Obese Subjects Show Sex-Specific Differences in Right Ventricular Hypertrophy

Abstract

One of the potential reasons for the underinvestigation of RV remodeling in obesity lies in the fact that accurate 2-dimensional echocardiographic assessment of RV size and function is inherently more difficult as a result of the complexity of the shape of the RV, which, in contrast to the ellipsoidal shape of the LV, seems triangular, when viewed from the side, and crescentic, when viewed from above. This is hampered further by the increased difficulty of generating adequate acoustic windows in obesity. Despite these limitations, the majority of these studies have shown RV hypertrophy in obesity. [5][6][7][8] A few previous studies investigating RV geometry in obesity, have, in the main, not excluded subjects with obesityrelated comorbidities, such as hypertension, 9 which are known to have independent effects on RV mass.5 In contrast to echocardiography, cardiovascular magnetic resonance imaging is Background-As right ventricular (RV) remodeling in obesity remains underinvestigated, and the impact of left ventricular (LV) diastolic dysfunction on RV hypertrophy is unknown, we aimed to investigate whether (1) sex-specific patterns of RV remodeling exist in obesity and (2) LV diastolic dysfunction in obesity is related to RV hypertrophy. Methods and Results-Seven hundred thirty-nine subjects (women, n=345; men, n=394) without identifiable cardiovascular risk factors (body mass index [BMI], 15.3-59.2 kg/m 2 ) underwent cardiovascular magnetic resonance (1.5 T) to measure RV mass (g), RV end-diastolic volume (mL), RV mass/volume ratio, and LV diastolic peak filling rate (mL/s). All subjects were normotensive (average, 119±11/73±8 mm Hg), normoglycaemic (4.8±0.5 mmol/L), and normocholesterolaemic (4.8±0.9 mmol/L) at the time of scanning. Across both sexes, there was a moderately strong positive correlation between BMI and RV mass (men, +0.8 g per BMI point increase; women, +1.0 g per BMI point increase; both P<0.001). Whereas women exhibited RV cavity dilatation (RV end-diastolic volume, +1.0 mL per BMI point increase; P<0.001), BMI was not correlated with RV end-diastolic volume in men (R=0.04; P=0.51). Concentric RV remodeling was present in both sexes, with RV mass/volume ratio being positively correlated to BMI (men, R=0.41; women, R=0.51; both P<0.001

Cardiac and Metabolic Variables in Obese Dogs

“…As a shared structure, the interventricular septum also may be hypertrophied in right ventricular pressure overload diseases such as pulmonary hypertension. Obese people and dogs have been shown to have pulmonary dysfunction, pulmonary hypertension, and right ventricular hypertrophy . Occult pulmonary hypertension potentially could be a cause for the interventricular septal hypertrophy observed in obese dogs.…”

Geometry‐Related Right Ventricular Systolic Function Assessed by Longitudinal and Radial Right Ventricular Contractions

“…There were 6 overweight subjects (0.6%) with body mass index >25. 12 The TAPSE values ranged from 6.0 to 31.4 mm (mean 19.1 AE 4.4 mm). The RVWD values ranged from À5.8 to 6.9 mm (mean 0.044 AE 2.26 mm) and the RV/LV ratio values ranged from 14.0 to 83.5% (mean 36.3 AE 11.3%).…”

“…Approximately 10% of all subjects required sedation via the oral administration of triclofos sodium syrup. There were 6 overweight subjects (0.6%) with body mass index >25 …”

Two-dimensional echocardiographic right ventricle measurements adjusted to body mass index and surface area in a normal population

“…RV ejection fraction was lower in men than in women. The male pattern of hypertrophy is reported to be more concentric remodeling, whereas the female pattern is mainly mixed eccentric and concentric . However, more effective adaptive remodeling of the RV in response to increased afterload has been reported in females .…”

“…Both BMI and BSA have been considered predictors of right heart dimensions in several studies. Greater BMI has been shown to be substantially associated with RV hypertrophy with subsequent dysfunction and overt heart disease …”