Alterations of left ventricular myocardial strain in obese children

Labombarda, Fabien; Zangl, Eva; Dugué, Audrey Emmanuelle; Bouglé, Dominique; Pellissier, Arnaud; Ribault, Virginie; Maragnès, Pascale; Milliez, Paul; Saloux, Éric

doi:10.1093/ehjci/jes238

Cited by 35 publications

(42 citation statements)

References 33 publications

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“…These results confirm previous reports that obese adolescents and adults, with normal function by conventional measures have decreased GLS and early diastolic GLSR in association with the severity of obesity. 7, 31 These results raise the question of whether ventricular dysfunction may precede the development of ventricular structural abnormalities in some of obese adolescents. The development of ventricular dysfunction may serve as an early marker of cardiovascular involvement before the manifestation of cardiac clinical and structural signs of the impact of obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Another study assessed cardiac function in obese children using 2DSTE and showed that LV GLS negatively correlated with HOMA-IR and BMI Z-score 35 . However, the multivariate analysis performed in this study did not include measures of IR.…”

Section: Discussionmentioning

confidence: 99%

“…Bivariate analyses and backward stepwise multiple linear regression analyses were used to determine which variables best predicted changes in LV structure and function for the entire cohort of lean and obese subjects as well as for the cohort of obese subjects only. To predict LV structure and function, BMI Z-score, systolic blood pressure, and fasting insulin were used as independent variables 27, 30, 31 . The maximum R 2 from K-fold cross validation was used for the multiple linear regression analyses.…”

Section: Methodsmentioning

confidence: 99%

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Markers of Cardiovascular Risk, Insulin Resistance, and Ventricular Dysfunction and Remodeling in Obese Adolescents

Sanchez

Levy

Sekarski

et al. 2015

The Journal of Pediatrics

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Objectives To test our hypothesis that obese adolescents have left ventricular (LV) dysfunction and remodeling that are associated with markers of cardiovascular risk and insulin resistance (IR). Study design In a cross-sectional study of 44 obese and 14 lean age-, sex-, Tanner stage-, and race-matched adolescents, IR, markers of cardiovascular risks, conventional and 2-dimensional speckle tracking echocardiography (2DSTE) measures of LV function and structure were evaluated and compared. Results The obese adolescents had significantly increased body mass index (BMI) Z-score, systolic blood pressure, fasting insulin, IR, and atherogenic lipids compared with the lean adolescents. A subgroup of obese adolescents had LV remodeling characterized by significantly increased LV mass index (LVMI, g/m2.7) and relative wall thickness (RWT). Almost all obese adolescents had LV dysfunction with peak LV global longitudinal strain (GLS,%), systolic global GLS rate (GLSR, %/s) and early diastolic GLSR significantly lower than in lean adolescents and in the normal pediatric population. BMI Z-score predicted LV remodeling [LVMI (R2= 0.34) and RWT (R2 0.10], and peak LV GLS (R2 0.15), and along with systolic blood pressure, predicted systolic GLSR (R2 0.16); (P ≤ 0.01 for all). Fasting insulin predicted early diastolic GLSR (R2 0.17, P ≤ 0.01). Conclusions Obese adolescents have subclinical ventricular dysfunction associated with the severity of obesity, increased systolic blood pressure, and IR. Ventricular remodeling is present in a subgroup of obese adolescents in association with the severity of obesity. These findings suggest that obesity may have an early impact on the cardiovascular health of obese adolescents.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Markers of Cardiovascular Risk, Insulin Resistance, and Ventricular Dysfunction and Remodeling in Obese Adolescents

Sanchez

Levy

Sekarski

et al. 2015

The Journal of Pediatrics

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“…50-62,64-69 There were eight manuscripts eligible from Friedberg and Mertens et al (Toronto) 20,50-56 and six manuscripts eligible from Marcus et al (Netherlands) 16,58-62 that compared strain from a large database of overlapping pediatric controls to different disease outcomes in children, or healthy children. In consultation with the authors, the datasets from Fernandes et al 20 (Toronto) and Marcus et al 16 (Netherlands) were chosen as they contained the largest amount of control patients.…”

Section: Electronic Database Search Hedgesmentioning

confidence: 99%

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

258

215

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Background The establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE) derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims were to perform a meta-analysis of normal ranges of LV global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) measurements derived by 2DSTE in children and identify confounding factors that may contribute to variances in reported measures. Methods A systematic review was launched in Medline, Embase, Scopus, CINAHL, and Cochrane. Search hedges were created to cover the concepts of pediatrics, speckle-tracking echocardiography, and left heart ventricle. Two investigators independently identified and included studies if they reported the 2DSTE derived LV GLS, GCS or GRS. The weighted mean was estimated by using random-effects with 95% confidence interval (CI), heterogeneity was assessed by the Cochran's Q statistic and the inconsistency index (I2) and publication was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a meta-regression. Results The search identified 2325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean -20.2%, 95% CI -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean -22.3%, 95% CI -19.9% to -24.6%) and GRS, varied from 33.9% to 54.5 % (mean 45.2 95% CI 38.3 to 51.7). 26 studies reported LS only from the apical 4-chamber view with a mean of -20.4%, (95% CI -19.8% to -21.7%). 23 studies reported CS (mean, -20.3%, 95% CI -19.4% to -21.2%) and RS (mean, 46.7%, 95% CI 42.3% to 51.1%) from the short axis view at the mid-ventricular level. A significant apex-to-base segmental longitudinal strain (SLS) gradient (P < .01) was observed in the LV free wall. There was significant between- study heterogeneity and inconsistency (I2 > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, FR/HR ratio tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. These metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). Conclusions This study defined reference values of 2DSTE derived LV strain in children on the basis of a meta-analysis. In healthy children, the mean LV global longitudinal strain value is -20.2%, (95% CI -19.5% to -20.8%), mean global circumferential strain -22.3%, (95% CI -19.9% to -24.6%), and mean global radial strain is 45.2%, (95% CI 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturations. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor para...

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“…Exclusion criteria included valvular disease, dilated or hypertrophic or myocardiopathy were excluded. Clinical characteristics as age, gender, height, weight and risk factors as hypertension (defined as systolic blood pressure ≥ 140 mmHG and diastolic pressure ≥ 90mmHg [18]), dyslipidemia (cholesterol levels above>200 mg/dl and c-ldl > 160 mg/dl [19], diabetes (A1C ≥ 6.5% or fasting plasma glucose ≥ 126 mg/dL [20]) and smoking were asked before the assessment as part of their clinical history.…”

Section: Introductionmentioning

confidence: 99%

Gated-SPECT Functional Assessment in Overweight and Obese Patients

Puente-Barragán¹,

Morales-Portano²

2015

J Cardiovasc Dis Diagn

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Alterations of left ventricular myocardial strain in obese children

Abstract: Childhood obesity may be associated with an early alteration of the longitudinal and circumferential LV strain. These findings have potentially significant clinical implications for the outcomes and follow-up of obese children meriting further studies.

Cited by 35 publications

References 33 publications

Markers of Cardiovascular Risk, Insulin Resistance, and Ventricular Dysfunction and Remodeling in Obese Adolescents

Markers of Cardiovascular Risk, Insulin Resistance, and Ventricular Dysfunction and Remodeling in Obese Adolescents

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Gated-SPECT Functional Assessment in Overweight and Obese Patients

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