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Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study
Ayse Esin Kibar1, Feyza Aysenur Pac, Sevket Ballı
1Department of Pediatric Cardiology, Mersin Women's and Children's Hospital, Güneykent, Mersin, Turkey. dreseresin@yahoo.com
Insights
Obesity directly impacts heart function in children, causing preclinical left-ventricular (LV) dysfunction. Elevated body mass index (BMI) and insulin resistance (HOMA-IR) are linked to these cardiac changes.
Area of Science:
- Cardiology
- Pediatric Endocrinology
- Medical Imaging
Background:
- The direct impact of obesity on myocardial function in children remains under-established.
- Obesity is a growing concern with potential cardiovascular implications in pediatric populations.
Purpose of the Study:
- To investigate the effects of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children.
- To assess subclinical LV systolic and diastolic function using tissue Doppler imaging (TDI).
Main Methods:
- A prospective cross-sectional study involving 110 children (60 obese, 50 normal).
- Subjects categorized into control (BMI < 25), overweight (BMI 25-29.9 kg/m²), and morbidly obese (BMI ≥ 30 kg/m²) groups.
- Standard echocardiography and TDI were used to measure LV dimensions, mass, ejection fraction, mitral annular displacement index (DI), and myocardial performance index (MPI).
Main Results:
- Obese children exhibited increased LV diameters and mass with preserved ejection fraction.
- TDI revealed significantly impaired LV systolic and diastolic function in obese subgroups compared to controls (p < 0.001).
- Abnormalities in LV function, including DI and MPI, were significantly correlated with BMI and HOMA-IR, indicating preclinical impairment.
Conclusions:
- Isolated obesity, even at preclinical stages, is associated with subclinical left-ventricular dysfunction in children.
- BMI and insulin resistance are significant factors contributing to impaired LV myocardial function in pediatric obesity.
- TDI is a valuable tool for detecting early cardiac changes in obese children.
Abstract:
A direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 ± 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI ≥ 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 ± 2 cm/s), peak early myocardial velocity (Am = 8.7 ± 1.3 cm/s), Em/Am ratio (1.8 ± 0.3), isovolumetric relaxation time (IVRT = 59.2 ± 8.2 ms), MPI (0.39 ± 0.03), and DI (25.5 ± 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 ± 1.2 cm/sn, 6.9 ± 0.6 cm/sn, 2.6 ± 0.2, 51.2 ± 9.6 ms, 0.34 ± 0.03, and 33.13 ± 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.
