, it has the potential to contribute to the limitations in CRF. The current review will discuss aerobic exercise testing and the assessment of respiratory muscle function in the obese population.
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22
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Kibar AE, Pac FA, Ballı S, Oflaz MB, Ece I, Bas VN, Aycan Z. Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study. Pediatr Cardiol 2013; 34:1482-90. [PMID: 23503947 DOI: 10.1007/s00246-013-0674-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/13/2013] [Indexed: 11/24/2022]
Abstract
A direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 ± 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI ≥ 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 ± 2 cm/s), peak early myocardial velocity (Am = 8.7 ± 1.3 cm/s), Em/Am ratio (1.8 ± 0.3), isovolumetric relaxation time (IVRT = 59.2 ± 8.2 ms), MPI (0.39 ± 0.03), and DI (25.5 ± 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 ± 1.2 cm/sn, 6.9 ± 0.6 cm/sn, 2.6 ± 0.2, 51.2 ± 9.6 ms, 0.34 ± 0.03, and 33.13 ± 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.
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Affiliation(s)
- Ayse Esin Kibar
- Department of Pediatric Cardiology, Mersin Women's and Children's Hospital, Güneykent, Mersin, Turkey.
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23
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Effect of patient and hospital characteristics on outcomes of elective ventral hernia repair in the United States. Hernia 2013; 17:639-45. [DOI: 10.1007/s10029-013-1088-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/23/2013] [Indexed: 01/30/2023]
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Affiliation(s)
- Gerard P. Aurigemma
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
| | - Giovanni de Simone
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
| | - Timothy P. Fitzgibbons
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
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Obert P, Gueugnon C, Nottin S, Vinet A, Gayrard S, Rupp T, Dumoulin G, Tordi N, Mougin F. Two-dimensional strain and twist by vector velocity imaging in adolescents with severe obesity. Obesity (Silver Spring) 2012; 20:2397-405. [PMID: 22653310 DOI: 10.1038/oby.2012.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prevalence of severe obesity is increasing worldwide in adolescents. Whether it is associated with functional myocardial abnormalities remains largely unknown, potentially because of its frequent association with other cardiovascular risk factors and also use of insensitive techniques to detect subclinical changes in myocardial function. We used 2D vector velocity imaging (VVI) to investigate early changes in left ventricular (LV) myocardial function in youths with isolated severe obesity. Thirty-seven asymptomatic severely obese adolescents free of diabetes and hypertension, and 24 lean controls were enrolled. LV longitudinal, basal, and apical circumferential strain, strain rate (SR), rotations, and LV twist were measured. Obese adolescents had greater LV mass and reduced systolic and early diastolic tissue Doppler imaging (TDI) velocities than lean counterparts. L strain (-24%) and systolic and early diastolic SR were also diminished in the obese, whereas no intergroup differences existed for the circumferential deformation indexes. LV twist was more pronounced in the obese (+1.7°, P < 0.01) on account of greater apical rotation only (4.1 ± 0.9 vs. 5.2 ± 1.2°, P < 0.01), potentially compensating for the loss in longitudinal function. Systolic-diastolic coupling, an important component of early filling and diastolic function, was maintained with severe obesity. No intergroup differences were reported regarding time to peak values for all VVI indexes highlighting that dynamics of strain and twist/untwist along the cardiac cycle was preserved with severe obesity. Isolated severe obesity in adolescents, at a preclinical stage, is associated with changes in myocardial deformation and torsional mechanics that could be in part related to alterations in relaxation and contractility properties of subendocardial fibers.
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Affiliation(s)
- Philippe Obert
- EA 4278, "Laboratoire de Pharm-Ecologie Cardiovasculaire", Faculty of Sciences, University of Avignon, Avignon, France.
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Aljaroudi W, Halley C, Houghtaling P, Agarwal S, Menon V, Rodriguez L, Grimm RA, Thomas JD, Jaber WA. Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction. Nutr Diabetes 2012; 2:e39. [PMID: 23448803 PMCID: PMC3432184 DOI: 10.1038/nutd.2012.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD). Methods: We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m−2), overweight (25–29.9 kg m−2), obese (30–39.9 kg m−2) and morbidly obese (⩾40 kg m−2). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD. Results: The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic function was present in 13 414 (61.9%) patients, with stage 1 being the most common. As BMI increased, the prevalence of normal diastolic function decreased (P<0.0001). Furthermore, there were 1733 patients with age <35 years; 460 (26.5%) and 407 (23.5%) were overweight and obese, respectively, and had higher prevalence of DD (P<0.001). Using multivariable logistic regression, BMI remained significant in both ordinal (all stages of diastolic function) and binary (normal versus abnormal). Also, obesity was associated with increased odds of DD in all patients and those aged <35 years. Conclusions: In patients with normal LVEF, higher BMI was independently associated with worsening DD.
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Affiliation(s)
- W Aljaroudi
- Department of Cardiovascular Medicine, Heart and Vascular Imaging Institute, Cleveland, OH, USA
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Miszalski-Jamka T, Szczeklik W, Nycz K, Sokołowska B, Górka J, Bury K, Musiał J. Two-dimensional speckle-tracking echocardiography reveals systolic abnormalities in granulomatosis with polyangiitis (Wegener's). Echocardiography 2012; 29:803-9. [PMID: 22497538 DOI: 10.1111/j.1540-8175.2012.01699.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Two-dimensional speckle-tracking echocardiography (STE) is a novel technique providing accurate assessment of myocardial function. However, its value in granulomatosis with polyangiitis (Wegener's) (WG) has not been studied. OBJECTIVE To assess the presence and frequency of systolic left ventricular (LV) dysfunction using STE and to determine incremental value of STE over standard echocardiography to detect myocardial abnormalities in WG. METHODS Twenty-two WG patients (11 males, 11 females, mean age 46.8 ± 12.3 years) and 22 sex- and age-matched healthy subjects underwent standard and STE. Global longitudinal, circumferential, and rotational deformation parameters were calculated. RESULTS All patients had LV ejection fraction (EF) >50%. LVEF was 65.0 ± 7.5% and LV end-diastolic volume index 44.8 ± 11.8 mL/m(2) . Regional LV wall motion abnormalities were found in 7 (32%), while abnormal global STE determined systolic dysfunction in 16 (73%) subjects (P = 0.008). Global longitudinal, circumferential and radial peak-systolic deformational parameters (strain or strain rate) were decreased in 11 (50%), 9 (41%), and 3 (14%) patients (P = 0.02), respectively. Comparing patients with abnormal and normal STE derived global systolic function, the former had higher cumulative disease extent index (10.6 ± 3.0 vs 7.5 ± 1.8; P = 0.03) and vasculitis damage index (7.9 ± 1.9 vs 6.0 ± 1.7; P = 0.04). CONCLUSIONS Despite normal LVEF the global systolic LV abnormalities detected by STE are common in WG. They correspond to the extent and severity of WG and are more frequent than regional wall motion abnormalities in standard echocardiography.
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Schuster I, Vinet A, Karpoff L, Startun A, Jourdan N, Dauzat M, Nottin S, Perez-Martin A. Diastolic dysfunction and intraventricular dyssynchrony are restored by low intensity exercise training in obese men. Obesity (Silver Spring) 2012; 20:134-40. [PMID: 21869756 DOI: 10.1038/oby.2011.270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to evaluate the impact of a low-intensity training program on subclinical cardiac dysfunction and on dyssynchrony in moderately obese middle aged men. Ten obese and 14 age-matched normal-weight men (BMI: 33.6 ± 1.0 and 24.2 ± 0.5 kg/m(2)) were included. Obese men participated in an 8-week low-intensity training program without concomitant diet. Cardiac function and myocardial synchrony were assessed by echocardiography with tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). At baseline, obese men showed diastolic dysfunction on standard echocardiography, lower strain values (systolic strain: 15.9 ± 0.9 vs. 18.8 ± 0.3%, diastolic strain rate: 0.81 ± 0.09 vs. 1.05 ± 0.06 s(-1)), and significant intraventricular dyssynchrony (systolic: 13.3 ± 2.1 vs. 5.4 ± 2.1 ms, diastolic: 17.4 ± 3.2 vs. 9.1 ± 2.1 ms) (P < 0.05 vs. controls for all variables). Training improved aerobic fitness, decreased systolic blood pressure and heart rate, and reduced fat mass without weight loss. Diastolic function, strain values (systolic strain: 17.4 ± 0.9%, diastolic strain rate: 0.96 ± 0.12 s(-1)) and intraventricular dyssynchrony (systolic: 3.3 ± 1.7 ms, diastolic: 5.5 ± 3.4 ms) improved significantly after training (P < 0.05 vs. baseline values for all variables), reaching levels similar to those of normal-weight men. In conclusion, in obese men, a short and easy-to-perform low intensity training program restored diastolic function and cardiac synchrony and improved body composition without weight loss.
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Affiliation(s)
- Iris Schuster
- EA2992 Dysfunction of Vascular Interfaces Laboratory, Montpellier I University, Montpellier - Nimes Faculty of Medicine, Nimes, France
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Barbosa JAA, Nunes MCP, Simões e Silva AC, Barbosa MM. Newer Doppler echocardiography techniques in assessment of heart function in obese patients. J Pediatr Endocrinol Metab 2012; 25:69-77. [PMID: 22570953 DOI: 10.1515/jpem.2011.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is one of the major health problems of modem society. The prevalence of this condition has increased at an alarming rate, especially the most severe form (body mass index >40 kg/m2). The cardiovascular problems that generally accompany obesity are the focus of a large number of studies. Conventional echogram and more current modalities, such as tissue Doppler, strain and strain rate are valuable tools for the detection of subclinical dysfunction and the early diagnosis and treatment of patients.
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Affiliation(s)
- José Augusto A Barbosa
- Department of Pediatrics/Echocardiography, Federal University of Minas Gerais, Avenida Alfredo Balena, 190 Belo Horizonte, Minas Gerais 30130 100, Brazil.
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Barbosa MM, Beleigoli AM, de Fatima Diniz M, Freire CV, Ribeiro AL, Nunes MCP. Strain imaging in morbid obesity: insights into subclinical ventricular dysfunction. Clin Cardiol 2011; 34:288-93. [PMID: 21557254 PMCID: PMC6652736 DOI: 10.1002/clc.20907] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/08/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Obesity has become an important health problem throughout the world. Early detection of cardiovascular abnormalities may be useful in the future for patient management. This study aimed to identify subclinical ventricular dysfunction in obese patients. HYPOTHESIS Morbid obesity is associated with ventricular dysfunction. METHODS Doppler echocardiogram was performed in 92 morbidly obese and in 31 healthy controls. Conventional echocardiography and tissue Doppler-based strain imaging were used to analyze ventricular function. Intra- and interobserver strain imaging variabilities were tested on 15 randomly selected cases. RESULTS Left ventricular (LV) global strain (22.5% ± 3.5 vs 24.4% ± 2.5, P<0.005) and right ventricular (RV) strain (25.8% ± 5.2 vs 28.2% ± 5.2, P<0.029) were lower in obese patients when compared with healthy controls. Echocardiographic parameters of diastolic function were also different from controls. LV strain correlated with LV mass, E/e' ratio, left atrial volume, and RV strain. At multivariate analysis, morbid obesity remained a significant determinant of global LV strain, independently of associated comorbidities. CONCLUSIONS These findings suggest that incipient biventricular dysfunction is present in morbidly obese patients when new echocardiographic indices are used to investigate ventricular function. In addition, strain imaging may provide a more accurate assessment of the ventricular function in obese patients.
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MESH Headings
- Adult
- Body Mass Index
- Case-Control Studies
- Diastole
- Echocardiography, Doppler
- Female
- Humans
- Male
- Multivariate Analysis
- Obesity, Morbid/diagnosis
- Obesity, Morbid/diagnostic imaging
- Obesity, Morbid/pathology
- Risk Factors
- Stroke Volume
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/pathology
- Ventricular Function, Left
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Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, Di Tullio MR. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol 2011; 57:1368-74. [PMID: 21414533 PMCID: PMC3077126 DOI: 10.1016/j.jacc.2010.10.042] [Citation(s) in RCA: 274] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 10/26/2010] [Accepted: 10/28/2010] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the independent effect of increased body size on left ventricular (LV) diastolic function. BACKGROUND Obese and overweight persons are at increased risk of heart failure. Left ventricular 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. METHODS The LV diastolic function was evaluated in 950 participants from the CABL (Cardiovascular Abnormalities and Brain Lesions) study by traditional and tissue Doppler imaging. Peak early transmitral diastolic flow velocity (E), late transmitral diastolic flow velocity (A), and early diastolic mitral annulus velocity (E') were measured, and E/A and E/E' were calculated. The study sample was divided into 3 groups: normal weight (body mass index [BMI] <25.0 kg/m(2)), overweight (BMI 25.0 to 29.9 kg/m(2)), and obese (BMI ≥30 kg/m(2)). RESULTS In multivariate analyses, 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. The E/A was lower in obese subjects than in normal weight subjects (p < 0.01). The risk of diastolic dysfunction was significantly higher in overweight subjects (adjusted odds ratio: 1.52, 95% confidence interval: 1.04 to 2.22) and obese subjects (adjusted odds ratio: 1.60, 95% confidence interval: 1.06 to 2.41) compared to normal weight subjects. CONCLUSIONS Increased BMI was associated with worse LV diastolic function independent of LV mass and associated risk factors. The increased risk of LV diastolic dysfunction in both overweight and obese persons may partially account for the increased risk of heart failure associated with both conditions.
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Affiliation(s)
- Cesare Russo
- Department of Medicine, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, FL
| | | | - Ralph L. Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL
- Department of Epidemiology and Human Genetics, Miller School of Medicine, University of Miami, FL
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Litwin SE. Cardiac remodeling in obesity: time for a new paradigm. JACC Cardiovasc Imaging 2010; 3:275-7. [PMID: 20223424 DOI: 10.1016/j.jcmg.2009.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 12/23/2009] [Accepted: 12/29/2009] [Indexed: 12/01/2022]
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Kosmala W, O'Moore-Sullivan T, Plaksej R, Przewlocka-Kosmala M, Marwick TH. Improvement of left ventricular function by lifestyle intervention in obesity: contributions of weight loss and reduced insulin resistance. Diabetologia 2009; 52:2306-2316. [PMID: 19727663 DOI: 10.1007/s00125-009-1507-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 07/17/2009] [Indexed: 10/20/2022]
Abstract
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 >or=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 (beta = 0.14, p < 0.05), decrease in the HOMA insulin resistance index (beta = 0.20, p < 0.005) and absence of diabetes (beta = 0.18, p < 0.02). A decrease in HbA(1c) also predicted improvement of left ventricular diastolic function (beta = 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 VO(2) (beta = 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 co-existing 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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Affiliation(s)
- W Kosmala
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - T O'Moore-Sullivan
- University of Queensland Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Q4102, Australia
- Diamantina Institute for Cancer, Immunology and Metabolic Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - R Plaksej
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | | | - T H Marwick
- University of Queensland Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Q4102, Australia.
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Di Bello V, Talini E, Donne MGD, Aghini-Lombardi F, Monzani F, La Carrubba S, Antonini-Canterin F, Dini FL, Di Salvo G, Carerj S, Marzilli M. New Echocardiographic Techniques in the Evaluation of Left Ventricular Mechanics in Subclinical Thyroid Dysfunction. Echocardiography 2009; 26:711-9. [DOI: 10.1111/j.1540-8175.2008.00875.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Chadha DS, Gupta N, Goel K, Pandey RM, Kondal D, Ganjoo R, Misra A. Impact of Obesity on the Left Ventricular Functions and Morphology of Healthy Asian Indians. Metab Syndr Relat Disord 2009; 7:151-8. [DOI: 10.1089/met.2008.0054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Davinder S. Chadha
- Department of Cardiology, Air Force Central Medical Establishment, New Delhi, India
| | - Nidhi Gupta
- Maulana Azad Medical College, New Delhi, India
| | | | - Ravindra M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Dimple Kondal
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R.K. Ganjoo
- Department of Cardiology, Air Force Central Medical Establishment, New Delhi, India
| | - Anoop Misra
- Department of Diabetes and Metabolic Diseases, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, India
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Evidence for a causal role of oxidative stress in the myocardial complications of insulin resistance. Heart Lung Circ 2008; 18:11-8. [PMID: 19119069 DOI: 10.1016/j.hlc.2008.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Andersen NH, Bojesen A, Kristensen K, Birkebaek NH, Fedder J, Bennett P, Christiansen JS, Gravholt CH. Left ventricular dysfunction in Klinefelter syndrome is associated to insulin resistance, abdominal adiposity and hypogonadism. Clin Endocrinol (Oxf) 2008; 69:785-91. [PMID: 18248650 DOI: 10.1111/j.1365-2265.2008.03211.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Epidemiological data suggest there is an increased risk of dying from heart disease among patients with Klinefelter syndrome (KS). Due to high prevalence of hypogonadism and metabolic syndrome, we speculated that patients with KS may have subclinical changes in the left ventricular function. Therefore, the aim was to assess left ventricular long axis function by tissue Doppler echocardiography in patients with KS and relate these findings to the metabolic status and testosterone levels. DESIGN Cross-sectional study. Out-patient clinic. PATIENTS We investigated 25 unselected patients with KS, recruited from endocrine and fertility clinics. Twenty-five age-matched males served as controls. MEASUREMENTS Left ventricular systolic long axis function (velocities and strain rate) assessed by tissue Doppler echocardiography related to free testosterone, fasting values of plasma glucose, insulin, homeostasis model assessment (HOMA)-index, cholesterol and triglycerides in addition to dual energy X-ray absorptiometry (DEXA) scan derived assessment of truncal body fat. RESULTS The long axis function was significantly reduced in patients with KS (peak systolic velocities 4.4 +/- 1.3 vs. 5.3 +/- 1.0 cm/s, P < 0.01 and strain rate -1.3 +/- 0.3 vs.-1.6 +/- 0.3 s(-1), P < 0.01). However, the ventricular dysfunction was mainly attributed KS patients with metabolic syndrome. The peak systolic velocities were significantly correlated to truncal body fat (r = -0.72, P < 0.01) and free testosterone (r = 0.63, P < 0.01), but uncorrelated to plasma glucose, insulin and HOMA-index. CONCLUSION Systolic long axis function is decreased in patients with KS and metabolic syndrome. The decrease in myocardial systolic function was significantly related to truncal body fat and hypogonadism, but not correlated to insulin sensitivity.
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Affiliation(s)
- N H Andersen
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
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Kosmala W, O'Moore-Sullivan TM, Plaksej R, Kuliczkowska-Plaksej J, Przewlocka-Kosmala M, Marwick TH. Subclinical impairment of left ventricular function in young obese women: contributions of polycystic ovary disease and insulin resistance. J Clin Endocrinol Metab 2008; 93:3748-54. [PMID: 18682502 DOI: 10.1210/jc.2008-1017] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Obesity and insulin resistance (IR) may produce disturbances of left ventricular (LV) function. Obese women with polycystic ovary syndrome (PCO), characterized by hormonal and metabolic abnormalities, are thought to be at particularly increased cardiovascular risk. OBJECTIVES We sought to determine the influence of IR on LV function in obese young women with and without PCO and without other comorbidities. DESIGN This was a cross-sectional study. SETTING The study was performed at a university hospital. PATIENTS A total of 150 women aged younger than 40 yr with a body mass index (BMI) of 30 kg/m(2) or more was classified into three groups: with both PCO and IR, without PCO and with IR, and without either PCO or IR. MAIN OUTCOME MEASURES Tissue Doppler-derived myocardial velocities, strain-rate and strain, and metabolic and hormonal measurements were calculated. RESULTS Subclinical impairment of LV systolic and diastolic function as indicated by lower peak strain (P < 0.001), peak systolic strain rate (P < 0.001), peak early diastolic strain rate (P < 0.001), and peak early diastolic velocity (P < 0.01) was demonstrated in both groups with IR. IR subjects with and without PCO did not differ in any LV function indices. Strain was independently associated with fasting insulin (beta = -0.39; P < 0.001), urinary albumin excretion (UAE) (beta = -0.36; P < 0.001), and BMI (beta = -0.22; P < 0.03), and peak early diastolic strain rate was associated with UAE (beta = -0.35; P < 0.001), fasting insulin (beta = -0.24; P < 0.02), BMI (beta = -0.23; P < 0.02), and SHBG (beta = 0.20; P < 0.04). CONCLUSIONS In obese young women, fasting insulin, BMI, SHBG, and UAE are independent correlates of impaired LV performance. The contribution of PCO to LV function abnormalities is linked to IR, but not to other hormonal aberrations associated with this condition.
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Affiliation(s)
- Wojciech Kosmala
- University of Queensland Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Q4102, Australia
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Kosmala W, Wong C, Kuliczkowska J, Leano R, Przewlocka-Kosmala M, Marwick TH. Use of body weight and insulin resistance to select obese patients for echocardiographic assessment of subclinical left ventricular dysfunction. Am J Cardiol 2008; 101:1334-40. [PMID: 18435967 DOI: 10.1016/j.amjcard.2007.12.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 12/13/2007] [Accepted: 12/13/2007] [Indexed: 11/16/2022]
Abstract
Obesity is associated with heart failure. Recognition of subclinical left ventricular (LV) dysfunction may permit the initiation of therapy to prevent the development of heart failure. In this study of anthropometric, biochemical, and echocardiographic measurements in 295 healthy overweight subjects, we sought to investigate the effect of insulin resistance and severity of obesity on LV function and to establish a strategy for detection of LV dysfunction using metabolic and echocardiographic measurements. Correlates of subclinical dysfunction (defined from myocardial deformation in a matched group of 98 slim controls) were sought, and receiver operator characteristic curves for clinical and laboratory parameters were performed to identify optimal cutoffs to permit an effective diagnostic strategy. Subclinical impairment of LV function (average strain<18%) was present in 124 subjects (42%), and 52% of severely obese patients (body mass index [BMI]>35 kg/m2). Independent correlates of strain were BMI (beta=-0.25, p<0.0001), fasting insulin (beta=-0.22, p<0.001), and age (beta=-0.18, p<0.003). In patients with a BMI<35 kg/m2, subclinical impairment was uncommon in the absence of hyperinsulinemia. Using a BMI<35 kg/m2 and an insulin level<13 mIU/L to select patients for further testing allowed echocardiography to be avoided in 35% of subjects in whom the prevalence of LV dysfunction was low. In conclusion, obesity and insulin resistance are important contributors to LV dysfunction, a deleterious effect of hyperinsulinemia on LV performance is particularly seen in overweight and moderately obese subjects, and the combination of BMI, fasting insulin, and echocardiography appears optimal for efficient identification of subclinical LV dysfunction in overweight and obese subjects.
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Di Bello V, Santini F, Di Cori A, Pucci A, Talini E, Palagi C, Delle Donne MG, Marsili A, Fierabracci P, Valeriano R, Scartabelli G, Giannetti M, Anselmino M, Pinchera A, Mariani M. Effects of Bariatric Surgery on Early Myocardial Alterations in Adult Severely Obese Subjects. Cardiology 2007; 109:241-8. [PMID: 17873488 DOI: 10.1159/000107787] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 01/12/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aim of this study was to investigate the effect of weight loss on structural and functional myocardial alterations in severely obese subjects treated with bariatric surgery. PATIENTS AND METHODS Thirteen severely obese patients (2 males and 11 females) were enrolled in the study. All subjects underwent conventional 2D color Doppler echocardiography. The new ultrasonic techniques used were: (a) integrated backscatter for the analysis of myocardial reflectivity, referred to pericardial interface as expression of myocardial structure (increase in collagen content) and of cyclic variation index as expression of intrinsic myocardial contractility and (b) color Doppler myocardial imaging (CDMI) for the analysis of strain and strain rate (myocardial deformability). All subjects underwent bariatric surgery and were resubmitted to echocardiographic and biochemical examination 6-24 months after surgery. RESULTS The main finding of the present study was a quite complete normalization of myocardial functional and structural alterations after weight loss. In particular, the cyclic variation index at septum level improved from 14.6 +/- 7.0 before to 25.7 +/- 11.2 (means +/- SD) after surgery (controls: 36.2 +/- 9.1). Mean reflectivity at septum level significantly decreased from 55.8 +/- 9.5 to 46.5 +/- 8.8 (controls: 43.0 +/- 8.0). Also, the strain at septum level significantly improved after surgery (from -11.9 +/- 3.2 to -20.4 +/- 5.3; controls: -23.4 +/- 9). CONCLUSION This study establishes: (a) the utility of new ultrasonic techniques to detect very early structural and functional myocardial alterations in severely obese patients, and (b) the regression of these subclinical abnormalities after weight loss achieved by bariatric surgery.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas II. Curr Opin Endocrinol Diabetes Obes 2007; 14:329-57. [PMID: 17940461 DOI: 10.1097/med.0b013e3282c3a898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Persic V, Ruzic A, Miletic B, Balen S, Jovanovic Z, Vcev A, Racki S, Vujicic B. Left ventricle diastolic dysfunction in obese patients with newly diagnosed arterial hypertension. Wien Klin Wochenschr 2007; 119:423-7. [PMID: 17671824 DOI: 10.1007/s00508-007-0818-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The frequent coexistence of obesity and arterial hypertension is well known. Although both conditions have been identified as independent risk factors for impaired left ventricular diastolic function, there is a paucity of data on the dysfunction among obese patients with newly diagnosed arterial hypertension. The study was performed to determine the prevalence of diastolic dysfunction in obese individuals with newly diagnosed arterial hypertension and to compare it with the prevalence in normotensive obese persons. METHODS We enrolled 125 obese patients: 65 with newly diagnosed hypertension and 60 normotensive patients matched for age, sex and body mass index. Left ventricular diastolic function was assessed from the following Doppler-echocardiographic measurements: mitral inflow velocities (E and A wave), E wave deceleration time, isovolumetric relaxation time, left atrial and left ventricular diameters, left ventricular wall thickness and left ventricular heart mass index. Diastolic dysfunction was considered when the E/A ratio was <1. RESULTS We found significantly higher A wave, lower E/A ratio, longer E deceleration time and a bigger left atrium in obese patients with newly diagnosed arterial hypertension. We did not find significant differences in E wave peak velocities between the two groups. Although there was no difference in left ventricle heart mass or the prevalence of left ventricle hypertrophy, the prevalence of diastolic dysfunction was higher in the group with newly diagnosed arterial hypertension. CONCLUSION This study suggests that newly diagnosed arterial hypertension significantly contributes to impairment of left ventricular diastolic function in obese patients before development of structural aberrations detectable on echocardiography.
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Affiliation(s)
- Viktor Persic
- Department of Cardiology, Thalassotherapia Opatija, M. Tita 188, 51410 Opatija, Croatia
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Di Bello V, Aghini-Lombardi F, Monzani F, Talini E, Antonangeli L, Palagi C, Di Cori A, Caraccio N, Delle Donne MG, Dardano A, Pinchera A, Mariani M. Early abnormalities of left ventricular myocardial characteristics associated with subclinical hyperthyroidism. J Endocrinol Invest 2007; 30:564-71. [PMID: 17848839 DOI: 10.1007/bf03346350] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of the present study was to analyze heart function in subclinical hyperthyroidism (sHT) in otherwise healthy subjects by new methods using intramyocardial ultrasonic techniques. Twenty-four newly diagnosed and untreated sHT patients (20 women, 4 men; mean age: 42+/-4 yr) and 24 sex- and age-matched healthy volunteers were studied. All subjects were submitted to conventional 2D color-Doppler echocardiography, pulsed wave tissue Doppler imaging (PWTDI) for the analysis of diastolic function, color Doppler myocardial imaging (CDMI) for the analysis of regional strain and strain rate (SR) expression of regional myocardial deformability, and to integrated backscatter (IBS) for the evaluation of intrinsic contractility and tissue characterization. Regional myocardial systolic strain findings were significantly higher in sHT patients when compared with controls (p<0.001). Considering diastolic SR, the early phase of diastolic SR was compromised in sHT subjects as compared with controls (p<0.001). Cyclic variation index (CVI), expression of intrinsic contractility, was significantly higher in sHT subjects in comparison with controls (p<0.0001). IBS values were comparable between the 2 study groups. In conclusion, the present study suggests that in patients with sHT early systolic hyperdeformability and hypercontractility are present, together with impairment of both active and passive phases of diastole. On the contrary, no left ventricular hypertrophy or other structural alterations are documented.
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Affiliation(s)
- V Di Bello
- Cardiac Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy.
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