Weight problems is a worldwide pandemic and is a recognised danger issue for cardiovascular ailments. Nonetheless, its influence on cardiac construction and performance utilizing echocardiography, in addition to its affiliation with anthropometric parameters in in any other case wholesome people, requires additional investigation. Subsequently, we performed an observational research with a cohort of 196 contributors, evaluating varied echocardiographic parameters in regular weight people and those that have been obese or overweight however had no different danger components. Our findings revealed that overweight contributors had vital adjustments in echocardiographic measurements of the construction and capabilities of the left ventricle, left ventricular international longitudinal pressure, left atrium, proper ventricle and proper ventricular international longitudinal pressure in contrast with the management group. Physique floor space and physique mass index have been essential anthropometric options that correlated with the above echocardiographic adjustments, and needs to be routinely evaluated to evaluate cardiovascular danger in sufferers. Additional bigger research are obligatory to find out the scientific significance of the echocardiographic adjustments noticed in overweight people and their influence on well being.
Introduction
The World Well being Organisation (WHO) defines weight problems as “irregular or extreme fats accumulation which will impair well being” and classifies weight problems primarily based on physique mass index (BMI), with these with a BMI of 25–30 kg/m2 termed as obese and people with BMI over 30 kg/m2 outlined as overweight.1,2 Weight problems has reached pandemic ranges within the final 50 years.3 One and a half billion folks over the age of 20 on this planet are regarded as obese or overweight.4 Weight problems is related to low-grade power irritation resulting in insulin resistance, which can progress to diabetes mellitus.5 Furthermore, fatty liver illness, systemic hypertension and power kidney illness could also be extra outstanding on this inhabitants, all of that are impartial danger components for cardiovascular morbidity and mortality.5–7
In a latest meta-analysis of 28 research, Aune et al. discovered that prime BMI and belly weight problems, as measured by waist circumference (WC), are essential danger components for coronary heart failure (HF).8 Nonetheless, BMI just isn’t an correct parameter for all people, as some folks, equivalent to skilled athletes in varied sports activities who’ve elevated muscle mass, will not be ‘overweight’ regardless that they’ve an elevated BMI.9,10 Current research haven’t demonstrated a direct vital relationship between BMI and heart problems (CVD), typically known as the weight problems paradox.9,11,12 Subsequently, it could be a suboptimal parameter to danger stratify people for heart problems. Different research have discovered that waist-to-height ratio (WHtR), waist circumference (WC) and top, when raised to allometric energy, could also be extra predictive of cardiovascular ailments.13–15 Equally, neck circumference is thought to have a optimistic correlation with the above parameters, along with an elevated danger of hypertension, diabetes and hyperlipidaemia.16,17 Different parameters, equivalent to physique form index (BSI) and physique floor space (BSA), haven’t been validated up to now. Furthermore, it’s unclear whether or not a number of of those components could also be predictive of the influence of weight problems on cardiac construction and performance, as assessed utilizing transthoracic echocardiography, in in any other case wholesome people.
Subsequently, to know the results of weight problems on cardiac construction and performance within the absence of different confounding comorbid situations, our research was carried out to judge the correlation between varied echocardiography and anthropometric parameters.
Supplies and methodology
A potential, cohort-matched, observational research was carried out on the outpatient cardiology division of Mashhad College of Medical Sciences Ghaem Hospital between 1 Might 2019 and 31 September 2019. Sufferers aged 20 to 60 years referred to the cardiology clinic for varied cardiovascular signs have been thought-about for the research. Inclusion standards comprised of sufferers with a standard scientific examination, sinus rhythm and no recognized cardiovascular danger components and a BMI ≥25 kg/m2. These people with new irregular scientific findings or recognized historical past of heart problems (earlier myocardial infarction, coronary heart failure, valvular coronary heart illness, overt cardiomyopathy and arrhythmias together with atrial fibrillation), diabetes mellitus (fasting blood glucose >126 mg/dL), hypertension (systolic blood strain [SBP] >140 mmHg and/or diastolic blood strain [DBP] >90 mmHg), impaired renal or liver capabilities assessments and thyroid ailments have been excluded. The management group had contributors who reported no historical past of heart problems and had regular BMI (18.5–24.9 kg/m2). Members within the two teams have been matched in response to age and intercourse. The WC was measured in centimetres (cm) on a standing topic from the half-point of the bottom rib margin to the iliac crest. The WHtR was calculated by dividing the WC (cm) by top (cm). BMI, BSI (m11/6 kg–2/3) and BSA have been calculated as weight/top(m)2, WC/BMI2/3 × top(cm)1/2 and [height(cm) × weight/3,600]1/2, respectively. All contributors signed a consent kind earlier than commencing the research. Moral approval for the research was granted by the native ethics committee. Transthoracic echocardiography (TTE) was carried out by regionally accredited echocardiologists utilizing Siemens ACUSON SC2000 Ultrasound System with 4V1c Transducer (frequency bandwidth: 1.25–4.5 MHz). Commonplace views have been obtained as per American Society of Echocardiography (ASE) tips.15 Statistical evaluation was carried out utilizing SPSS v. 24.0. Quantitative knowledge have been described by imply and customary deviation (SD) and qualitative knowledge have been described by frequency and share. Within the knowledge evaluation, t-test was used and, within the case of non-normality, the Mann-Whitney U take a look at was used. Chi-square take a look at was used for categorical knowledge evaluation, and in instances the place greater than 20% of the anticipated frequencies of the tables have been lower than 5, Fisher’s precise take a look at was used. The correlation of quantitative variables was analysed by Pearson correlation. A p worth ≤0.05 was thought-about statistically vital for all analyses.
Outcomes
A complete of 196 contributors, of which 51.5% have been girls, have been recruited to the research. The common age for contributors was 39.67 ± 10.55 years. Group 1 comprised 100 non-obese (BMI <25 kg/m2), wholesome people whereas group 2 included 96 obese and overweight people (BMI ≥25 kg/m2). The research pattern baseline traits may be present in desk 1. The echocardiographic structural and purposeful measurements in relation to BMI are listed in desk 2. Left atrial space (LAA), left atrial diameter (LAD), left atrial quantity (LAV), left ventricular mass (LVM), mitral influx E velocity, mitral influx S velocity, Tei index, left ventricular international longitudinal pressure (LVGLS), and proper ventricular international longitudinal pressure (RVGLS) have been all considerably completely different in overweight contributors as compared with the management group (desk 2).
Desk 1. Demographics and classifications of studied people
Intercourse
N
Imply age ± SD, years
Imply weight ± SD, kg
Imply top ± SD, cm
Imply coronary heart price ± SD, bpm
Imply BMI ± SD, kg/m2
Imply WC ± SD, cm
Management group (n=100)
F
51
38.29 ± 11.31
58.11 ± 6.58
162.98 ± 6.29
79.50 ± 12.17
21.90 ± 1.85
77.90 ± 5.13
M
49
38.61 ± 11.56
71.52 ± 6.78
175.00 ± 6.08
74.63 ± 10.19
23.20 ± 1.44
90.77 ± 5.12
Case group (n=96)
F
50
42.10 ± 9.99
82.93 ± 12.49
161.26 ± 7.10
79.22 ± 10.32
32.10 ± 4.73
108.5 ± 8.23
M
46
39.69 ± 9.02
89.67 ± 15.02
167.36 ± 7.87
76.10 ± 9.39
32.10 ± 5.08
108.89 ± 7.46
Management Group = sufferers with none pathologic discovering and previous medical historical past of heart problems and have regular BMI (18–24.9 kg/m2). Case Group = sufferers with none pathologic discovering and previous medical historical past of heart problems and have elevated BMI (≥25 kg/m2).Key: BMI = physique mass index; bpm = beats per minute; F = feminine; M = male; SD = customary deviation; WC = waist circumference
Desk 2. Comparability of varied echocardiographic parameters between case and management teams as primarily based on physique mass index (BMI)
ParameterMean ± SD
Management group
Case group
p worth
LAA, cm2
16.47 ± 4.22
18.47 ± 2.42
≤0.001
LAD, cm
3.21 ± 0.26
3.46 ± 0.46
≤0.001
LAV, ml
45.70 ± 11.98
55.93 ± 7.88
≤0.001
LVM, g
121.94 ± 37.43
138.91 ± 35.198
0.001
LVEDD, cm
46.33 ± 3.83
48.97 ± 2.97
≤0.001
LVESD, cm
28.41 ± 3.51
25.08 ± 3.39
≤0.001
LVEDV, ml
97.26 ± 11.48
99.65 ± 18.13
0.271
LVESV, ml
33.90 ± 5.25
37.97 ± 8.35
≤0.001
RVEDD, cm
30.96 ± 2.02
30.05 ± 2.68
0.008
IVS, cm
7.97 ± 1.32
8.26 ± 1.06
0.092
ASC, cm
2.99 ± 0.35
3.02 ± 0.29
0.448
EF, %
63.03 ± 3.90
61.96 ± 4.63
0.081
E’, cm/s
74.64 ± 16.90
60.23 ± 12.19
≤0.001
A, cm/s
61.32 ± 17.19
58.34 ± 18.74
0.248
Em, cm/s
9.70 ± 1.89
7.62 ± 1.50
≤0.001
Sm, cm/s
8.15 ± 1.01
7.39 ± 1.50
≤0.001
E/A
1.29 ± 0.42
1.21 ± 0.66
0.276
E/Em
7.68 ± 0.97
8.05 ± 1.92
0.092
Tei
0.408 ± 0.02
0.45 ± 0.08
≤0.001
IVRT, ms
80.14 ± 5.47
92.84 ± 13.61
≤0.001
STV
12.10 ± 1.44
12.46 ± 2.05
0.152
LVGLS, %
18.93 ± 0.78
21.05 ± 2.46
≤0.001
RVGLS, %
20.78 ± 0.64
19.65 ± 1.76
≤0.001
Key: ASC = ascending aorta; EF = ejection fraction; IVRT = isovolumic rest time; IVS = interventricular septum; LAA = left atrial space; LAD = left atrial diameter; LAV = left atrial quantity; LVEDD = left ventricle finish diastolic diameter; LVESD = left ventricle finish systolic diameter; LVEDV = left ventricle finish diastolic quantity; LVESV = left ventricle finish systolic quantity; LVGLS = left ventricular international longitudinal pressure; LVM = left ventricle mass; RVEDD = proper ventricle finish diastolic diameter; RVGLS = proper ventricular international longitudinal pressure; STV = segmental thickness variability
Left ventricular finish diastolic diameter (LVEDD) had a major correlation with BMI (p≤0.001), WC (p≤0.001), BSI (p=0.002) and BSA (p≤0.001), with an analogous vital relationship of left ventricular finish systolic diameter (LVESD) with these components. Tei index, isovolumic rest time (IVRT), LVGLS and RVGLS all had vital correlation with all 5 anthropometric parameters. Each Tei index and IVRT had a damaging correlation with BSI, whereas LVGLS and RVGLS had optimistic correlation with BSI. Then again, left ventricular ejection fraction (LVEF) had no vital correlation with any of the echocardiographic parameters analysed (desk 3, accessible on-line).
Desk 3. Correlation of anthropometric components with structural and purposeful indicators of coronary heart in inhabitants with BMI ≥25 kg/m2
Parameter
WC, cmCorrelation (p worth)
BMI, kg/m2Correlation (p worth)
WHtR, cm/m × 100Correlation (p worth)
BSI, cm/(kg/m2)2/3×cm1/2Correlation (p worth)
BSA, m2Correlation (p worth)
LAA (cm2)
r=0.192 (p=0.060)
r=0.313 (p=0.002)
r=–0.170 (p=0.098)
r=0.001 (p=0.990)
r=0.713 (p≤0.001)
LAD (cm)
r=0.259 (p=0.011)
r=0.377 (p≤0.001)
r=–0.143 (p=0.166)
r=–0.012 (p=0.907)
r=0.793 (p≤0.001)
LAV (ml)
r=0.141 (p=0.169)
r=0.299 (p=0.003)
r=–0.205 (p=0.045)
r=–0.034 (p=0.744)
r=0.693 (p≤0.001)
LVM (g)
r=0.634 (p≤0.001)
r=0.792 (p≤0.001)
r=0.382 (p≤0.001)
r=–0.487 (p≤0.001)
r=0.759 (p≤0.001)
LVEDD (cm)
r=0.446 (p≤0.001)
r=0.626 (p≤0.001)
r=0.114 (p=0.267)
r=–0.306 (p=0.002)
r=0.825 (p≤0.001)
LVESD (cm)
r=0.300 (p=0.003)
r=0.415 (p≤0.001)
r=0.121 (p=0.241)
r=–0.230 (p=0.024)
r=0.489 (p≤0.001)
LVEDV (ml)
r=0.530 (p≤0.001)
r=0.603 (p≤0.001)
r=0.254 (p=0.013)
r=–0.250 (p=0.014)
r=0.699 (p≤0.001)
LVESV (ml)
r=0.485 (p≤0.001)
r=0.552 (p≤0.001)
r=0.268 (p=0.008)
r=–0.263 (p=0.010)
r=0.575 (p≤0.001)
RVEDD (cm)
r=0.632 (p≤0.001)
r=0.698 (p≤0.001)
r=0.352 (p≤0.001)
r=–0.308 (p=0.002)
r=0.735 (p≤0.001)
IVS (cm)
r=0.664 (p≤0.001)
r=0.770 (p≤0.001)
r=0.500 (p≤0.001)
r=–0.515 (p≤0.001)
r=0.597 (p≤0.001)
ASC (cm)
r=0.129 (p=0.209)
r=0.277 (p=0.006)
r=–0.020 (p=0.844)
r=–0.208 (p=0.042)
r=0.383 (p≤0.001)
EF (%)
r=–0.151 (p=0.142)
r=–0.142 (p=0.168)
r=–0.172 (p=0.095)
r=0.111 (p=0.284)
r=–0.009 (p=0.930)
E’ (cm/s)
r=–0.131 (p=0.202)
r=–0.114 (p=0.270)
r=–0.145 (p=0.159)
r=0.078 (p=0.452)
r=–0.012 (p=0.909)
A (cm/s)
r=0.275 (p=0.007)
r=0.402 (p≤0.001)
r=0.283 (p=0.005)
r=–0.406 (p≤0.001)
r=0.176 (p=0.086)
Em (cm/s)
r=–0.393 (p≤0.001)
r=–0.404 (p≤0.001)
r=–0.370 (p≤0.001)
r=0.281 (p=0.006)
r=–0.196 (p=0.056)
Sm (cm/s)
r=–0.307 (p=0.002)
r=–0.248 (p=0.015)
r=–0.262 (p=0.010)
r=0.080 (p=0.437)
r=–0.149 (p=0.148)
E/A
r=–0.183 (p=0.074)
r=–0.213 (p=0.037)
r=–0.205 (p=0.045)
r=0.197 (p=0.054)
r=–0.050 (p=0.631)
E/EM
r=0.197 (p=0.054)
r=0.231 (p=0.023)
r=0.177 (p=0.084)
r=–0.179 (p=0.080)
r=0.141 (p=0.171)
Tei
r=0.642 (p≤0.001)
r=0.782 (p≤0.001)
r=0.524 (p≤0.001)
r=–0.592 (p≤0.001)
r=0.551 (p≤0.001)
IVRT (ms)
r=0.496 (p≤0.001)
r=0.536 (p≤0.001)
r=0.453 (p≤0.001)
r=–0.389 (p≤0.001)
r=0.295 (p=0.004)
STV
r=–0.099 (p=0.336)
r=–0.156 (p=0.129)
r=–0.067 (p=0.515)
r=0.123 (p=0.234)
r=–0.121 (p=0.239)
LVGLS (%)
r=–0.722 (p≤0.001)
r=–0.814 (p≤0.001)
r=–0.613 (p≤0.001)
r=0.584 (p≤0.001)
r=–0.531 (p≤0.001)
RVGLS (%)
r=–0.611 (p≤0.001)
r=–0.664 (p≤0.001)
r=–0.526 (p≤0.001)
r=0.458 (p≤0.001)
r=–0.418 (p≤0.001)
Key: ASC= ascending aorta; BMI = physique mass index; BSA:= physique floor space; BSI = physique form index; EF = ejection fraction; IVRT= isovolumic rest time; IVS = interventricular septum; LAA= left atrial space; LAD= left atrial diameter; LAV = left atrial quantity; LVEDD = left ventricle finish diastolic diameter; LVEDV = left ventricle finish diastolic quantity; LVESD = left ventricle finish systolic diameter; LVESV = left ventricle finish systolic quantity; LVGLS = left ventricular international longitudinal pressure; LVM = left ventricle mass; RVEDD = proper ventricle finish diastolic diameter; RVGLS = proper ventricular international longitudinal pressure; STV = S tricuspid valve; WC = waist circumference; WHtR = waist-to-height ratio
Dialogue
On this research, we evaluated the results of weight problems on echocardiographic structural and purposeful parameters, and higher outlined which anthropometric components are greatest predictive of those adjustments. Our outcomes present that in obese and overweight adults, who in any other case don’t have any prior cardiovascular situations, there’s vital variation in cardiac construction, diastolic and systolic operate. Moreover, of the anthropometric options, though BMI is most regularly correlated with such abnormalities, BSA is the strongest parameter to foretell such abnormalities, with the proportional related (r worth) constantly larger for BSA than BMI for parameters the place vital adjustments have been detected (p<0.05). Solely LVM, IVS, IVRT, Tei index, RVGLS and LVGLS had a higher r worth for BMI than BSA (when p<0.05). Related findings have been additionally famous by Moukarzel et al., the place BSA was most strongly related to echocardiographic parameters as compared with different anthropometric options.18
BMI ≥25 kg/m2 was related to enlargement in left atrial dimensions, enhance in LVEDD, LVESD, LVM, E mitral influx velocity, S mitral influx velocity, Tei index, and E/EM ratio, the latter two being dependable estimates of left ventricular diastolic pressures. Mehta et al. assessed the utility of WC and BMI in 49 youngsters with belly weight problems and famous vital adjustments in LA dimensions, in addition to LV filling parameters.13 In sufferers with secure ischaemic coronary heart illness or kind 2 diabetes mellitus, weight problems results in impairment in left atrial quantity and contractility, as compared with non-obese people.19,20 Different research confirmed that overweight people have considerably elevated LVEDD, septal wall thickness (SWT), left atrial diameter (LAD), LV finish systolic quantity (LVESV), left ventricular finish diastolic quantity (LVEDV) and IVRT.14,21,22 Our research confirmed related findings with these parameters with vital variations between the 2 teams for LVEDD, LAD, LVESV and ISRT (p<0.05), though SWT and LVEDV have been discovered to be non-significant. There was additionally a major affiliation between LVM and all 5 of the anthropometric parameters assessed. Daniels et al., of their research on youngsters aged 6 to 17 years, discovered a statistically vital affiliation between lean and fats physique mass with LVM, though they decided that lean physique mass had a stronger correlation with LVM than adiposity.23
Mehta et al. additionally famous that WC was the one anthropometric characteristic that had a major damaging affiliation with septal, inferior wall and RV wall early and late peak velocities.13 Our outcomes confirmed a major correlation of early diastolic tissue velocity (EM) and systolic tissue velocity (SM) with BMI, WC and WHtR, though BSI was solely vital for EM. These findings could also be defined by the older age group of the contributors, the place the results of weight problems could also be extra outstanding, though the period of weight problems in particular person contributors was not documented. Equally, different research on overweight people discovered considerably decreased trans-mitral early-to-late velocity ratio and E mitral influx velocity, findings additionally famous in our research.14,24 We additionally decided that WHtR, however not BSI, BSA and WC, had a major affiliation with this ratio.
Though this research couldn’t discover any vital relationship between LVEF and varied anthropometric components, a major correlation of LVGLS and RVGLS was famous with weight problems. LVGLS is now thought-about an essential parameter for prognostication. In sufferers with acute coronary heart failure, regardless of ejection fraction (EF), a discount in LVGLS was instantly associated to extend in cardiovascular outcomes.25 It is a vital think about sufferers with coronary heart failure and preserved ejection fraction (HFpEF) the place the EF worth will not be useful in figuring out high-risk people.26–28 Equally, different investigators decided considerably decreased tissue Doppler lateral peak velocities with vital variations in regional and international longitudinal pressure in overweight people in each grownup and paediatric age teams, and together with sufferers with kind 2 diabetes mellitus.14,20,29–32 This will likely spotlight the truth that overweight people, who don’t have any different recognized cardiovascular situations, could also be at excessive danger of growing coronary heart failure.
The findings of predicting anthropometric measurements within the current research is supported by earlier research,12,13,33 by which BMI and BSA are higher than different anthropometric measurements to foretell cardiac remodelling and alter of cardiac operate. Nonetheless, different parameters, equivalent to top and waist circumference, might higher predict occasions in overweight people.15,34 These contradictory outcomes could also be defined by such variations between topics enrolled in several research: race, age, gender, period of weight problems, comorbid illness and household historical past.
The primary limitation of this research is the small pattern measurement, from a single establishment, and that contributors with BMI ≥25 kg/m2 weren’t additional subdivided into completely different grades of weight problems severity. Subsequently, whether or not or not the findings would have been extra vital because the diploma of weight problems progressed is unknown. Moreover, different essential components which will play a job in these findings, together with leptin ranges, presence of obstructive sleep apnoea, intravascular quantity and invasive pulmonary and intrathoracic strain, weren’t assessed. Nonetheless, our outcomes have to be interpreted with warning and bigger research with larger affected person numbers needs to be carried out to verify our findings.
We discovered that the presence of weight problems in in any other case ‘wholesome’ folks affected most echocardiographic parameters of left atrial/ventricular and proper ventricle chamber measurement and performance. Whether or not this will result in clinically vital abnormalities, together with arrhythmias, equivalent to atrial fibrillation (AF), continues to be not clear. Nonetheless, such adjustments could possibly danger stratify sufferers which can be susceptible to growing coronary heart failure at a later stage of life, and could also be used as a motivation technique in these sufferers to assist them work on weight reduction.
In abstract, weight problems can lead to vital adjustments in cardiac construction, in addition to alterations of systolic and diastolic operate, as detected by transthoracic echocardiography. Though BMI most regularly correlates with such adjustments, BSA is the strongest parameter to foretell abnormalities of cardiac construction, nevertheless, different anthropometric options, equivalent to WC and BSI, might assist additional help in predicting these people at larger danger of growing such options, and, due to this fact, needs to be routinely calculated in sufferers presenting to the cardiovascular staff for evaluation. Additional research should be carried out to evaluate whether or not such adjustments have an effect on cardiovascular outcomes together with coronary heart failure, arrhythmias and mortality.
Key messages
Weight problems, within the absence of some other cardiovascular situations, might lead to vital adjustments in cardiac construction and performance as assessed on transthoracic echocardiography
Chamber dimensions, in addition to systolic and diastolic parameters, could also be considerably altered
Whereas there was no vital correlation of weight problems with left ventricular ejection fraction (LVEF), affiliation with different parameters of left ventricular systolic operate, equivalent to left ventricular international longitudinal pressure (LVGLS), was famous, with the latter now thought-about an essential prognostication parameter for coronary heart failure
Physique floor space (BSA) is a vital anthropometric issue for predicting abnormalities of cardiac construction, however different parameters equivalent to physique mass index (BMI) and physique form index (BSI) also needs to be thought-about in routine observe for extra correct affected person evaluation and might help establish at-risk people
Conflicts of curiosity
None declared.
Funding
None.
Examine approval
All contributors signed an knowledgeable consent kind earlier than commencing the research. Moral approval for the research was granted by the native ethics committee (code: IR.IAU.MSHD.REC.1397.067).
Editors’ observe
Desk 3 is offered on-line.
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