The impact of body weight on the diagnosis of aortic dilation—misdiagnosis in overweight and underweight groups

Braley, Katherine; Tang, Xinyu; Makil, Elizabeth S.; Borroughs-Ray, Desiree; Collins, R. Thomas

doi:10.1111/echo.13565

Cited by 12 publications

(5 citation statements)

References 43 publications

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“…Left ventricular mass normalization for body size is physiologically justified and widely accepted. However, LVM normalization for body mass or its derivatives like BSA, may abate or even eliminate influence of excess body mass producing false normal results [4,5,11,12,32]. The problem of bias related to BMI or more generally, bias related to body mass in cardiac size scaling, has been raised many times for more than twenty years [4,5,33].…”

Section: Discussionmentioning

confidence: 99%

“…Body surface area (BSA) seems to be the most-used scaling variable [10]. However, BSA calculation takes into account both the lean and fat components of body mass, so normalization for BSA may hide the influence of excess body mass, adiposity or musculature for example, on cardiac size, producing underestimated results [4,11,12]. This effect is referred to as a bias related to body mass index (BMI) or BMI bias [11].…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization

et al. 2019

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Background Left ventricular mass normalization for body size is recommended, but a question remains: what is the best body size variable for this normalization—body surface area, height or lean body mass computed based on a predictive equation? Since body surface area and computed lean body mass are derivatives of body mass, normalizing for them may result in underestimation of left ventricular mass in overweight children. The aim of this study is to indicate which of the body size variables normalize left ventricular mass without underestimating it in overweight children. Methods Left ventricular mass assessed by echocardiography, height and body mass were collected for 464 healthy boys, 5–18 years old. Lean body mass and body surface area were calculated. Left ventricular mass z-scores computed based on reference data, developed for height, body surface area and lean body mass, were compared between overweight and non-overweight children. The next step was a comparison of paired samples of expected left ventricular mass, estimated for each normalizing variable based on two allometric equations—the first developed for overweight children, the second for children of normal body mass. Results The mean of left ventricular mass z-scores is higher in overweight children compared to non-overweight children for normative data based on height (0.36 vs. 0.00) and lower for normative data based on body surface area (-0.64 vs. 0.00). Left ventricular mass estimated normalizing for height, based on the equation for overweight children, is higher in overweight children (128.12 vs. 118.40); however, masses estimated normalizing for body surface area and lean body mass, based on equations for overweight children, are lower in overweight children (109.71 vs. 122.08 and 118.46 vs. 120.56, respectively). Conclusion Normalization for body surface area and for computed lean body mass, but not for height, underestimates left ventricular mass in overweight children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization

et al. 2019

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“…A disadvantage of both of these z‐scores is that they are based on BSA, which could lead to over‐ or underestimation of aortic dilatation in patients with a relatively high or low weight for their height (Braley et al, 2017 ). Correcting the aortic diameter using height instead of BSA could partly solve this problem (Duijnhouwer et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Cardiac abnormalities in girls with Turner syndrome: ECG abnormalities, myocardial strain imaging, and karyotype–phenotype associations

Noordman

Fejzic

Bos

et al. 2021

American J of Med Genetics Pt A

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Turner syndrome (TS) is a chromosomal condition which is associated with an increased prevalence of cardiac morbidity and mortality. In this cross-sectional study, Minnesotabased electrocardiographic (ECG) abnormalities, aortic dimensions, routine-and myocardial strain echocardiographic parameters, and karyotype-cardiac phenotype associations were assessed in girls with TS. In total, 101 girls with TS (0-18 years) were included.The prevalence of major ECG abnormalities was 2% (T-wave abnormalities) and 39% had minor ECG abnormalities. Dilatation of the ascending aorta (z-score > 2) was present in 16%, but the prevalence was much lower when using TS-specific z-scores. No left ventricular hypertrophy was detected and the age-matched global longitudinal strain was reduced in only 6% of the patients. Cardiac abnormalities seemed more common in patients with a non-mosaic 45,X karyotype compared with other karyotypes, although no statistically significant association was found. Lowering the frequency of echocardiography and ECG screening might be considered in girls with TS without cardiovascular malformations and/or risk factors for aortic dissection. Nevertheless, a large prospective study is needed to confirm our results. The appropriate z-score for the assessment of aortic dilatation remains an important knowledge gap. The karyotype was not significantly associated with the presence of cardiac abnormalities, therefore cardiac screening should not depend on karyotype alone.

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“…5,6 The circadian system reacts differently to the environmental cues, depending on the internal phase and the relationship with the zeitgeber (time-giver, in German), for example, the phase response curve to the light-dark cycle stimuli can be individually modulated. 7 Zeitgebers are diverse and include some social clues, such as working time, feed schedule and the light-dark cycle, and they are an important stimulation to entrain the clock phase, and thereafter, the circadian system. 8 The feed schedule can synchronize the behavior, not only the feeding time, but also the food quantity and quality.…”

Section: Introductionmentioning

confidence: 99%

Shift Work and Metabolic Syndrome Updates: A Systematic Review

2023

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Shift work can cause circadian cycles disturbances and misaligns the endogenous rhythms. The physiological variables are driven by the circadian system and, its misalignment, can impair the metabolic functions. Thus, the main objective of this study was to evaluate the metabolic alterations as a result of shift work and night work reported in articles published in the last 5 years, using the eligibility criteria both gender and indexed articles in English language. In order to execute this work, we perform a systematic review according to PRISMA guidelines and searched about Chronobiology Disorders and Night Work, both related to metabolism, in Medline, Lilacs, ScienceDirect and Cochrane. Cross-sectional, cohort and experimental studies with low risk of bias were included. We found a total of 132 articles, and, after the selection process, 16 articles remained to be analyzed. It was observed that shift work can cause circadian misalignment and, consequently, some metabolic parameters alterations such as an impaired glycemic control and insulin functioning, cortisol phase release, cholesterol fractions imbalance, changes in morphological indexes and melatonin secretion. There are some limitations, such as heterogenicity in used databases and the 5 years restriction period, because the effects of sleep disturbance may have been reported earlier. In conclusion, we suggest that shift work interferes with the sleep-wake cycle and eating patterns, which cause crucial physiological alterations that, together, can lead to metabolic syndrome.

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The impact of body weight on the diagnosis of aortic dilation—misdiagnosis in overweight and underweight groups

Abstract: Using current recommended methods, AoD will be missed in overweight and obese patients and overdiagnosed in underweight patients. For children of normal weight, a Z-score based on BSA may be reliable. As obesity rates increase, weight-independent Z-scores must be developed.

Cited by 12 publications

References 43 publications

Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization

Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization

Cardiac abnormalities in girls with Turner syndrome: ECG abnormalities, myocardial strain imaging, and karyotype–phenotype associations

Shift Work and Metabolic Syndrome Updates: A Systematic Review

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