1
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Yong JN, Ng CH, Lee CWM, Chan YY, Tang ASP, Teng M, Tan DJH, Lim WH, Quek J, Xiao J, Chin YH, Foo R, Chan M, Lin W, Noureddin M, Siddiqui MS, Muthiah MD, Sanyal A, Chew NWS. Non-alcoholic fatty liver disease association with structural heart, systolic and diastolic dysfunction: a meta-analysis. Hepatol Int 2022; 16:269-281. [PMID: 35320497 DOI: 10.1007/s12072-022-10319-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/11/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Several studies have documented a relationship between non-alcoholic fatty liver disease (NAFLD) and structural heart disease, particularly diastolic function. This meta-analysis will be the first to examine the echocardiographic-derived cardiac function and structural characteristics in NAFLD patients, and its association with liver disease severity and metabolic profile. METHODS Medline and Embase were searched and pairwise meta-analysis was conducted in DerSimonian and Laird to obtain the odds ratio (OR) and mean difference (MD) for dichotomous and continuous variables, respectively, to compare the effects of NAFLD on the echocardiography parameters. RESULTS Forty-one articles involving 33,891 patients underwent echocardiography. NAFLD patients had worse systolic indices with lower ejection fraction (EF, MD: - 0.693; 95% CI: - 1.112 to - 0.274; p = 0.001), and worse diastolic indices with higher E/e' (MD: 1.575; 95% CI: 0.924 to 2.227; p < 0.001) compared to non-NAFLD patients. NAFLD patients displayed increased left ventricular mass (LVM, MD: 34.484; 95% CI: 26.236 to 42.732; p < 0.001) and epicardial adipose thickness (EAT, MD: 0.1343; 95% CI: 0.055 to 0.214; p = 0.001). An increased severity of NAFLD was associated with worse diastolic indices (decreased E/A ratio, p = 0.007), but not with systolic indices. CONCLUSIONS NAFLD is associated with impaired systolic and diastolic function with changes in cardiac structure. Concomitant metabolic risk factors and liver disease severity are independently associated with worsening systolic and diastolic function.
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Affiliation(s)
- Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chloe Wen-Min Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yu Yi Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Mark Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Weiqin Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Department of Cardiology, National University Heart Centre, National University Hospital, Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Siurana JM, Ventura PS, Yeste D, Riaza-Martin L, Arciniegas L, Clemente M, Torres M, Amigó N, Giralt G, Roses-Noguer F, Sabate-Rotes A. Myocardial Geometry and Dysfunction in Morbidly Obese Adolescents (BMI 35-40 kg/m 2). Am J Cardiol 2021; 157:128-134. [PMID: 34392890 DOI: 10.1016/j.amjcard.2021.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
This study evaluated the preclinical effect of obesity on the ventricular remodeling in adolescents with morbid obesity, and determined if subjects labelled as metabolically healthy obesity (MHO) presented better heart index than those with metabolically unhealthy obesity (MUO). Prospective case-control research of 45 adolescents (14-year-old) with morbid obesity and 25 normal weight adolescents' gender- and age-matched with Tanner stage 4-5. Left ventricle (LV) was evaluated by conventional Doppler echocardiography, tissue Doppler imaging and two-dimensional speckle tracking echocardiography. Compared to normal-weight subjects, adolescents with morbid obesity presented a high percentage of pathological LV geometry (87%; p<0.01), and systolic and diastolic dysfunctions only detected by E/A ratio (2.0 vs 1.7, p<0.01), global longitudinal strain (-21.0% vs -16.5%, p<0.01), and early diastolic strain rate (3.2 vs 2.2, p<0.01). A correlation was found between impaired cardiac index and body mass index (BMI), high blood pressure, hyperglycemia, low HDL-cholesterol and hypertriglyceridemia. BMI and HDL-cholesterol were the most significant independent variables. No significant differences were found in structural and functional cardiac index when MHO and MUO subjects were compared (global longitudinal strain: -17.0% vs -16.4%, p0.79). Morbidly obese adolescents have an abnormal LV geometry, closely related to BMI, and systolic and diastolic LV dysfunctions. Adolescents labelled as MHO, despite exhibiting better BMI and insulin-resistance values, present the same pathological heart changes as MUO.
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Affiliation(s)
- Jose M Siurana
- Hospital HM Nens. HM Hospitales, Barcelona, Spain; Autonomous University of Barcelona, Spain.
| | - Paula S Ventura
- Hospital HM Nens. HM Hospitales, Barcelona, Spain; Autonomous University of Barcelona, Spain
| | - Diego Yeste
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; CIBER of Rare Diseases (CIBERER) ISCIII, Spain
| | | | | | - Maria Clemente
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; CIBER of Rare Diseases (CIBERER) ISCIII, Spain
| | | | - Núria Amigó
- Biosfer Teslab - Metabolomics Platform, Rovira i Virgili University, Tarragona, Spain
| | - Gemma Giralt
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ferran Roses-Noguer
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain
| | - Anna Sabate-Rotes
- Autonomous University of Barcelona, Spain; Vall d'Hebron University Hospital, Barcelona, Spain
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Paysal J, Merlin E, Rochette E, Terral D, Nottin S. Global and Regional Myocardial Work in Female Adolescents with Weight Disorders. J Clin Med 2021; 10:jcm10204671. [PMID: 34682793 PMCID: PMC8537237 DOI: 10.3390/jcm10204671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Anorexia nervosa (AN) and obesity (OB) lead to changes in SBP (i.e., loading conditions) that may affect left ventricular (LV) myocardial work (MW). The novel concept of LV pressure-strain loops allows non-invasive estimation of MW, this latter being correlated with cardiac energy metabolism. In addition, the study of regional MW can detect subtle alterations in cardiac function by highlighting an abnormal distribution of MW. Objective: The aim of this study was to assess the cardiac function of AN and OB patients by evaluating global and regional LV strains and MW. Methods: Eighty-seven female adolescents, comprising 26 with AN (14.6 ± 1.9 yrs. old), 28 with OB (13.2 ± 1.4 yrs. old), and 33 controls (14.0 ± 2.0 yrs. old) underwent speckle-tracking echography to assess global and regional LV strains and MW. Results: SBP was higher in adolescents with obesity than in AN patients or controls. Global MW was similar between groups. In AN patients and controls, longitudinal strains were higher at the apex than at the base of the LV, whereas they were similar in obesity patients, owing to a decrease in their apical longitudinal strain. Consequently, their MW was higher at the basal level than either of the other two groups (1854 ± 272 vs. 1501 ± 280 vs. 1575 ± 295 mmHg% in OB patients, AN patients, and controls, respectively. Conclusion: Despite altered SBP, the global MW of adolescents with weight disorders was unaffected. However, in adolescents with obesity, the distribution of their regional LV MW was altered, which might reflect specific regional remodeling.
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Affiliation(s)
- Justine Paysal
- LAPEC EA4278 Laboratory, Avignon University, F-84000 Avignon, France;
- Néonatologie et Réanimation Pédiatrique, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Etienne Merlin
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (E.M.); (E.R.); (D.T.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (E.M.); (E.R.); (D.T.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Daniel Terral
- Pédiatrie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (E.M.); (E.R.); (D.T.)
| | - Stéphane Nottin
- LAPEC EA4278 Laboratory, Avignon University, F-84000 Avignon, France;
- Correspondence: ; Tel.: +33-490-162-931
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Burden S, Weedon B, Whaymand L, Rademaker J, Dawes H, Jones A. The effect of overweight/obesity on diastolic function in children and adolescents: A meta-analysis. Clin Obes 2021; 11:e12476. [PMID: 34278720 PMCID: PMC8767098 DOI: 10.1111/cob.12476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
Left ventricular diastolic function (LVDF) is an important marker of early cardiovascular remodelling, which has not been well summarized in young people with overweight/obesity. Weighted, random-effects regression was used to determine the strength of associations of both body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) with LVDF measures, adjusting for age and sex. Six databases were searched after PROSPERO registration (CRD42020177470) from inception to July 2020 for studies that compared LVDF between overweight/obesity and control groups aged ≤24 years, yielding 70 studies (9983 individuals). Quality and risk of bias were assessed using NHLBI tools, with scores of good, fair, and poor for 6, 48, and 16 studies, respectively. Increased BMI was associated with worse LVDF in all measures except early mitral inflow deceleration time, with septal early diastolic tissue peak velocity to late diastolic tissue peak velocity ratio having the strongest association (n = 13 studies, 1824 individuals; r = -0.69; P < 0.001). Elevated HOMA-IR was also associated with worse LVDF. Although we could not determine the causality of reduced LVDF in young people, our findings should aid the development of paediatric guidelines for the assessment of LVDF and support further work to address the longitudinal consequences of childhood obesity and IR on LVDF.
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Affiliation(s)
- Samuel Burden
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
- Department of PaediatricsUniversity of OxfordOxfordUK
| | - Benjamin Weedon
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
- Department of PaediatricsUniversity of OxfordOxfordUK
| | - Luke Whaymand
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
| | | | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Health Biomedical Research CentreOxford Health NHS Foundation TrustOxfordUK
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5
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Abstract
OBJECTIVE Ventricular repolarisation changes may lead to sudden cardiac death in obese individuals. We aimed to investigate the relationship between ventricular repolarisation changes, echocardiographic parameters, anthropometric measures, and metabolic syndrome laboratory parameters in obese children. METHODS The study involved 81 obese and 82 normal-weight healthy children with a mean age of 12.3 ± 2.7 years. Anthropometric measurements of participants were evaluated according to nomograms. Obese patients were subdivided into two groups; metabolic syndrome and non-metabolic syndrome obese. Fasting plasma glucose, fasting insulin, and lipid profile were measured. QT/QTc interval, QT/QTc dispersions were measured, and left ventricular systolic and diastolic measurements were performed. RESULTS Body weight, body mass index, relative body mass index, waist/hip circumference ratio, and systolic and diastolic blood pressures were significantly higher in obese children. QT and QTc dispersions were significantly higher in obese children and also obese children with metabolic syndrome had significantly higher QT and QTc dispersions compared to non-metabolic syndrome obese children (p < 0.001) and normal-weight healthy children (p < 0.001). Waist/hip circumference ratio, body mass index, and relative body mass index were the most important determinant of QT and QTc dispersions. Left ventricular wall thickness (left ventricular posterior wall thickness at end-diastole, left ventricular posterior wall thickness at end-systole, interventricular septal thickness at end-diastole) and left ventricular mass index were significantly higher and ejection fraction was lower in obese children. Left ventricular mass index and interventricular septal thickness at end-diastole were positively correlated with QT and QTc dispersions. CONCLUSIONS Our study demonstrated that QT/ QTc interval prolongation and increase in QT and QTc dispersion on electrocardiogram may be found at an early age in obese children.
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Hirose K, Nakanishi K, Daimon M, Sawada N, Yoshida Y, Iwama K, Yamamoto Y, Ishiwata J, Hirokawa M, Koyama K, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Impact of insulin resistance on subclinical left ventricular dysfunction in normal weight and overweight/obese japanese subjects in a general community. Cardiovasc Diabetol 2021; 20:22. [PMID: 33478525 PMCID: PMC7818760 DOI: 10.1186/s12933-020-01201-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Insulin resistance carries increased risk of heart failure, although the pathophysiological mechanisms remain unclear. LV global longitudinal strain (LVGLS) assessed by speckle-tracking echocardiography has emerged as an important tool to detect early LV systolic abnormalities. This study aimed to investigate the association between insulin resistance and subclinical left ventricular (LV) dysfunction in a sample of the general population without overt cardiac disease. METHODS We investigated 539 participants who voluntarily underwent extensive cardiovascular health check including laboratory test and speckle-tracking echocardiography. Glycemic profiles were categorized into 3 groups according to homeostatic model assessment of insulin resistance (HOMA-IR): absence of insulin resistance (HOMA-IR < 1.5), presence of insulin resistance (HOMA-IR ≥ 1.5) and diabetes mellitus (DM). Multivariable logistic regression models were conducted to evaluate the association between abnormal glucose metabolism and impaired LVGLS (> - 16.65%). RESULTS Forty-five (8.3%) participants had DM and 66 (12.2%) had abnormal HOMA-IR. LV mass index and E/e' ratio did not differ between participants with and without abnormal HOMA-IR, whereas abnormal HOMA-IR group had significantly decreased LVGLS (- 17.6 ± 2.6% vs. - 19.7 ± 3.1%, p < 0.05). The prevalence of impaired LVGLS was higher in abnormal HOMA-IR group compared with normal HOMA-IR group (42.4% vs. 14.0%) and similar to that of DM (48.9%). In multivariable analyses, glycemic abnormalities were significantly associated with impaired LVGLS, independent of traditional cardiovascular risk factors and pertinent laboratory and echocardiographic parameters [adjusted odds ratio (OR) 2.38, p = 0.007 for abnormal HOMA-IR; adjusted OR 3.02, p = 0.003 for DM]. The independent association persisted even after adjustment for waist circumference as a marker of abdominal adiposity. Sub-group analyses stratified by body mass index showed significant association between abnormal HOMA-IR and impaired LVGLS in normal weight individuals (adjusted OR 4.59, p = 0.001), but not in overweight/obese individuals (adjusted OR 1.62, p = 0.300). CONCLUSIONS In the general population without overt cardiac disease, insulin resistance carries independent risk for subclinical LV dysfunction, especially in normal weight individuals.
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Affiliation(s)
- Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Iwama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Yamamoto
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhiro Koyama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Atici A, Asoglu R, Barman HA, Sarikaya R, Arman Y, Tukek T. Multilayer global longitudinal strain assessment of subclinical myocardial dysfunction related to insulin resistance. Int J Cardiovasc Imaging 2020; 37:539-546. [PMID: 32951097 DOI: 10.1007/s10554-020-02037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
Myocardial tissue is sensitive to insulin resistance (IR) due to its interactions with insulin levels. Previous studies demonstrated that heart failure prevalence was higher in IR patients. Evaluation of myocardial deformation by multilayer global longitudinal strain (MGLS) might provide more information about IR related left ventricular dysfunction. In this study, we aimed to investigate subclinical LV dysfunction with MGLS in patients with IR. The study was designed as a prospective cross-sectional study. The present study included 64 patients with IR (+), and 54 subjects without IR (-) prospectively. The homeostasis model of insulin resistance (HOMA-IR) was used to quantify insulin resistance. Specific analysis for endocardial, mid-myocardial and epicardial layers were performed by two-dimensional (2D) speckle tracking echocardiography (STE) for multilayer global longitudinal strain. MGLS (Endocard-Mid-myocard-Epicard) values were significantly lower in the IR (+) group compared to IR (-) group ((GLS-endocard; - 15.1 ± 1.5 vs. - 18.7 ± 1.3, p < 0.001), (GLS-mid-myocard; - 16.0 ± 2.0 vs. - 18.0 ± 2.0, p < 0.001), (GLS-epicard; - 17.0 ± 1.7 vs. - 18.01 ± 1.94, p = 0.004)). GLS-endocard levels were significantly and positively correlated with HOMA-IR levels (r = 0.643, p < 0.001). HOMA-IR and age were found to be independent factors in detecting a decrease in GLS-endocard level in regression analysis. In conclusion, our data reveal that IR (+) patients had significantly lower strain values compared to IR (-) group. Besides, we presented that the HOMA-IR value was an independent predictor of subclinical left ventricular dysfunction.
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Affiliation(s)
- Adem Atici
- Cardiology Department, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Dr. Erkin street, 34722, Istanbul, Turkey.
| | - Ramazan Asoglu
- Cardiology Department, Adiyaman Training Ve Research Hospital, Yunus Emre Mahallesi, 1164 Sokak No: 13, Merkez/Adıyaman, Turkey
| | - Hasan Ali Barman
- Cardiology Department, Istanbul University - Cerrahpasa, Institute of Cardiology, Haseki street, Fatih, 34096, Istanbul, Turkey
| | - Remzi Sarikaya
- Cardiology Department, Istanbul University Istanbul School of Medicine, Turgut Ozal street No: 118, Fatih, 34093, Istanbul, Turkey
| | - Yucel Arman
- Cardiology Department, Istanbul University - Cerrahpasa, Institute of Cardiology, Haseki street, Fatih, 34096, Istanbul, Turkey
| | - Tufan Tukek
- Cardiology Department, Istanbul University Istanbul School of Medicine, Turgut Ozal street No: 118, Fatih, 34093, Istanbul, Turkey
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Brar PC, Chun A, Fan X, Jani V, Craft M, Bhatla P, Kutty S. Impaired myocardial deformation and ventricular vascular coupling in obese adolescents with dysglycemia. Cardiovasc Diabetol 2019; 18:172. [PMID: 31856856 PMCID: PMC6921397 DOI: 10.1186/s12933-019-0976-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022] Open
Abstract
Background It is unknown that dysglycemia in obese adolescents has effects on myocardial deformation that are more pronounced when compared to obesity alone. We hypothesized that obesity associated abnormal glucose tolerance (dysglycemia) would have adverse effects on two-dimensional speckle tracking echocardiography derived longitudinal, radial and circumferential strain (LS, RS, CS) compared to age and gender lean controls. We also examined if changes in deformation would be reflected in abnormal ventricular vascular coupling indices (VVI). Methods In a prospective cross-sectional design 39 obese adolescents (15.9 ± 1.7 years; 101.5 ± 39 kg; female − 58%) were compared to age and gender matched lean controls (15.7 ± 1.8 yrs, 60 ± 12.8 kg). Based on results from an oral glucose tolerance test (OGTT), obese adolescents were categorized as obese normoglycemic (ONG, n = 25) or obese dysglycemic (ODG, n = 14). Left ventricular (LV) global and average LS, CS, RS and strain rate were measured. LV ejection fraction and mass index were measured and VVI approximated as ratio of arterial elasticity (Ea) and end-systolic elastance (Ees). Results Adolescents with ODG had significantly (P = 0.005) impaired global LS (− 20.98% ± 2.8%) compared to controls (− 23.01% ± 2.3%). A similar (P = 0.0027) reduction was observed in average LS for adolescents with ODG (18.87% ± 2.5%) compared to controls (20.49% ± 2%). Global CS was also decreased (P = 0.03) in ODG (− 23.95%) compared to ONG (− 25.80). A similar trend was observed in average CS after multivariate regression for BMI and blood pressure. CS correlated with HbA1c in both groups (P = 0.05). VVI had a negative correlation with both LS (r = − 0.4, P = 0.025) and CS rate (r = − 0.36, P = 0.04). Conclusions Myocardial strain and strain rate were significantly altered in obese adolescents. Unfavorable subclinical reductions in global and average CS were more pronounced in adolescents with dysglycemia compared to obese adolescents with normoglycemia and controls. These data indicate progressive worsening of subendocardial function across the spectrum of glucose tolerance. Strain rate was predictive of VVI in obese adolescents, suggesting strain rate may be a sensitive marker for cardiac remodeling in abnormal glucose homeostasis states.
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Affiliation(s)
- Preneet Cheema Brar
- Division of Endocrinology and Diabetes, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Anne Chun
- Division of Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Xiazhou Fan
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Vivek Jani
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans Street, Baltimore, MD, 21205-2196, USA
| | - Mary Craft
- Division of Pediatric Cardiology, University of Nebraska College of Medicine, Omaha, NE, 68918, USA
| | - Puneet Bhatla
- Division of Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans Street, Baltimore, MD, 21205-2196, USA.
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Wijarnpreecha K, Lou S, Panjawatanan P, Cheungpasitporn W, Pungpapong S, Lukens FJ, Ungprasert P. Association between diastolic cardiac dysfunction and nonalcoholic fatty liver disease: A systematic review and meta-analysis. Dig Liver Dis 2018; 50:1166-1175. [PMID: 30292566 DOI: 10.1016/j.dld.2018.09.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Recent studies have suggested an association between nonalcoholic fatty liver disease (NAFLD) and diastolic cardiac dysfunction, although the results were inconsistent. This study was conducted to investigate this possible association. METHODS A comprehensive literature review was conducted utilizing the MEDLINE and Embase databases from inception through May 2018 to identify all cross-sectional studies that compared the prevalence of diastolic cardiac dysfunction among patients with NAFLD to individuals without NAFLD. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS A total of 12 studies with 280,645 participants fulfilled the eligibility criteria and were included in the meta-analysis. There was a significant association between NAFLD and diastolic cardiac dysfunction with a pooled odds ratio (OR) of 2.02 (95% confidence interval (CI), 1.47-2.79; I2 89%). Subgroup analysis based on the country of origin continued to demonstrate a significant association in subgroups of both Western and Eastern countries with pooled ORs of 1.76 (95% CI, 1.14-2.72; I2 85%) and 2.59 (95% CI, 1.42-4.69; I2 87%), respectively. Limitations included high between-study heterogeneity, lack of unified definition of diastolic dysfunction and presence of publication bias. CONCLUSIONS A significant association between diastolic cardiac dysfunction and NAFLD was observed in this meta-analysis. This observation could suggest the need for careful cardiovascular surveillance among patients with NAFLD.
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Affiliation(s)
- Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Susan Lou
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Wisit Cheungpasitporn
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Surakit Pungpapong
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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10
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Rivet D, Nelson O, Vella C, Jansen H, Robbins C. Systemic effects of a high saturated fat diet in grizzly bears (Ursus arctos horribilis). CAN J ZOOL 2017. [DOI: 10.1139/cjz-2016-0271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Food sources for North America’s grizzly bear (Ursus arctos horribilis Ord, 1815) population have changed as habitats have fragmented, altering available resources and putting bears in contact with unnatural foods. Bears have evolved mechanisms to tolerate obesity, and do not develop adverse health consequences despite storing massive amounts of body fat. Captive adult grizzly bears were used to determine the effects of dietary fat on health. Group 1 was fed a diet high in polyunsaturated fatty acids (PUFA) wherein 9.5% of available calories came from saturated fatty acids (SFA). Group 2 was fed a diet wherein 28.8% of calories came from SFA. Plasma fatty acids, serum lipid profiles, insulin, inflammatory markers, systolic and diastolic blood pressure, and cardiac function parameters were measured. Serum lipids, SFA, and insulin did not differ between the two groups, although omega-3 fatty acids differed. Bears eating the SFA diet had significantly higher circulating adiponectin, interleukin-7 and interleukin-15, and tumor necrosis factor-alpha. Mild, asymptomatic systolic and diastolic dysfunctions were detected by strain echocardiography in the SFA group. The SFA diet group exhibited higher diastolic arterial pressures. Even though mild metabolic derangements were observed, grizzly bears were remarkably resistant to metabolic effects of diets high in SFA.
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Affiliation(s)
- D.R. Rivet
- School of Biological Sciences, Washington State University, Pullman, WA 99164, USA
| | - O.L. Nelson
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA 99164, USA
| | - C.A. Vella
- Department of Movement Sciences, University of Idaho, Moscow, ID 83844, USA
| | - H.T. Jansen
- Integrative Physiology and Neuroscience, Washington State University, Pullman, WA 99164, USA
| | - C.T. Robbins
- School of the Environment and School of Biological Sciences, Washington State University, Pullman, WA 99164, USA
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11
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Morris R, Prasad A, Asaro J, Guzman M, Sanders L, Hauck A, Singh GK, Levy PT. Markers of Cardiovascular Dysfunction in Adolescents With Anorexia Nervosa. Glob Pediatr Health 2017; 4:2333794X17727423. [PMID: 28890913 PMCID: PMC5580842 DOI: 10.1177/2333794x17727423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/14/2017] [Indexed: 12/16/2022] Open
Abstract
Background. Cardiovascular complications contribute to the high morbidity and mortality rate among children with anorexia nervosa (AN). Advances in cardiac imaging permit a more comprehensive assessment of myocardial performance in children that could not be previously obtained with conventional imaging. Myocardial strain analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in children. Objective. To assess global and regional left ventricular (LV0 function in children newly diagnosed with AN with conventional and quantitative 2-dimensional speckle tracking echocardiographic (2DSTE)–derived strain imaging. Materials. In a cross-sectional study of 30 patients with AN (DSM-5) and 14 age-, sex-, and race-matched healthy children, markers of cardiovascular risk, conventional and 2DSTE measures of LV function, and structure were evaluated and compared. The AN cohort was further stratified by behavioral patterns (restrict, exercise, or purge). Results. Conventional measures and LV global strain were similar between controls and children with AN. A subgroup of AN children with purging behavior had LV remodeling characterized by significantly decreased LV mass index. Regional ventricular function at the apex, as measured by strain, was also decreased in all AN patients. Percent change from ideal body weight, body mass index Z-score, electrolyte profiles, heart rate, and blood pressure were similar. Conclusions. Subclinical regional ventricular dysfunction is present in children with AN. Ventricular remodeling exists in a subgroup of children with AN in association with purging behavior. Future studies may utilize strain imaging to identify those AN patients who are at an increased risk for developing significant cardiac dysfunction.
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Affiliation(s)
- Reshmi Morris
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Aparna Prasad
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Joseph Asaro
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Marla Guzman
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Leslie Sanders
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Amanda Hauck
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Gautam K Singh
- Washington University, School of Medicine, Saint Louis, MO, USA
| | - Philip T Levy
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA.,Washington University, School of Medicine, Saint Louis, MO, USA
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12
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Jung JY, Park SK, Ryoo JH, Oh CM, Kang JG, Lee JH, Choi JM. Effect of non-alcoholic fatty liver disease on left ventricular diastolic function and geometry in the Korean general population. Hepatol Res 2017; 47:522-532. [PMID: 27379875 DOI: 10.1111/hepr.12770] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/16/2016] [Accepted: 07/02/2016] [Indexed: 02/08/2023]
Abstract
AIM Previous studies showed that non-alcoholic fatty liver disease (NALFD) could be related to subclinical left ventricular (LV) diastolic dysfunction and remodeling. However, this association is still equivocal in the general population. Thus, this study was carried out to examine whether NAFLD is associated with the risk for LV diastolic dysfunction and remodeling. METHODS A cross-sectional study was carried out for 20 821 Korean men and women who received a health checkup including echocardiography from 2011 to 2012. The study population was divided into three groups of normal, mild and moderate-to-severe NAFLD detected by ultrasonography. Using multivariable logistic regression analysis, the odd ratios of abnormal LV relaxation and remodeling were analyzed according to the degree of NAFLD. Additionally, adjusted mean values of LV diastolic functional and structural parameters were evaluated in the three groups. RESULTS Compared with the normal group, the mild and moderate-to-severe NAFLD groups had higher odd ratios for abnormal LV relaxation (mild group 1.29, 95% confidence interval 1.15-1.46; moderate-to-severe group 1.95, 95% confidence interval 1.61-2.35) and increased relative wall thickness (>0.42; mild group 1.26, 95% confidence interval 1.05-1.52; moderate-to-severe group 1.46, 95% confidence interval 1.08-1.95). Analyzing adjusted mean values of LV parameters also showed the significant association between the degree of NAFLD and impaired LV diastolic function and concentric LV remodeling. CONCLUSIONS The risk for LV diastolic dysfunction and remodeling proportionally increased according to the degree of NAFLD. NAFLD is significantly associated with LV functional and structural alteration.
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Affiliation(s)
- Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Goyang, Korea.,School of Medicine, Departments of Medicine, Graduate School, Kyung Hee University, Goyang, Korea
| | - Sung Keun Park
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Goyang, Korea
| | - Jae-Hong Ryoo
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Goyang, Korea
| | - Chang-Mo Oh
- Cancer Registration and Statistic Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jeong Gyu Kang
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, Goyang, Korea
| | - Jae-Hon Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Joong-Myung Choi
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Goyang, Korea
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13
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Thota P, Perez-Lopez FR, Benites-Zapata VA, Pasupuleti V, Hernandez AV. Obesity-related insulin resistance in adolescents: a systematic review and meta-analysis of observational studies. Gynecol Endocrinol 2017; 33:179-184. [PMID: 28102091 DOI: 10.1080/09513590.2016.1273897] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Insulin resistance is common among obese adolescents; however, the extent of this problem is not clear. We conducted a systematic review of PubMed-Medline, CINAHL, The Web of Science, EMBASE and Scopus for observational studies evaluating components defining insulin resistance (insulin, C-peptide and homeostatic model assessment-insulin resistance [HOMA-IR]) in obese adolescents (12-18 years) versus non-obese adolescents. Our systematic review and meta-analysis followed the PRISMA guidelines. Data were combined using a random-effects model and summary statistics were calculated using the mean differences (MDs). 31 studies were included (n = 8655). In 26 studies, fasting insulin levels were higher in obese adolescents when compared to non-obese adolescents (MD = 64.11 pmol/L, 95%CI 49.48-78.75, p < 0.00001). In three studies, fasting C-peptide levels were higher in obese adolescents when compared to non-obese adolescents (MD = 0.29 nmol/L, 95%CI 0.22-0.36, p < 0.00001). In 24 studies, HOMA-IR values were higher in obese adolescents when compared to non-obese adolescents (MD = 2.22, 95%CI 1.78-2.67, p < 0.00001). Heterogeneity of effects among studies was moderate to high. Subgroup analyses showed similar results to the main analyses. Circulating insulin and C-peptide levels and HOMA-IR values were significantly higher in obese adolescents compared to those non-obese.
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Affiliation(s)
- P Thota
- a School of Medicine , Case Western Reserve University , Cleveland , OH , USA
| | - F R Perez-Lopez
- b Department of Obstetrics and Gynecology , University of Zaragoza Faculty of Medicine and Lozano Blesa University Hospital , Domingo Miral s/n, Zaragoza , Spain
| | - V A Benites-Zapata
- c Center for Public Health Research, Research Institute, Faculty of Medicine, University of San Martin de Porres , Lima , Peru
| | - V Pasupuleti
- a School of Medicine , Case Western Reserve University , Cleveland , OH , USA
| | - A V Hernandez
- d School of Medicine , Universidad Peruana de Ciencias Aplicadas (UPC) , Lima , Peru , and
- e Department of Quantitative Health Sciences , Health Outcomes and Clinical Epidemiology Section, Cleveland Clinic, Cleveland, OH , USA
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14
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Association of Parental Overweight and Cardiometabolic Diseases and Pediatric Adiposity and Lifestyle Factors with Cardiovascular Risk Factor Clustering in Adolescents. Nutrients 2016; 8:nu8090567. [PMID: 27649237 PMCID: PMC5037552 DOI: 10.3390/nu8090567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/30/2016] [Accepted: 09/05/2016] [Indexed: 12/17/2022] Open
Abstract
Cardiometabolic risk factors or their precursors are observed in childhood and may continue into adulthood. We investigated the effects of parental overweight and cardiometabolic diseases and pediatric lifestyle factors on the clustering of cardiovascular risk factors among adolescents, and examined the mediating and modifying effects of pediatric adiposity on these associations. Representative adolescents (n = 2727; age, 12–16 years) were randomly recruited through multistage stratified sampling from 36 schools in Southern Taiwan. Adolescent and parent surveys were conducted in schools and participant homes, respectively. Their demographic factors, diet patterns, and physical, anthropometric, and clinical parameters were collected and analyzed. Adolescents with 1–2 and ≥3 risk components for pediatric metabolic syndrome (MetS) were defined as potential MetS (pot-MetS) and MetS, respectively. Adolescents whose parents were overweight/obese, or with diabetes and hypertension had a higher prevalence ratio of pot-MetS and MetS (1.5–1.6 and 1.9–4.2-fold, respectively). Low physical activity (<952.4 MET·min/week), long screen time (≥3 h/day) and high sugar-sweetened beverage intake (>500 mL/day) were associated with a 3.3- (95% confidence intervals (CI) = 1.5–7.3), 2.2- (95% CI = 1.1–4.4), and 26.9-fold (95% CI = 3.2–229.0) odds ratio (OR) of MetS, respectively. Pediatric body mass index (BMI) accounted for 18.8%–95.6% and 16.9%–60.3% increased prevalence ratios of these parental and pediatric risk factors for MetS. The OR of pot-MetS + MetS for sugar-sweetened beverage consumption was multiplicatively enhanced among adolescents with overweight/obesity (combined OR, 8.6-fold (95% CI = 4.3–17.3); p for multiplicative interaction, 0.009). The results suggest that parental overweight and cardiometabolic diseases and pediatric sedentary and high sugar-intake lifestyles correlate with the development of adolescent MetS, and an elevated child BMI explains a part of these associations. Pediatric adiposity might be multiplicatively associated with sugar-sweetened beverage consumption for enhancing the MetS prevalence ratio among adolescents.
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15
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Colquitt JL, Pignatelli RH. Strain Imaging: The Emergence of Speckle Tracking Echocardiography into Clinical Pediatric Cardiology. CONGENIT HEART DIS 2016; 11:199-207. [DOI: 10.1111/chd.12334] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 01/04/2023]
Affiliation(s)
- John L. Colquitt
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Ricardo H. Pignatelli
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
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16
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Levy PT, Machefsky A, Sanchez AA, Patel MD, Rogal S, Fowler S, Yaeger L, Hardi A, Holland MR, Hamvas A, Singh GK. Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2015; 29:209-225.e6. [PMID: 26747685 DOI: 10.1016/j.echo.2015.11.016] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE)-derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims of this study were to perform a meta-analysis of normal ranges of LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) measurements derived by 2DSTE in children and to identify confounding factors that may contribute to variance in reported measures. METHODS A systematic review was launched in MEDLINE, Embase, Scopus, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Search hedges were created to cover the concepts of pediatrics, STE, and left-heart ventricle. Two investigators independently identified and included studies if they reported 2DSTE-derived LV GLS, GCS, or GRS. The weighted mean was estimated by using random effects models with 95% CIs, heterogeneity was assessed using the Cochran Q statistic and the inconsistency index (I(2)), and publication bias was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a metaregression. RESULTS The search identified 2,325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean, -20.2%; 95% CI, -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean, -22.3%; 95% CI, -19.9% to -24.6%), and GRS varied from 33.9% to 54.5% (mean, 45.2%; 95% CI, 38.3% to 51.7%). Twenty-six studies reported longitudinal strain only from the apical four-chamber view, with a mean of -20.4% (95% CI, -19.8% to -21.7%). Twenty-three studies reported circumferential strain (mean, -20.3%; 95% CI, -19.4% to -21.2%) and radial strain (mean, 46.7%; 95% CI, 42.3% to 51.1%) from the short-axis view at the midventricular level. A significant apex-to-base segmental longitudinal strain gradient (P < .01) was observed in the LV free wall. There was significant between-study heterogeneity and inconsistency (I(2) > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, frame rate/heart rate ratio, tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. The metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). CONCLUSIONS This study defines reference values of 2DSTE-derived LV strain in children on the basis of a meta-analysis. In healthy children, mean LV GLS was -20.2% (95% CI, -19.5% to -20.8%), mean GCS was -22.3% (95% CI, -19.9% to -24.6%), and mean GRS was 45.2% (95% CI, 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturation. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor parameters, age- and vendor-specific referenced ranges were established as well.
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Affiliation(s)
- Philip T Levy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey.
| | - Aliza Machefsky
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Aura A Sanchez
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Meghna D Patel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah Rogal
- Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey
| | - Susan Fowler
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Lauren Yaeger
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Angela Hardi
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mark R Holland
- Department of Radiology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Aaron Hamvas
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gautam K Singh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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