Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity

Alpert, Martin A.; Lambert, Charles R.; Terry, Boyd E.; Cohen, Michael V.; Mukerji, Vaskar; Massey, Clara V.; Hashimi, M.Wail; Panayiotou, Hercules

doi:10.1016/0002-8703(95)90210-4

Cited by 103 publications

(86 citation statements)

References 25 publications

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“…A previous study showed that an impairment of diastolic function, as evaluated by Doppler methodology, is independently correlated with higher levels of TC and LDL-cholesterol, and is associated with lower levels of HDL-cholesterol in postmenopausal women with mild-to-moderate hypertension. 50 Nevertheless, at an in vitro level, no independent effect of HDL-cholesterol on fibroblast transformation or on procollagen synthesis has yet been described or studied. Although obesity is a strong clinical predictor of LV mass, 57 LVM is more strongly independently associated with FFM than with other measures of body size.…”

Section: Discussionmentioning

confidence: 99%

“…Serum concentrations of this propeptide depend on other factors, including the rate of release, how they reach the blood and the volume of distribution. 66,67 Nevertheless, several studies have raised the prospect that the extent of myocardial fibrosis or ischemic cardiomyopathy can be predicted from these serum markers and that they have prognostic value.…”

Section: Study Limitationmentioning

confidence: 99%

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Myocardial collagen turnover in normotensive obese patients: relation to insulin resistance

et al. 2005

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OBJECTIVES:The present study was undertaken to assess the differential impact of insulin resistance, leptin and body composition on myocardial mass and serum markers of cardiac fibrosis in obese subjects, within a small range of elevated BMI (30-40 kg/m 2 ), without pulmonary disease, cardiovascular disease, hypertension, cardiac hypertrophy or other cardiovascular disease. BACKGROUND: Obesity is an independent predictor of left ventricular mass (LVM) and is associated with disturbances in cardiac structure. The extent of the interstitial fibrosis in obese patients is not known, especially in the absence of cardiac hypertrophy. METHODS AND RESULTS:We included 160 obese subjects. The LVM was obtained using the Devereux formula. Body composition was estimated from a total body scan. Insulin sensitivity was assessed by homeostasis model assessment (HOMA), and cardiac collagen turnover by measurement of procollagen type III aminopeptide (PIIINP). PIIINP was correlated to the E/A ratio (r ¼ 0.24; P ¼ 0.012), a marker of ventricular function. PIIINP was independently correlated with glucose concentration (r ¼ 0.27; P ¼ 0.004), indexes of insulin resistance (HOMA (r ¼ 0.27; P ¼ 0.003), insulin (r ¼ 0.24; P ¼ 0.008)), and parameters associated with the insulin-resistance syndrome (HDL-cholesterol r ¼ À0.27; P ¼ 0.004) and fat trunk/fat leg ratio (r ¼ 0.24; P ¼ 0.053)). The variable most correlated with PIIINP was HDL-cholesterol, followed by HOMA (r 2 ¼ 0.13). When HOMA was substituted for blood glucose concentration and insulinemia (Model 2), HDL-cholesterol was strongly related to lower PIIINP levels, followed by higher glucose concentration (r 2 ¼ 0.21). Regression analyses showed that LVM had the strongest independent positive correlation with fat-free mass (FFM) (r ¼ 0.39; P ¼ 0.0002), followed by systolic blood pressure (r ¼ 0.19; P ¼ 0.034). Neither adipose mass nor height independently added information to multivariate models. The ratio leptin/fat mass was correlated with LVM (r ¼ À0.27; P ¼ 0.004), but not independently of the FFM. Markers for fibrosis were not significantly correlated with LVM. As a result, FFM was the most predictive factor of LVM in obese subjects. CONCLUSION: We found that serum levels of markers of cardiac collagen synthesis were significantly associated with insulin resistance in normotensive, nondiabetic obese subjects, and not related to the LVM. As a result, PIIINP could be a very early marker of ventricular dysfunction in these patients. Furthermore, we suggest that, for better detection of left ventricle hypertrophy in obese subjects, LVM should be indexed to FFM rather than to body surface area, or height.

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Section: Discussionmentioning

confidence: 99%

Section: Study Limitationmentioning

confidence: 99%

Myocardial collagen turnover in normotensive obese patients: relation to insulin resistance

et al. 2005

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“…2,3 Over time, MO results in structural myocardial changes, including increased left ventricular (LV) dimensions and mass, and impaired LV relaxation and systolic function. 4,5 The mechanisms underlying these changes remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Ramani

McCloskey

Ramanathan

et al. 2008

Clinical Cardiology

103

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Background: Morbid obesity (MO) is a risk factor for congestive heart failure (CHF). The presence of MO impairs functional status and disqualifies patients for cardiac transplantation. Bariatric surgery (BAS) is a frontline, durable treatment for MO; however, the safety and efficacy of BAS in advanced CHF is unknown. Hypothesis: We hypothesized that by utilizing a coordinated approach between an experienced surgical team and heart failure specialists, BAS is safe in patients with advanced systolic CHF and results in favorable outcomes. Methods: We performed a retrospective chart review of 12 patients with MO (body mass index [BMI] 53±7 kg/m 2 ) and systolic CHF (left ventricular ejection fraction [LVEF] 22±7%, New York Heart Association [NYHA] class 2.9±0.7) who underwent BAS, and then compared outcomes with 10 matched controls (BMI 47.2±3.6 kg/m 2 , LVEF 24±7%, and NYHA class 2.4±0.7) who were given diet and exercise counseling. Results: At 1 y, hospital readmission in BAS patients was significantly lower than controls (0.4±0.8 versus 2.5±2.6, p = 0.04); LVEF improved significantly in BAS patients (35±15%, p = 0.005), but not in controls (29±14%, p = not significant [NS]). The NYHA class improved in BAS patients (2.3±0.5, p = 0.02), but deteriorated in controls (3.3±0.9, p = 0.02). One BAS patient was successfully transplanted, and another listed for transplantation. Conclusions: Bariatric surgery is safe and effective in patients with MO and severe systolic CHF, and should be considered in patients who have failed conventional therapy to improve clinical status.

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“…Excessive body weight, the blood supply of surplus of adipose tissue mass means an additional burden on the heart, especially on the LV muscle. [1][2][3][4][5] Cardiac overload can occur also in persons with a normal body weight and can induce LV hypertrophy as well; for example, in hypertension where usually increased total peripheral resistance persists that in the long run overburdens the heart. 6 Since obesity and hypertension often coexist, one might assume that LV hypertrophy of obese patients is mainly caused by hypertension.…”

Section: Introductionmentioning

confidence: 99%

Cardiac hypertrophy and diastolic function in physically well trained and in obese men

Sidó¹,

Jákó²,

Kneffel

et al. 2003

Int J Obes

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OBJECTIVE:The aim of the present study was to compare cardiac hypertrophy and diastolic function in extremely obese male patients and physically active adult male subjects of similar age (means 43.0-43.4 y). DESIGN: Data of male patients referred to our hospital ward in order to reduce their body weight (BW) were compared with those of physically active and nonactive healthy males. SUBJECTS: The groups contained 21-24 male subjects, very active and moderately active subjects taking part in regular competitive or leisure time physical activity were in the two athletic groups, severely overweight patients constituted the obese group and healthy persons served as controls. MEASUREMENTS: Two-dimensionally guided M-mode and Doppler recordings. RESULTS: In comparison with the controls, obese patients had larger left atrial systolic and left ventricular (LV) diastolic internal diameters, LV diastolic wall thickness and muscle mass. Of the body size-related indices, only the left atrial systolic diameter index was significantly higher. LV systolic and diastolic functions were impaired as indicated by a decreased ejection fraction (EF), higher heart rate (HR), decreased E/A quotient and increased isovolumetric relaxation time. In the physically very active subjects, a thicker LV diastolic wall was seen without LV dilatation. Body size-related wall thickness and muscle mass were significantly higher than in the controls. EF and HR did not differ from those of the controls. CONCLUSION: The most useful help to distinguish between physiological and pathological left ventricular hypertrophy can be to investigate diastolic functions. The most salient difference appeared in diastolic function, because E/A quotient was higher in the very active subjects than in the controls and it was the lowest in the obese persons.

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Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity

Cited by 103 publications

References 25 publications

Myocardial collagen turnover in normotensive obese patients: relation to insulin resistance

Myocardial collagen turnover in normotensive obese patients: relation to insulin resistance

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Cardiac hypertrophy and diastolic function in physically well trained and in obese men

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