Impact of 6-year body weight change on cardiac geometry and function in ageing adults: the SUpplémentation en Vitamines et Minéraux AntioXydants -2 (SU.VI.MAX-2) cardiovascular ultrasound substudy

Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction

Background

Early detection of risk factors for left ventricular (LV) dysfunction may be useful in patients with high blood pressure (HBP).

Methods

Patient from an outpatient HBP clinic underwent a two-dimensional Doppler-coupled echocardiography with determination of LV global longitudinal strain (GLS) by speckle-tracking.

Results

Among 200 patients (mean age 61.7 ± 9.7 years), 155 were overweight, 93 had diabetes, 83 had dyslipidemia, and 109 had uncontrolled HBP. LV hypertrophy (LVH) was found in 136 patients (68%), including concentric (n = 106) and eccentric (n = 30) LVH. Diastolic dysfunction patterns were observed in 178 patients (89%), and increased filling pressures were observed in 37 patients (18.5%). GLS ranged from –25% to –11.6% (mean –16.9 ± 3.2%). Low GLS values (>–17%) were found in 91 patients (45.5%), 68 with and 23 without LVH. In univariate analysis, a reduced GLS was associated with HBP lasting for >10 years (odds ratio (OR) = 3.51, 95% confidence interval (CI) 1.73–7.09; p = 0.002), uncontrolled HBP (OR = 3.55, 95% CI 1.96–6.43; p < 0.0001), overweight (OR = 2.01, 95% CI 0.93–4.31; p = 0.0028), diabetes (OR = 2.21, 95% CI 1.25–3.90; p = 0.006), dyslipidemia (OR = 2.16, 95% CI 1.22–3.84; p = 0.008), renal failure (OR = 4.27, 95% CI 1.80–10.10; p = 0.001), an increased Cornell index (OR = 3.70, 95% CI 1.98–6.90; p < 0.0001), concentric LVH (OR = 9.26, 95% CI 2.62–32.73; p = 0.001), remodeling (OR = 8.51, 95% CI 2.18–33.23; p = 0.002), and filling pressures (OR = 7.1, 95% CI 2.9–17.3; p < 0.0001). In multivariable analysis, duration of HBP (p = 0.038), uncontrolled BP (p = 0.006), diabetes (p = 0.023), LVH (p = 0.001), and increased filling pressures (p = 0.003) remained associated with GLS decline.

Conclusion

Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH.

Weight loss and progressive left ventricular remodelling: The Multi-Ethnic Study of Atherosclerosis (MESA)

AIMS

Impact of weight loss on cardiac structure has not been extensively investigated in large, multi-ethnic, community-based populations. We investigated the longitudinal impact of weight loss on cardiac structure by cardiac magnetic resonance (CMR).

METHODS AND RESULTS

2351 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent CMR at Exam 1 (2002) and Exam 5 (2011) were included. Primary outcomes were percentage change in LV mass (indexed to height) and LV mass-to-volume ratio (concentric LV remodelling). Multivariable linear regression was used to measure the association between outcomes and weight change. At median 9.4 years' follow-up, 639 individuals (27%) experienced >5% weight loss (median 6.9 kg) and 511 (22%) had >5% weight gain (median 6.4 kg). A >5% weight gain was associated with the greatest increase in LV mass (+5.4% median) and LV mass-to-volume ratio (+12.2% median). Adjusting for medications, hypertension/diabetes (and change in these risk factors), age, race and other risk factors, every 5% weight loss was associated with a 1.3% decrease in height-indexed LV mass and 1.3% decrease in LV mass-to-volume ratio (p<0.0001). There was no effect modification/confounding by age, race, gender or baseline BMI. Change in LV mass-to-volume ratio was roughly linear, specifically for modest degrees of weight loss (-10% to +10%). Change in LV mass was linear with weight loss, suggesting no threshold of weight loss is needed for LV mass regression.

CONCLUSIONS

In a large multi-ethnic population, weight loss is associated with beneficial effects on cardiac structure, independent of age, race, gender, BMI and obesity-related cardiometabolic risk. There is no threshold of weight loss required to produce these effects.