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Abnormal left ventricular diastolic filling in eccentric left ventricular hypertrophy of obesity
S Chakko1, M Mayor, M D Allison
1Medical Service, Veterans Administration Medical Center, Miami, Florida 33125.
Insights
Obese individuals with eccentric left ventricular (LV) hypertrophy exhibit impaired diastolic filling patterns. These findings highlight significant differences in LV diastolic function compared to normal controls and hypertensive patients.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Background:
- Obesity is linked to cardiovascular changes, including left ventricular (LV) hypertrophy.
- Diastolic dysfunction can precede or accompany LV hypertrophy, impacting cardiac function.
- Understanding the specific pattern of diastolic filling in obese individuals with eccentric LV hypertrophy is crucial for clinical assessment.
Purpose of the Study:
- To investigate the left ventricular (LV) diastolic filling pattern in obese subjects with eccentric LV hypertrophy.
- To compare these patterns with normal control subjects and hypertensive patients exhibiting concentric LV hypertrophy.
Main Methods:
- Utilized M-mode, 2-dimensional, and Doppler echocardiography in three groups: obese normotensive patients with eccentric LV hypertrophy, normal controls, and nonobese hypertensive patients with concentric LV hypertrophy.
- Defined LV hypertrophy using LV mass/height ratio (>143 g/m).
- Assessed LV diastolic filling using pulsed-wave Doppler echocardiographic indexes.
Main Results:
- Obese patients presented with eccentric LV hypertrophy (larger LV internal dimension, thinner walls compared to hypertensive group).
- Obese subjects showed impaired diastolic filling: higher peak atrial filling velocity, lower early/atrial filling velocity ratio, prolonged deceleration half-time, and lower peak filling rate corrected to stroke volume compared to normal controls.
Conclusions:
- Obesity-associated eccentric LV hypertrophy is characterized by distinct diastolic filling abnormalities.
- These findings suggest that obesity significantly alters LV diastolic function, independent of hypertension in this cohort.
- Echocardiographic assessment of diastolic function is vital in managing obese patients with cardiac structural changes.
Abstract:
Left ventricular (LV) diastolic filling pattern of obese subjects with eccentric LV hypertrophy was studied. Findings were compared with those of normal control subjects and hypertensive patients with concentric LV hypertrophy. M-mode, 2-dimensional and Doppler echocardiograms were recorded in 11 obese (body mass index greater than 30 kg/m2) normotensive patients with eccentric LV hypertrophy, 10 normal control subjects, and 18 nonobese, hypertensive patients with concentric LV hypertrophy whose antihypertensive medications were discontinued 2 weeks before study. LV hypertrophy was defined as LV mass/height greater than 143 g/m. Hypertrophy in the obese patients was eccentric: Their LV internal dimension (61 +/- 3 mm) was greater than that of hypertensive patients (55 +/- 5 mm, p less than 0.001) and normal control subjects (55 +/- 2 mm, p less than 0.01); their septal (10.7 +/- 0.7 mm) and posterior (10.9 +/- 0.6 mm) wall thicknesses were smaller than those of the hypertensive patients (12.2 +/- 1.7 mm, p less than 0.05 and 11.7 +/- 1.2 mm, respectively, difference not significant). Pulsed-wave Doppler echocardiographic filling indexes were used to evaluate LV diastolic filling. Obese patients had a higher peak velocity of atrial filling (69 +/- 14 vs 54 +/- 15 cm/s, p less than 0.05), lower early/atrial filling velocity ratio (1.0 +/- 0.26 vs 1.32 +/- 0.21, p less than 0.05), prolonged deceleration half-time (108 +/- 9 vs 86 +/- 15 ms, p less than 0.01) and lower peak filling rate corrected to stroke volume (4.08 +/- 0.68 vs 4.96 +/- 0.88 stroke volume/s, p less than 0.05) than normal control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)