Left ventricular diastolic function and cardiometabolic factors in obese normotensive children
M Porcar-Almela1, P Codoñer-Franch2, M Tuzón3
1Department of Pediatrics, Dr. Peset University Hospital, Valencia, Spain.
Insights
Obese children show early cardiac changes, including altered left ventricular diastolic function. These changes are linked to metabolic risk and endothelial activation markers, highlighting the need for early screening.
Area of Science:
- Pediatric Cardiology
- Obesity Medicine
- Cardiovascular Research
Background:
- Obesity is linked to cardiac changes in adults, but data on children are limited.
- Early detection of cardiac alterations in obese children is crucial for cardiovascular risk management.
Purpose of the Study:
- To identify early changes in left ventricular (LV) structure and function in obese children.
- To investigate the association between these cardiac alterations and biomarkers of metabolic risk and endothelial activation.
Main Methods:
- Echocardiography (2D ultrasound, M-mode, Tissue Doppler imaging) to assess LV mass index (LVMi) and diastolic function (E/E', PVFD).
- Evaluation of metabolic control, inflammation, and endothelial cell activation markers.
- Study included 130 children (88 obese, 42 normal-weight) aged 7-16 years with normal blood pressure.
Main Results:
- Obese children exhibited significantly higher LVMi and E/E', and lower PVFD compared to controls.
- Severely obese subjects showed more pronounced diastolic function alterations.
- Diastolic function parameters (E/E', PVFD) were independently associated with obesity, apolipoprotein A1, sVCAM-1, and RBP4.
Conclusions:
- Echocardiographic assessment of diastolic function effectively detects early cardiac changes in obese children.
- Emerging cardiovascular risk markers (apolipoprotein A1, RBP4, sVCAM-1) correlate with diastolic function parameters.
- Early identification and monitoring of cardiac function in obese children are essential for preventing future cardiovascular events.
Background And Aim:
Left ventricular (LV) hypertrophy and diastolic function have been found to be associated with obesity and hypertension in adults. However, there are scarce data about the association of obesity itself to cardiac alteration in children. The aim of this study was to detect early changes in LV structure and function in obese children and whether they are associated with the biomarkers of metabolic risk and endothelial activation.
Methods And Results:
A total of 130 children aged 7-16 years (88 obese and 42 normal-weight children) were studied. All children had normal resting blood pressure. Two-dimensional ultrasound with M-mode imaging was performed to assess the LV mass index (LVMi), calculated as LV mass/height(2.7), and the peak diastolic of pulmonary venous flow velocity (PVFD). Tissue Doppler imaging was used to analyze ventricular performance through the ratio of the transmitral peak early filling velocity to the early average diastolic peak myocardial velocity (E/E'). The indicators of metabolic control, inflammation, and endothelial cell activation were evaluated. Compared to the controls, the obese subjects had significantly higher LVMi and E/E' and lower PVFD values, the two latest being found especially in severely obese subjects. In the multivariate analysis, the parameters of diastolic function (E/E' and PVFD) were independently associated with obesity, apolipoprotein A1, soluble vascular cell endothelial molecule-1 (sVCAM-1), and retinol-binding protein 4 (RBP4).
Conclusion:
An echocardiographic evaluation of diastolic function is a useful tool to detect early cardiac changes in obese children. Emergent cardiovascular risk markers such as apolipoprotein A1, RBP4, and sVCAM-1 are associated with the parameters of diastolic function.
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