Analysis of Right Atrial Function in Obese Pediatric Patients

Abstract

IntroductionObesity has become an epidemic in both developed and developing countries. Statistics from the United States of America reveal a 32.2% rate of obesity among adult men and 25.5% among adult women [1]. It is estimated that Five to 10 million adult individuals in the United States alone have severe obesity (body mass index ≥ 40 kg/m 2 ) [2]. In developing countries, the prevalence of obesity has reached more than 20% of the population. Reports on the pediatric population (children and adolescents aged two to 19 years) reveal that 11.9% are at or above the 97 th percentile of the body mass index (BMI) for age, 16.9% are at or above the 95 th percentile and 31.7% are at or above the 85 th percentile [3]. Ten percent of children starting school in the United Kingdom are already obese [4]. Cardiovascular complications associated with obesity contribute to high rates of morbidity and mortality. Structural and functional alterations in the heart, such as left ventricular hypertrophy, diastolic/systolic dysfunction and atrial enlargement, are well established in adult and pediatric patients with obesity [5][6][7][8][9][10]. Left atrial dysfunction with left ventricular diastolic dysfunction in subjects with preserved systolic function is well established in patients with hypertension [11,12]. There is strong evidence that left atrial enlargement and dysfunction are associated with an increase in morbidity and mortality rates in patients with cardiovascular disease and present clinical relevance with respect to the rate of long-term events, survival and the risk of developing atrial fibrillation [13]. Using Doppler-derived strain and strain rate (SR) MethodsObese pediatric patients six to 18 years of age with a BMI above the 95 th percentile were prospectively recruited from the nutrition clinic of a university hospital (Universidade Federal de Minas Gerais) in Belo Horizonte, Brazil. The control group was formed by children aged six to 18 years with a BMI below the 85 th percentile recruited from the general pediatrics clinic of the same institution. Patients with a history of hypertension, diabetes mellitus, endocrinological disorders, hereditary or inflammatory systemic diseases, sleep apnea (according to parents' information) and athletes were excluded in both groups. This study received approval from the Human Research Ethics Committee of the institution and written informed consent was obtained from all participants and/or parents. The participants were weighed in light clothing without shoes using a Welmy ® scale with a capacity of 300 Kg and accuracy of 100 g. Height was measured with a stadiometer (accuracy of 0.5 cm). BMI was calculated using the conventional formula of weight in kilograms divided by the square of height in AbstractBackground : Left atrial enlargement and right and left ventricular dysfunction have been described in obese Patients. A number of studies have also described atrial dysfunction in obese children and adolescents.