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

Abstract

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.

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

“…9,20,23,24,30,38,44-46 The normal mean values of systolic GLSr varied from -1.08 to -1.32 (mean -1.18, 95% CI -1.10 to -1.25) Between-study heterogeneity was evidenced by a Cochran's Q statistic of 83 (P < 0.0001) and inconsistency by an I 2 value of 94.0%. The normal mean values of early diastolic GLSr varied from 1.40 to 1.85 (mean 1.62, 95% CI 1.31 to 1.92).…”

“…Forty-one datasets with 2084 patients were eligible for the meta-analysis of GLS or LS ; 7-24,26-34,36-49 26 datasets with 1506 patients were eligible for the meta-analysis of GCS or CS , 7,9,11,12,14-20,23,25,26,28-31,33,34,41-44,46,48 and 15 datasets with 1092 patients were eligible for the meta-analysis of GRS or RS. 11,15,16,19,20,23,25,26,28,29,33,41-43,46 The patient characteristics of the included studies are listed in Table 1.…”

“…11,15,16,19,20,23,25,26,28,29,33,41-43,46 The patient characteristics of the included studies are listed in Table 1. The echocardiographic variables included from the studies are listed in Table 2.…”

“…All the studies used a deformation imaging acquisition and post-processing protocol. Reproducibility analysis was performed in 32/43 7-10,14-21,23-27,33,35-46,48,49 datasets and referenced in 4/43. 11,30,31,47 …”

Systemic effects of a high saturated fat diet in grizzly bears (Ursus arctos horribilis)

“…Obesity alone has also been shown to be an independent risk factor for heart disease in humans, even after accounting for comorbid conditions such as type-2 diabetes and coronary artery disease (Roberts et al 2009;Orhan et al 2010). Subclinical cardiac diastolic dysfunction appears to be a common initial consequence of obesity and may be overlooked early in the clinical evaluation (Millen et al 2014;Sanchez et al 2015). Such findings highlight the potential for lipid-induced heart dysfunction prior to overt clinical signs.…”