Young Women With Abdominal Obesity Have Subclinical Myocardial Dysfunction

Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies

BACKGROUND

Obesity is a risk factor for left ventricular hypertrophy (LVH) and diastolic dysfunction. Available evidence on impaired myocardial deformation in obese patients without apparent systolic dysfunction assessed by LV ejection fraction (LVEF) is based on single studies. The aim of the present meta-analysis was to provide a comprehensive and updated information on this issue.

METHODS

The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search English-language articles published from the inception up to 31 December 2023. Studies were identified by using MeSH terms and crossing the following search items: ' myocardial strain', 'left ventricular mechanics', 'longitudinal global strain', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular ejection fraction', and 'obesity'.

RESULTS

Twenty-four studies including 5792 obese and 5518 nonobese individuals from different clinical settings were considered for the analysis. LV global longitudinal strain (GLS) was significantly impaired in the obese group [standard means difference (SMD): -0.86 ± 0.08; confidence interval (CI) -1.02 to -0.69, P  < 0.0001] and this was paralleled by a significant difference in pooled LVEF between obese and controls (SMD -0.27 ± 0.06; CI -0.40 to -0.15, P  < 0.0001). Unlike GLS, however, the majority of the selected studies failed to show statistically significant differences in LVEF. Furthermore, in patients with advanced obesity (BMI > 35 kg/m 2 , data from six studies), LV systolic dysfunction was more significantly detected by GLS (SMD -1.24 ± 0.19, CI -1.61/-0.87, P  < 0.0001) than by LVEF (SMD -0.54 ± 0.27, CI -1.07 to -0.01, P  = 0.046).

CONCLUSION

The present meta-analysis suggests that GLS may unmask systolic dysfunction often undetected by conventional LVEF in the obese setting; thus, this parameter should be incorporated into routine work-up aimed to identify obesity-mediated subclinical cardiac damage.

The Influence of Anthropometrics on Cardiac Mechanics in Healthy Women With Opposite Obesity Phenotypes (Android vs Gynoid)

BACKGROUND

The possible influence exerted by mechanical factors and/or compressive phenomena on myocardial strain parameters in healthy individuals with opposite obesity phenotypes (android vs gynoid) has never been previously investigated. Accordingly, we aimed at evaluating the relationship between anthropometrics, such as the waist-to-hip ratio (WHR), modified Haller index (MHI, the ratio of chest transverse diameter over the distance between sternum and spine), and epicardial adipose tissue (EAT), and left ventricular (LV)-global longitudinal strain (GLS), in healthy women with opposite obesity phenotypes (android vs gynoid).

METHODS

Forty healthy women with obesity (body mass index (BMI) ≥30 Kg/m2) and WHR ≥0.85 ("android group") (52.5±13.2 yrs), 40 age- and BMI-matched healthy women with obesityand WHR <0.78 ("gynoid group") (49.8±13.4 yrs) and 40 age-matched healthy women without obesity (BMI <30 Kg/m2) (controls) (50.3±12.5 yrs) were retrospectively analyzed. All women underwent transthoracic echocardiography implemented with echocardiographic strain analysis of all cardiac chambers. Correlation between LV-GLS and anthropometrics (WHR, MHI, and EAT) was assessed in both groups of obese women. Age, WHR, homeostasis model assessment for insulin resistance (HOMA-IR), and left ventricular mass index (LVMi) were included in the logistic regression analysis performed for evaluating the independent predictors of reduced LV-GLS magnitude (less negative than -20%) in women with android obesity.

RESULTS

Compared to the other groups of women, those with android obesity were found with significantly greater LVMi, higher LV filling pressures, and lower biventricular and biatrial deformation indices. A strong inverse correlation between LV-GLS and all anthropometrics (WHR, MHI, and EAT) was demonstrated in both groups of women with obesity. Univariate logistic regression analysis revealed that WHR (OR 1.58, 95%CI 1.22-2.03, p<0.001) and LVMi (OR 1.09, 95%CI 1.02-1.16, p=0.006) were independently correlated with LV-GLS impairment in women with android obesity. On multivariate logistic regression analysis, the WHR maintained a statistically significant association with the above-mentioned outcome (OR 1.68, 95%CI 1.14-2.48, p=0.009). Receiver operating characteristic (ROC) curve analysis showed that a WHR value ≥1.01 had 93% sensitivity and 100% specificity for detecting LV-GLS impairment in women with android obesity (AUC=0.98; 95%CI 0.96-1.00).

CONCLUSIONS

Anthropometrics may strongly influence cardiac mechanics in healthy women with obesity. The WHR is associated with reduced LV-GLS magnitude in healthy women with android obesity, independent of age, glycometabolic status, and LV size.

Clinical observation on acupuncture for 80 patients with abdominal obesity in Germany: based on the theory of unblocking and regulating the Belt Vessel

Objective

To observe the efficacy of unblocking and regulating the Belt Vessel acupuncture method for patients with abdominal obesity in Germany and its influence on the body fat parameters and glycolipids metabolism.

Methods

A total of 82 cases of abdominal obesity in Germany were selected. There were two dropout cases in the treatment process. All of the patients received acupuncture at Daimai (GB26), Daheng (SP15), Tianshu (ST25), Zhongwan (CV12), Shuidao (ST28), Waiguan (TE5), and Zulinqi (GB41). The patients received acupuncture therapy once every 2–3 d, 3 times a week. The treatment duration lasted four weeks. Before and after treatment, the body mass (BM), waist circumference (WC), abdominal circumference (AC), hip circumference (HC), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose (GLU) were measured respectively, and the body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body fat rate (BFR) were calculated.

Results

After treatment, the total effective rate was 72.5%; the levels of BM, WC, AC, HC, BMI, WHR, WHtR, BFR, TC, LDL-C, and GLU declined significantly compared with those before treatment (P<0.01), while the TG and HDL-C slightly declined, but the differences were statistically insignificant (P>0.05).

Conclusion

The unblocking and regulating the Belt Vessel acupuncture method can significantly reduce body fat parameters such as BM, AC, and BFR, and correct the disorders of glucose and lipid metabolism in patients with abdominal obesity in Germany.

Association between sleep quality and central obesity among southern Chinese reproductive-aged women

BACKGROUND

The connections between sleep quality and central obesity among reproductive-aged women are not clear. The study aimed to explore the association between sleep quality and central obesity among Chinese reproductive-aged women and identify the independent contributions of sociodemographic characteristics, health-related factors, and sleep quality to central obesity.

METHODS

In this cross-sectional survey, the minimal sample sizes were 2404 subjects; 2449 Chinese women aged 18-49 participated in this study. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Central obesity as the outcome of interest was a binary variable; women were categorized as with versus without central obesity measured by waist circumference (WC). The independent contribution of sociodemographic characteristics (Cluster 1), health-related variables (Cluster 2), and sleep quality (Cluster 3) to central obesity was derived from the corresponding R² change (individual R² change/total R² × 100%), using clustered multiple logistic regression analyses.

RESULTS

The risk of central obesity increased significantly with poor sleep quality (assessed by global PSQI score) [adjusted odds ratio (OR) = 2.20 per SD increase; 95% confidence interval (CI) = 1.28-3.78; P = 0.004], increased sleep disturbance score (adjusted OR = 1.11 per SD increase; 95% CI = 1.01-1.22; P = 0.042) and decreased subjective sleep quality score (adjusted OR = 0.81 per SD increase; 95% CI = 0.73-0.90; P < 0.001). The independent contribution of sleep quality was 9.9%, less than those of sociodemographic (73.3%) and health-related (16.8%) variables. Among complaints related to sleep disturbance, the inability to breathe comfortably, and having bad dreams showed significant associations with central obesity.

CONCLUSIONS

There exists some degree of correlation between sleep quality and central obesity among Chinese reproductive-aged women. These findings underscore the need for future public health guidelines to formulate some detailed strategies to improve sleep quality, such as preventing and intervening risk factors that influence sleep quality and suggesting optimal sleep duration, which might effectively reduce the incidence of central obesity in this population group.

Metabolic syndrome - Evidence-based strategies for patient optimization

With the increasing prevalence of obesity worldwide, it is inevitable that anesthesiologists will encounter patients with metabolic syndrome. Metabolic syndrome encompasses multiple diseases, which include central obesity, hypertension, dyslipidemia, and hyperglycemia. Given the involvement of multiple diseases, metabolic syndrome involves numerous complex pathophysiological processes that negatively impact several organ systems. Some of the organ systems that have been well-documented to be adversely affected include the cardiovascular, pulmonary, and endocrine systems. Metabolic syndrome also leads to prolonged hospital stays, increased rates of infections, a greater need for care after discharge, and overall increased healthcare costs. Several interventions have been suggested to mitigate these negative outcomes ranging from lifestyle modifications to surgeries. Therefore, anesthesiologists should understand metabolic syndrome and formulate management strategies that may modify perianesthetic and surgical risks.

Speckle tracking derived reference values of myocardial deformation and impact of cardiovascular risk factors - Results from the population-based STAAB cohort study

AIMS

We aimed to provide reference values for speckle-tracking derived systolic and diastolic myocardial deformation markers, and to determine their relation with age, sex, and cardiovascular risk factors.

METHODS AND RESULTS

The Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study recruited a representative sample of the population of Würzburg, Germany, aged 30-79 years. In a sample of 1818 participants (52% female, mean age 54±12 years) global longitudinal peak systolic strain (GL-PSS, n = 1218), systolic (GL-SSR, n = 1506), and early (GL-EDSR, n = 1506) and late diastolic strain rates (GL-LDSR, n = 1500) were derived from 2D speckle tracking analysis. From a subgroup of 323 individuals without any cardiovascular risk factor, sex- and age-specific reference values were computed. GL-PSS, GL-SSR, and GL-EDSR were associated with sex, GL-EDSR decreased and GL-LDSR increased with age. In the total sample, dyslipidemia was associated with altered GL-PSS, GL-SSR, and GL-EDSR in women but not in men, whereas obesity was associated with less favorable GL-PSS and GL-EDSR in either sex. Hypertension impacted more adversely on systolic and diastolic myocardial deformation in women compared to men (all p<0.01).

CONCLUSION

The female myocardium appeared more vulnerable to high blood pressure and dyslipidemia when compared to men, while obesity was associated with adverse myocardial deformation in either sex. The reference values for echocardiographic myocardial deformation provided for a non-diseased population and their here reported associations with cardiovascular risk factors will inform future observational and intervention studies regarding i) effect sizes and power calculation, ii) cross-study comparisons, and iii) categorization of myocardial deformation in specific patient groups.

Cardiac maladaptation in obese pregnant women at term

OBJECTIVE

Obesity is an increasing problem worldwide, with well recognized detrimental effects on cardiovascular health; however, very little is known about the effect of obesity on cardiovascular adaptation to pregnancy. The aim of the present study was to compare biventricular cardiac function at term between obese pregnant women and pregnant women with normal body weight, utilizing conventional echocardiography and speckle-tracking assessment.

METHODS

This was a prospective case-control study of 40 obese, but otherwise healthy, pregnant women with a body mass index (BMI) of ≥ 35 kg/m² and 40 healthy pregnant women with a BMI of ≤ 30 kg/m² . All women underwent a comprehensive echocardiographic examination and speckle-tracking assessment at term.

RESULTS

Obese pregnant women, compared with controls, had significantly higher systolic blood pressure (117 vs 109 mmHg; P = 0.002), cardiac output (6.73 vs 4.90 L/min; P < 0.001), left ventricular (LV) mass index (74 vs 64 g/m² ; P < 0.001) and relative wall thickness (0.43 vs 0.37; P < 0.001). Diastolic dysfunction was present in five (12.5%) controls and 16 (40%) obese women (P = 0.004). In obese women, compared with controls, LV global longitudinal strain (-15.59 vs -17.61%; P < 0.001), LV endocardial (-17.30 vs -19.84%; P < 0.001) and epicardial (-13.10 vs -15.73%; P < 0.001) global longitudinal strain as well as LV early diastolic strain rate (1.05 vs 1.24 /s; P = 0.006) were all significantly reduced. No differences were observed in the degree of LV twist and torsion between the two groups.

CONCLUSIONS

Morbidly obese, but otherwise healthy, pregnant women at term had significant LV hypertrophy with evidence of diastolic dysfunction and impaired deformation indices compared with pregnant women of normal weight. These findings are likely to represent a maladaptive response of the heart to volume overload in obese pregnancy. The impact of theses changes on pregnancy outcome and long-term maternal outcome is unclear. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Effect of fitness on cardiac structure and function in overweight and obesity (the FATCOR study)

BACKGROUND AND AIMS

Obesity is associated with reduced left ventricular (LV) systolic myocardial function. We aimed to explore by means of a cross-sectional study whether this effect is offset in the presence of good fitness.

METHODS AND RESULTS

We studied clinical and echocardiographic data from 469 overweight (body mass index [BMI] >27 kg/m²) and obese (BMI ≥30 kg/m²) women and men without known cardiovascular (CV) disease in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. The participants were grouped according to obesity and sex- and age adjusted peak oxygen uptake, obtained by ergospirometry. LV systolic myocardial function was assessed by peak systolic global longitudinal strain (GLS) measured by speckle tracking echocardiography. The association of fitness with GLS was tested in logistic regression analyses and reported as odds ratio (OR) with 95% confidence interval (CI). In the total study population, participants were 47 years old, 60% were women, and mean BMI was 32.0 kg/m². GLS did not differ between fit and unfit subjects within the overweight and obese groups (both p > 0.05), but the overweight fit group had higher GLS (more negative value) compared to the obese unfit group (-20.1 ± 2.6 vs. -19.0 ± 3.0, p < 0.05). In obese subjects, fitness was associated with higher GLS (OR 0.88 [95% CI 0.79-0.99, p < 0.05) in multivariable logistic regression analysis, independent of significant associations with higher arterial stiffness and lower fat percentage (all p < 0.05). In the overweight group, fitness was not significantly associated with GLS.

CONCLUSION

In obesity, fitness was independently associated with higher GLS, while no association was found in overweight.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.govNCT02805478.

Patients With Obesity Exhibit a Plateau Pattern of the Right Ventricular Waveform

Background

Ventricular waveforms are characterized by a dip-and-plateau pattern during diastole owing to an abrupt termination of ventricular filling because of pericardial constraint under conditions such as constrictive pericarditis (CP). However, constrictive hemodynamics is not specifically caused by CP. Therefore, this study aimed to evaluate whether patients with obesity exhibited constrictive hemodynamics.

Methods

Overall, 60 consecutive Japanese patients (mean age, 69.5 years; 45% women) who underwent right heart catheterization at the Japan Community Healthcare Organization Osaka Hospital from July 2016 to September 2018 were examined. Two-dimensional echocardiography was used to measure the epicardial adipose tissue (EAT) in the standard parasternal long-axis view during end-diastole. Because patients who underwent open-heart surgery were highly likely to have CP, they were excluded.

Results

Among the 60 patients, 11 (18%) exhibited a plateau pattern of the right ventricular waveform and had a mean EAT value of 4.2 mm, which was significantly higher than that of patients without such a pattern (2.1 mm, P < 0.001). Similarly, the mean body mass index (BMI) values were significantly higher in patients with a plateau pattern than in those without it (27.2 vs. 21.8 kg/m², P < 0.001). EAT was significantly correlated with the BMI (r = 0.72, P < 0.001). In patients with a plateau pattern, the triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher (TG: 150 vs. 100 mg/dL, LDL-C: 121 vs. 95 mg/dL, P < 0.05) and the left atrial diameter (52.8 vs. 44.7 mm, P < 0.01) and left atrial volume index (58.7 vs. 47.6 mL/m², P < 0.05) were significantly greater than those in the patients without it. The EAT was also significantly correlated with the TG level (r = 0.37, P < 0.01).

Conclusions

Obese patients may present with constrictive hemodynamics, suggesting left ventricular diastolic dysfunction. EAT was significantly correlated with metabolic syndrome components, namely obesity and TG levels.

The importance of speckle tracking echocardiography in the early detection of left ventricular dysfunction in patients with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is characterized by hormonal and metabolic abnormalities and is thought to increase a risk for cardiovascular diseases. In this study we use speckle tracking echocardiography (STE) to evaluate left ventricular (LV) dysfunction in the early period of the disease. We enrolled 31 patients with PCOS and 32 healthy volunteers as a control group. The participants' ages ranged between 18 and 40 years. PCOS was diagnosed according to the Rotterdam criteria. LV strain (LS) and strain rate (SR) were evaluated using apical two-chamber (2C), three-chamber (3C), and four-chamber (4C) imaging. Global LS and SR were calculated as average of three apical views. The waist-to-hip ratio, homeostasis model assessment-insulin resistance (HOMA-IR), and fasting insulin and triglyceride levels were higher in the PCOS group than in the controls (p=0.001, p=0.001, p=0.001, and p=0.005, respectively). In the PCOS group, the mitral A wave, deceleration time (DT), and isovolumetric relaxation time (IVRT) were significantly higher than in the controls (all p<0.05). The LV global longitudinal strain (GLS) and global longitudinal SR systolic (GLSRS) were significantly lower in the PCOS patient group (both p= 0.001). There were strong negative correlations between GLS and both fasting insulin (r=-0.64) and DT (r=-0.62) (both p<0.05). The study demonstrated that PCOS patients had decreased LV function using STE. Therefore, STE imaging appears to be useful for the early detection of subclinical LV dysfunction in patients with PCOS.