CLINICAL RESEARCH: ATHEROSCLEROTIC RISK FACTORS
Alterations in left ventricular structure and function in young healthy obese women
Assessment by echocardiography and tissue Doppler imaging
Linda R. Peterson, MD, FACC* ,*,
Alan D. Waggoner, MHS, RDCS*,
Kenneth B. Schechtman, PhD ,
Timothy Meyer, MS ,
Robert J. Gropler, MD, FACC||,
Benico Barzilai, MD, FACC* and
Víctor G. Dávila-Román, MD, FACC*
* Department of Medicine, Cardiovascular Imaging and Clinical Research Core Laboratory, St. Louis, Missouri, USA
Cardiovascular Division; Division of Geriatrics and Nutritional Sciences, St. Louis, Missouri, USA
Division of Biostatistics, St. Louis, Missouri, USA
Department of Physical Therapy, St. Louis, Missouri, USA
|| Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
Manuscript received August 14, 2003;
revised manuscript received September 25, 2003,
accepted October 7, 2003.
* Reprint requests and correspondence: Dr. Linda R. Peterson, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110, USA.
lpeterso{at}im.wustl.edu
OBJECTIVES: This study was designed to determine the effects of obesity on left ventricular (LV) structure and function in young obese women.
BACKGROUND: Severe prolonged obesity in older adults results in increased plasma volume, eccentric LV hypertrophy, and systolic and diastolic dysfunction. Obese women are at increased risk for the development of heart failure. However, the effects of the obesity on cardiac structure and function in young, otherwise-healthy women are controversial.
METHODS: Fifty-one women were evaluated: 20 were obese (body mass index [BMI]  30 kg/m2) and 31 were non-obese (BMI <30 kg/m2). Left ventricular structure and systolic and diastolic function were assessed by two-dimensional echocardiography and tissue Doppler imaging, including the load-independent systolic myocardial velocity (Sm global) and early diastolic myocardial velocity (Em global), respectively. The effects of BMI on LV structure and function were assessed using multivariate regression analyses.
RESULTS: Obese women had higher end-diastolic septal and posterior wall thickness, LV mass, and relative wall thickness than non-obese women; BMI values showed significant correlations with these variables (r = 0.58, p < 0.0001; r = 0.50, p < 0.0002; r = 0.52, p < 0.0001, and r = 0.40, p < 0.005, respectively). The Sm global and Em global were lower in obese women, suggesting systolic and diastolic function are decreased; both were negatively correlated with BMI (r = –0.43, p <. 002 and r = –0.61, p < 0.0001, respectively). Multivariate analysis showed BMI was the only independent predictor of relative wall thickness, Sm global, and Em global.
CONCLUSIONS: Obesity in young otherwise-healthy women is associated with concentric LV remodeling and decreased systolic and diastolic function. These early abnormalities in LV structure and function may have important implications for explaining the myocardial dysfunction that is associated with increased cardiovascular morbidity and mortality caused by obesity.
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Abbreviations and Acronyms
| | BMI | = body mass index | | BP | = blood pressure | | DBP | = diastolic blood pressure | | Ded | = left ventricular mid-cavity dimensions at end-diastole | | Des | = left ventricular mid-cavity dimensions at end-systole | | E/A ratio | = early diastolic and atrial velocity ratio | | Em | = early diastolic myocardial velocity | | %FS | = percent fractional shortening | | HF | = heart failure | | LV | = left ventricle/ventricular | | LVEF | = left ventricular ejection fraction | | LVM | = left ventricular mass | | MAP | = mean arterial pressure | | RWT | = relative wall thickness | | SBP | = systolic blood pressure | | Sm | = systolic myocardial velocity | | TDI | = tissue Doppler imaging | | Vcf | = velocity of circumferential fiber shortening |
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