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Left ventricular filling in the systemic hypertension of obesity
E Grossman1, S Oren, F H Messerli
1Department of Internal Medicine, Ochsner Clinic, New Orleans, Louisiana 70121.
Insights
Obesity impairs cardiac diastolic function and increases left ventricular (LV) mass, particularly in hypertensive patients. This cardiac burden from obesity affects LV filling regardless of blood pressure levels.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Obesity Medicine
Background:
- Hypertension and obesity are prevalent conditions affecting cardiovascular health.
- Left ventricular (LV) function is crucial for maintaining cardiac output.
- The combined effects of obesity and hypertension on cardiac structure and function require further investigation.
Purpose of the Study:
- To evaluate cardiac structure and systolic and diastolic functions in lean and obese patients with and without hypertension.
- To determine the impact of obesity on cardiac parameters independent of blood pressure.
- To assess the correlation between obesity indicators and left ventricular remodeling and filling dynamics.
Main Methods:
- Two-dimensional M-mode echocardiography was used to assess cardiac structure and function.
- Patients were categorized into lean/obese and normotensive/hypertensive groups.
- Diastolic function was evaluated using normalized early peak filling rate and duration of rapid filling.
Main Results:
- Hypertensive patients showed decreased diastolic function compared to normotensive patients.
- Obese patients exhibited a lower normalized peak filling rate than lean patients, irrespective of blood pressure.
- Obesity was associated with increased LV dimensions, wall thickness, and mass, correlating with impaired filling.
- Impaired LV filling was most severe in obese hypertensive patients.
Conclusions:
- Obesity imposes a significant burden on the left ventricle, leading to cardiac enlargement.
- Obesity impairs left ventricular filling, independent of arterial pressure levels.
- Combined obesity and hypertension exacerbate cardiac dysfunction, highlighting the detrimental effects of excess weight on the heart.
Abstract:
Cardiac structure and systolic as well as diastolic functions were evaluated by 2-dimensional M-mode echocardiography in lean and obese patients who were either hypertensive or normotensive. Diastolic function, as assessed by diminished normalized early peak filling rate and prolonged duration of rapid filling, was decreased in hypertensive patients compared with normotensive patients (p = 0.02). When compared with lean patients with similar blood pressure levels, obese patients exhibited a lower normalized peak filling rate (p = 0.0014) but no difference in duration of rapid filling. A significant correlation was observed between the normalized peak filling rate and either body mass index or left ventricular (LV) mass (r = 0.355 and r = -0.32, respectively; p less than 0.001). Obese patients had greater LV end-diastolic and systolic dimensions (p less than 0.005 and p less than 0.02, respectively), LV wall thickness (p less than 0.05) and LV mass (p less than 0.007) than lean patients. Impairment of LV filling was most pronounced in obese hypertensive patients. It is concluded that the burden on the left ventricle imposed by obesity causes cardiac enlargement and impairment of LV filling regardless of levels of arterial pressure.