Evaluation of left ventricular function in obese children without hypertension by a tissue Doppler imaging study

Abstract

Background:The prevalence of obesity is increasing worldwide. Obese children without hypertension are becoming an important health challenge.Aims:Complications of obesity in adults are well established, but in obese children, cardiac dysfunction has not been reported clinically.Settings and Design:The present crosssectional study investigates subclinical systolic and diastolic dysfunction using echocardiographic modalities.Materials and Methods:Twentyfive youngsters with body mass index (BMI) >30 and 25 healthy children with BMI <25 were assigned into case and control group, respectively. In all participants, complete cardiovascular examination, electrocardiography, and echocardiography were fulfilled. Echocardiography surveys included standard, pulsed wave Doppler (PWD), and tissue Doppler imaging (TDI).Statistical Analysis Used:SPSS software, version 24.Results:The two groups were matched for age and sex. The resting heart rate and blood pressure were markedly higher in the obese group (P = 0.0001) though they were within the normal range in either category. Ejection fraction in the two groups was similar. Left ventricular (LV) mass (P = 0.0001), LV mass index (P = 0.029), left atrialtoaortic diameter ratio (P = 0.0001), and LV enddiastolic diameter (P = 0.008) were significantly greater in the case group, indicating cardiomegaly and subclinical systolic and diastolic dysfunction. Except for the aortic velocity, all PWD variables were considerably lower in the case group, suggesting subclinical diastolic dysfunction. All TDI parameters varied significantly between the two categories. There was a direct correlation between isovolumetric relaxation time and BMI.Conclusions:Obesity in children without hypertension is associated with subclinical systolic and diastolic cardiac dysfunction. We propose the evaluation of blood pressure as well as myocardial performance using PWD and TDI in all obese children without hypertension, regularly.

Anthropometric and Biochemical Markers as Possible Indicators of Left Ventricular Abnormal Geometric Pattern and Function Impairment in Obese Normotensive Children

“…Significant differences in diastolic function between groups, expressed by lower E/A ratio and higher E/e', emerged in accordance with previous studies [21,22,52]. The ratio of peak early and late transmitral flow velocities E/A, correlated significantly with WHtR ratio and hs-CRP, but not with left ventricular mass like previously shown [53].…”

“…Lambobarda et al found no significant difference in E/e' ratio between obese children and lean controls [17] and the same applies to the study of Barbosa et al in which only higher velocities a' of mitral annulus in late diastole were recorded [63]. On the contrary, Ghandi et al reported a statistically significant dampening in E/e' in the case group [52]. In the present study, E/e' ratio was significantly higher in the obese group in accordance to previous studies [22,53,64] and correlated significantly with WHR, skinfold and uric acid levels when both groups were considered together.…”

Anemia and Its Effect on Cardiovascular Findings in Obese Adolescents

“…In our study, the anemic obese group was found to have significantly higher cardiac pulse rates than the nonanemic obese group, even though the anemia was mild. The changes in E- and A-waves seen in PWD might be caused by increased heart rates in our anemic obese group, which may be indicative of early subclinical ventricular diastolic dysfunction [ 21 , 23 , 25 , 26 ].…”

“…Sharpe et al [ 27 ] demonstrated that BMI is directly related to LVMI. An increased LVMI results in ventricular hypertrophy, which eventually results in left ventricular diastolic dysfunction [ 23 , 25 , 26 , 27 , 28 , 29 , 30 ]. Similarly, in our study, measurements of LVM, LVMI, LVPWDD, and IVSDD were found to be increased in both obese groups compared to the healthy control group.…”

<p>Leptin Levels are Associated with Subclinical Cardiac Dysfunction in Obese Adolescents</p>

“…[2][3][4] However, a number of studies demonstrated normal systolic function in obese participants. 5,6 Recently, we also found normal left ventricular ejection fraction (LVEF) and fractional shortening (FS) with altered cardiac morphologic indices in obese adolescents. 7 This discrepancy is probably because the stages of cardiac dysfunction are differentially affected by the severity and duration of obesity.…”