Obesity-related adjunctive systo–diastolic ventricular dysfunction in patients with hypertension: echocardiographic assessment with tissue Doppler velocity and strain imaging

Leggio, Massimo; Cruciani, Giancarlo; Sgorbini, Luca; Mazza, Andrea; Bendini, Maria Grazia; Pugliese, Marco; Leggio, F; Jesi, Anna Patrizia

doi:10.1038/hr.2010.266

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…Regardless of age and severity of obesity, data on the effect of obesity on myocardial mechanics are scarce. Previous studies using color TDI have demonstrated reduced myocardial velocities, strain, and SR in obese adults (9,10,11,12,13) and children and adolescents (5,14). As a result of TDI angle‐dependency, obesity‐related myocardial deformation alterations reported in these studies were principally restricted to basal segments evaluated in apical views.…”

Section: Discussionmentioning

confidence: 90%

“…Reduced longitudinal strains as well as systolic and diastolic strain rates (SR) measured using color tissue Doppler imaging (TDI) have been found in adults (9,10,11,12,13) and recently in children and adolescents (5,14) with obesity. The angle‐dependency is a serious limitation of all Doppler‐based techniques (15) and most of the aforementioned studies reported data only on myocardial longitudinal function.…”

Section: Introductionmentioning

confidence: 99%

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Two‐Dimensional Strain and Twist by Vector Velocity Imaging in Adolescents With Severe Obesity

Obert

Gueugnon

Nottin

et al. 2012

Obesity

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The prevalence of severe obesity is increasing worldwide in adolescents. Whether it is associated with functional myocardial abnormalities remains largely unknown, potentially because of its frequent association with other cardiovascular risk factors and also use of insensitive techniques to detect subclinical changes in myocardial function. We used 2D vector velocity imaging (VVI) to investigate early changes in left ventricular (LV) myocardial function in youths with isolated severe obesity. Thirty‐seven asymptomatic severely obese adolescents free of diabetes and hypertension, and 24 lean controls were enrolled. LV longitudinal, basal, and apical circumferential strain, strain rate (SR), rotations, and LV twist were measured. Obese adolescents had greater LV mass and reduced systolic and early diastolic tissue Doppler imaging (TDI) velocities than lean counterparts. L strain (−24%) and systolic and early diastolic SR were also diminished in the obese, whereas no intergroup differences existed for the circumferential deformation indexes. LV twist was more pronounced in the obese (+1.7°, P < 0.01) on account of greater apical rotation only (4.1 ± 0.9 vs. 5.2 ± 1.2°, P < 0.01), potentially compensating for the loss in longitudinal function. Systolic—diastolic coupling, an important component of early filling and diastolic function, was maintained with severe obesity. No intergroup differences were reported regarding time to peak values for all VVI indexes highlighting that dynamics of strain and twist/untwist along the cardiac cycle was preserved with severe obesity. Isolated severe obesity in adolescents, at a preclinical stage, is associated with changes in myocardial deformation and torsional mechanics that could be in part related to alterations in relaxation and contractility properties of subendocardial fibers.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Two‐Dimensional Strain and Twist by Vector Velocity Imaging in Adolescents With Severe Obesity

Obert

Gueugnon

Nottin

et al. 2012

Obesity

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“…DD has clinical, prognostic and therapeutic ramifications. 23, 24, 25, 26, 27 Hypertension, LV hypertrophy, diabetes mellitus and insulin resistance are complications of obesity and have all been associated with worsening of DD. 10 In fact, these cardiovascular risk factors were much more prevalent in the obese and morbidly obese patients than those with normal BMI for all patients and those <35 years old (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction

AlJaroudi¹,

Halley²,

Houghtaling

et al. 2012

Nutr & Diabetes

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Background:Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD).Methods:We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m−2), overweight (25–29.9 kg m−2), obese (30–39.9 kg m−2) and morbidly obese (⩾40 kg m−2). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD.Results:The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic function was present in 13 414 (61.9%) patients, with stage 1 being the most common. As BMI increased, the prevalence of normal diastolic function decreased (P<0.0001). Furthermore, there were 1733 patients with age <35 years; 460 (26.5%) and 407 (23.5%) were overweight and obese, respectively, and had higher prevalence of DD (P<0.001). Using multivariable logistic regression, BMI remained significant in both ordinal (all stages of diastolic function) and binary (normal versus abnormal). Also, obesity was associated with increased odds of DD in all patients and those aged <35 years.Conclusions:In patients with normal LVEF, higher BMI was independently associated with worsening DD.

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“…Previous studies for detecting LV systolic functions in EHT patients depend mainly on tissue Doppler imaging (TDI), cardiac magnetic resonance imaging (cardiac MRI), and cardiac radionuclide imaging. [2][3][4] However, these techniques all have limitations, like angle dependence in TDI, 5,6 long-term examination in cardiac MRI, and radioactivity of cardiac radionuclide imaging. Two-dimensional speckle-tracking echocardiography (2D-STE) has become one of the leading reliable diagnostic techniques for the assessment of cardiac functions because of its non-invasiveness, convenience, and repeatability.…”

Section: Introductionmentioning

confidence: 99%

Global myocardial work: A new way to detect subclinical myocardial dysfunction with normal left ventricle ejection fraction in essential hypertension patients: Compared with myocardial layer‐specific strain analysis

et al. 2021

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Objectives:The aim of this study was to determine whether global myocardial work (MW), derived from non-invasive left ventricle (LV) pressure-strain loops (PSL) at rest, could predict subclinical LV myocardial dysfunction in preserved left ventricular ejection fraction (LVEF) essential hypertension (EHT) patients. Methods: A total of 105 untreated EHT patients and 55 normal controls were enrolled in this study. Apical 4-, 3-and 2-chamber views were acquired by two-dimensional echocardiography. The peak systolic myocardial layer-specific longitudinal strain (epimyocardial: GLSEpi; middle layer: GLSMid; and endomyocardial: GLSEndo), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and myocardial work efficiency (GWE) were generated by speckle-tracking echocardiography (STE).Results: The values of GLSEpi, GLSMid, and GLSEndo were significantly lower in EHT patients with LVH than in EHT patients without LVH and normal controls. GWW was significantly increased in EHT patients with LVH compared with without LVH and normal subjects, while GWE was significantly reduced in EHT patients with LVH compared with without LVH and normal subjects. ROC analysis showed that combined global MW values were a more sensitive predictor for detecting the accuracy of LV subclinical dysfunction in EHT patients than layer-specific GLS. Conclusion:From the research, we conclude that global MW is more sensitive to layer-specific GLS in its ability to detect subclinical LV dysfunction even in EHT patients even without LVH.

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Obesity-related adjunctive systo–diastolic ventricular dysfunction in patients with hypertension: echocardiographic assessment with tissue Doppler velocity and strain imaging

Cited by 15 publications

References 30 publications

Two‐Dimensional Strain and Twist by Vector Velocity Imaging in Adolescents With Severe Obesity

Two‐Dimensional Strain and Twist by Vector Velocity Imaging in Adolescents With Severe Obesity

Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction

Global myocardial work: A new way to detect subclinical myocardial dysfunction with normal left ventricle ejection fraction in essential hypertension patients: Compared with myocardial layer‐specific strain analysis

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