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Wang Q, Yang W, Chen Y, Liu J, Zhou C, Dong Z, Wang C, Guo J. Impact of Bariatric Surgery on Cardiac Function and Structure in Chinese Patients with Obesity. Metab Syndr Relat Disord 2023; 21:378-388. [PMID: 37733057 DOI: 10.1089/met.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Introduction: Obesity contributes to cardiac dysfunction and has an impact on atherosclerotic cardiovascular disease. Bariatric surgery (BS) is being considered a therapeutic option for patients with obesity and also can improve cardiac function. Very few studies considered the Chinese population. This study aimed to examine the effect of BS on cardiac function and structure in Chinese subjects with obesity. Methods: A single-center retrospective analysis of 143 patients with obesity was included. To observe and analyze the short-term, midterm, and long-term effects of BS on cardiovascular function and structure, the study population was divided into three groups according to the time of review. Fifty-two patients in group T1 (re-examination within 12 months); 53 patients in group T2 (re-examination within 12 to 24 months); and 38 patients in group T3 (re-examination over 24 months). The effects of BS on the cardiac function and structure were evaluated by analyzing the echocardiographic parameters. Results: After BS, body mass index (BMI) decreased from 39.7 ± 8.0 to 28.4 ± 6.4 kg/m2 (P < 0.001). Blood pressure decreased significantly. Left ventricular mass index (LVMI) decreased (43.7 ± 16.4 to 37.8 ± 13.4 g/m2.7, P < 0.001). The change in LVMI was correlated with the change in BMI (R2 = 0.14, P < 0.001). In subgroup analyses at different follow-ups, echocardiographic parameters showed varying degrees of change compared with the baseline. Conclusions: Significant weight loss by BS was associated with improved left ventricular structure and function in Chinese patients with obesity, suggesting potential favorable effects of BS on the cardiac function and structure.
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Affiliation(s)
- Qianyun Wang
- Department of Cardiology and The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China
| | - Yuan Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China
| | - Junqing Liu
- Department of Cardiology and The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chaofan Zhou
- Department of Cardiology, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, Guangzhou, China
| | - Jun Guo
- Department of Cardiology and The First Affiliated Hospital of Jinan University, Guangzhou, China
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Esparham A, Shoar S, Kheradmand HR, Ahmadyar S, Dalili A, Rezapanah A, Zandbaf T, Khorgami Z. The Impact of Bariatric Surgery on Cardiac Structure, and Systolic and Diastolic Function in Patients with Obesity: A Systematic Review and Meta-analysis. Obes Surg 2023; 33:345-361. [PMID: 36469205 DOI: 10.1007/s11695-022-06396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022]
Abstract
The purpose of this study was to provide pooled data from all studies on the impact of bariatric surgery on cardiac structure, and systolic and diastolic function evaluated by either echocardiography or cardiac magnetic resonance. PubMed, Web of Science, Embase, and Scopus databases were searched. Almost all of cardiac left-side structural indices improved significantly after bariatric surgery. However, right-side structural indices did not change significantly. Left ventricular ejection fraction and most of the diastolic function indices improved significantly after the bariatric surgery. The subgroup analysis showed that the left ventricular mass index decreased more in long-term follow-up (≥ 12 months). In addition, subgroup analysis of studies based on surgery type did not reveal any difference in outcomes between gastric bypass and sleeve gastrectomy groups.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Shoar
- Department of Clinical Research, ScientificWriting Corp, Houston, TX, USA
| | - Hamid Reza Kheradmand
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Department of Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Rezapanah
- Department of Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of Surgery, School of Medicine, Islamic Azad University, Mashhad, Iran
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, OK, USA.
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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3
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Han PL, Li XM, Jiang L, Yan WF, Guo YK, Li Y, Li K, Yang ZG. Additive Effects of Obesity on Myocardial Microcirculation and Left Ventricular Deformation in Essential Hypertension: A Contrast-Enhanced Cardiac Magnetic Resonance Imaging Study. Front Cardiovasc Med 2022; 9:831231. [PMID: 35402539 PMCID: PMC8987987 DOI: 10.3389/fcvm.2022.831231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The combination of hypertension and obesity is a major cause of cardiovascular risk, and microvascular changes and subclinical dysfunction should be considered to illustrate the underlying mechanisms and early identification, thereby developing targeted therapies. This study aims to explore the effect of obesity on myocardial microcirculation and left ventricular (LV) deformation in hypertensive patients by cardiac magnetic resonance (CMR). Methods This study comprised 101 hypertensive patients, including 54 subjects with a body mass index (BMI) of 18.5–24.9 kg/m2 and 47 subjects with a BMI ≥25 kg/m2, as well as 55 age- and sex-matched controls with a BMI of 18.5–24.9 kg/m2. Myocardial perfusion indicators [upslope, time to maximum signal intensity (TTM), maximum signal intensity (Max SI)] and LV strains [radial, circumferential, and longitudinal global peak strain (PS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR)] were measured. Results Upslope was numerically increased in obese patients but statistically decreased in non-obese patients compared with controls. Longitudinal PS deteriorated significantly and gradually from controls to non-obese and obese hypertensive patients. Longitudinal PSSR and PDSR were significantly decreased in obese hypertensive patients compared with the other two groups. BMI was associated with upslope (β = −0.136, P < 0.001), Max SI (β = −0.922, P < 0.001), longitudinal PSSR (β = 0.018, P < 0.001), and PDSR (β = −0.024, P = 0.001). Myocardial perfusion was independently associated with longitudinal PSSR (TTM: β = 0.003, P = 0.017) and longitudinal PDSR (upslope: β = 0.067, P = 0.020) in hypertension. Conclusion Obesity had adverse effects on microvascular changes and subclinical LV dysfunction in hypertension, and BMI was independently associated with both myocardial perfusion and LV deformation. Impaired myocardial perfusion was independently associated with subclinical LV dysfunction in hypertension.
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Affiliation(s)
- Pei-Lun Han
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Kang Li,
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Zhi-Gang Yang,
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Alonso Gómez AM, Sierra LT, Mora MN, Toledo E, Alonso A, Uriarte MG, Sanchez CS, Portillo MP, Rodriguez LL, Arellano EE, Schröder H, Salas-Salvadó J. Left atrial strain improves echocardiographic classification of diastolic function in patients with metabolic syndrome and overweight-obesity. Int J Cardiol 2022; 348:169-174. [PMID: 34890763 PMCID: PMC8980725 DOI: 10.1016/j.ijcard.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current recommendations for echocardiographic assessment of diastolic function (2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) in patients with metabolic syndrome and overweight/obesity result in a significant number of patients with indeterminate diastolic dysfunction (LVDD). The aim of this article is to study whether the use of the left atrial strain criterion (LALS) reduces the number of indeterminate patients. METHODS 229 patients were studied with a complete echocardiographic study that included left ventricular longitudinal strain (LVLS) analysis, LALS and a maximal ergospirometry test with assessment of oxygen uptake (VO2max). RESULTS The mean age was 65 ± 5 years, 153 (67%) males, with a mean EF of 60 ± 5%. The mean LVLS was -19.4 ± 2% and the LALS Reservoir was 23.8 ± 7%. There were 140 patients who did not meet LVDD criteria and 82 who did meet the indeterminate LVDD criterion. When the left atrial volume index (LAVI) >34 ml/m2 criterion was replaced in the 2016 ASE/EACVI algorithm by LALS Reservoir ≤20%, the number of indeterminate patients was reduced from 36% to 23% (p < 0.001) at the expense of increasing normal studies (61% and 74%). Adding the LALS Reservoir criterion ≤23% in the 82 patients of the indeterminate group resulted in two groups with a different VO2max (11.6 ± 3 and 18 ± 5 ml/kg/min, p:0.081). CONCLUSIONS This study confirms the low prevalence of diastolic dysfunction in overweight/obese patients with metabolic syndrome. Adding left atrial strain criterion to the current recommendations significantly reduces the number of indeterminate patients by reclassifying them as normal.
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Affiliation(s)
- Angel M Alonso Gómez
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Lucas Tojal Sierra
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Marta Noris Mora
- Balearic Islands Health Research Institute. Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Estefanía Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - María Garrido Uriarte
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain
| | - Carolina Sorto Sanchez
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - María P Portillo
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Nutrition and Obesity Group, Dept. Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU) and Lucio Lascaray Research Centre, Vitoria, Spain
| | - Luis López Rodriguez
- Balearic Islands Health Research Institute. Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | | | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN). Hospital del Mar. Barcelona. Spain.,Medical Research Institute (IMIM), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Jordi Salas-Salvadó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Sant Joan de Reus University Hospital, IISPV, Rovira i Virgili University, c/Sant Llorenç 21, 43201 Reus, Spain
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5
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Chen X, Ashraf S, Ashraf N, Harmancey R. UCP3 (Uncoupling Protein 3) Insufficiency Exacerbates Left Ventricular Diastolic Dysfunction During Angiotensin II-Induced Hypertension. J Am Heart Assoc 2021; 10:e022556. [PMID: 34533037 PMCID: PMC8649532 DOI: 10.1161/jaha.121.022556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Left ventricular diastolic dysfunction, an early stage in the pathogenesis of heart failure with preserved ejection fraction, is exacerbated by joint exposure to hypertension and obesity; however, the molecular mechanisms involved remain uncertain. The mitochondrial UCP3 (uncoupling protein 3) is downregulated in the heart with obesity. Here, we used a rat model of UCP3 haploinsufficiency (ucp3+/‐) to test the hypothesis that decreased UCP3 promotes left ventricular diastolic dysfunction during hypertension. Methods and Results Ucp3+/‐ rats and ucp3+/+ littermates fed a high‐salt diet (HS; 2% NaCl) and treated with angiotensin II (190 ng/kg per min for 28 days) experienced a similar rise in blood pressure (158±4 versus 155±7 mm Hg). However, UCP3 insufficiency worsened diastolic dysfunction according to echocardiographic assessment of left ventricular filling pressures (E/e’; 18.8±1.0 versus 14.9±0.6; P<0.05) and the isovolumic relaxation time (24.7±0.6 versus 21.3±0.5 ms; P<0.05), as well as invasive monitoring of the diastolic time constant (Tau; 15.5±0.8 versus 12.7±0.2 ms; P<0.05). Exercise tolerance on a treadmill also decreased for HS/angiotensin II‐treated ucp3+/‐ rats. Histological and molecular analyses further revealed that UCP3 insufficiency accelerated left ventricular concentric remodeling, detrimental interstitial matrix remodeling, and fetal gene reprogramming during hypertension. Moreover, UCP3 insufficiency increased oxidative stress and led to greater impairment of protein kinase G signaling. Conclusions Our findings identified UCP3 insufficiency as a cause for increased incidence of left ventricular diastolic dysfunction during hypertension. The results add further support to the use of antioxidants targeting mitochondrial reactive oxygen species as an adjuvant therapy for preventing heart failure with preserved ejection fraction in individuals with obesity.
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Affiliation(s)
- Xu Chen
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | - Sadia Ashraf
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
| | | | - Romain Harmancey
- Department of Physiology and Biophysics University of Mississippi Medical Center Jackson MS.,Mississippi Center for Obesity Research University of Mississippi Medical Center Jackson MS
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Baruki SB, de Lima Montebello MI, Pazzianotto-Forti EM. Physical training in outdoor fitness gym improves blood pressure, physical fitness and quality of life of hypertensive patients: randomized controlled trial. J Sports Med Phys Fitness 2021; 62:997-1005. [PMID: 33619948 DOI: 10.23736/s0022-4707.21.10942-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypertension is risk factor for cardiovascular diseases, which is the leading cause of death worldwide. In addition to drug treatment, exercise is an important non-drug resource for the control of hypertension in function by hypotension post exercise. The study evaluated the effects of two physical exercise programs in outdoor fitness gym (OFG). METHODS Twenty-nine hypertensive adults were randomized to one of two physical training group, utilizing a circuit (CTG) (n=10) or sets (STG) (n= 10), or a control group (CG) (n=9). The CTG and STG performed 16-week of physical exercise, at OFG. The CG did not participate in a physical exercise program. After 16-weeks, all participants were evaluated of anthropometric measurements, physical fitness (6-Minute Walk Test; Sit-to-Stand; Sit-and-Reach); systolic blood pressure (SBP) and diastolic blood pressure (DBP); and quality of life (Short-Form 36). RESULTS There was reduction of neck and hip circumference in CTG; body mass index and body mass in STG. Physical fitness increased in STG and CTG. The greater flexibility was observed in STG compared to CG (p=0.042) and CTG (p=0.037). SBP and DBP decreased in CTG and STG. Reduction in DBP was more effective in STG compared to CTG (p = 0.031). Quality of life improved in total score in CTG (p=0.021); and in mental control in STG, compared to CTG (p=0.036). CONCLUSIONS Both interventions improved physical fitness, blood pressure, and quality of life, suggesting that physical training in OFG can promote health in adults with hypertension.
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Affiliation(s)
- Silvia B Baruki
- Faculty of Health Sciences, Post-Graduate Program in Human Movement Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil.,Faculty of Physical Education, Federal University of Mato Grosso do Sul (UFMS), Corumbá, MS, Brazil
| | - Maria Imaculada de Lima Montebello
- Faculty of Health Sciences, Post-Graduate Program in Human Movement Sciences, Faculty of Management and Business, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Eli M Pazzianotto-Forti
- Faculty of Health Sciences, Graduate Program in Physiotherapy, Post-Graduate Program in Human Movement Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil -
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7
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Early age at menarche and metabolic cardiovascular risk factors: mediation by body composition in adulthood. Sci Rep 2021; 11:148. [PMID: 33420216 PMCID: PMC7794383 DOI: 10.1038/s41598-020-80496-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
Evidence suggests that early menarche increases cardiometabolic risk, and adiposity would be a possible mediator of this association. We assessed the association between age at menarche and metabolic cardiovascular risk factors and estimated the indirect effect of body composition in adulthood. In 1982, all hospital births in the city of Pelotas/Brazil, were identified and live births were examined and have been prospectively followed. At 30 years, information on age at menarche and metabolic cardiovascular risk factors was available for 1680 women. Mediation analysis was performed using G-computation to estimate the direct effect of age at menarche and the indirect effect of body composition. The prevalence of age at menarche < 12 years was 24.5% and was associated with higher mean diastolic blood pressure [β: 1.98; 95% CI: 0.56, 3.40], total cholesterol (β: 8.28; 95% CI: 2.67, 13.88), LDL-cholesterol (β: 6.53; 95% CI: 2.00, 11.07), triglycerides (β: 0.11; 95% CI: 0.03, 0.19). For diastolic blood pressure, total cholesterol, LDL-cholesterol, triglycerides, body composition assessed by fat mass index captured from 43.8 to 98.9% of the effect of early menarche, except to systolic blood pressure, HDL-cholesterol, C-reactive-protein. Suggesting that the effect of menarche age < 12 years on some metabolic cardiovascular risk factors is mediated partially by body composition in adulthood.
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8
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Alonso-Gómez AM, Tojal Sierra L, Fortuny Frau E, Goicolea Güemez L, Aboitiz Uribarri A, Portillo MP, Toledo E, Schröder H, Salas-Salvadó J, Arós Borau F. Diastolic dysfunction and exercise capacity in patients with metabolic syndrome and overweight/obesity. IJC HEART & VASCULATURE 2019; 22:67-72. [PMID: 30619930 PMCID: PMC6314243 DOI: 10.1016/j.ijcha.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
Background Left ventricle diastolic dysfunction (LVDD) is a common finding in high risk individuals, its presence being associated with reduced exercise capacity (EC). We assessed the prevalence of LVDD, applying the 2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI), in a population with overweight/obesity and metabolic syndrome and its association with EC. Methods and results This was a prospective, cross-sectional study of a cohort of 235 patients (mean age of 65 ± 5 years old and 33% female) without heart disease and an ejection fraction >50% who underwent a complete echocardiographic assessment and cardiopulmonary exercise testing. Individuals meeting three or more criteria of the 2016 ASE/EACVI guidelines are considered to have LVDD, while tests are considered indeterminate in those meeting only two. Overall, 178 (76%) of our patients met one echocardiographic cutoff value for LVDD, 91 (39%) met two and 7 (3%) three or more. Patients meeting three cutoffs values showed a significant reduction in maximal oxygen uptake (16 ± 3 vs. 19.6 ± 5 ml/kg/min, p < .05), unlike those with indeterminate tests. In multiple regression analysis, meeting three cutoffs was associated with number of METS (ß = −2.2, p = .018). In exploratory analysis, using two criteria based on cutoffs different from those proposed in the guidelines, we identified groups with different EC. Conclusions The application of 2016 ASE/EACVI guidelines limited the prevalence of LVDD to 3%. This group showed a clear reduction of the EC. New echocardiographic cutoff values proposed in this study allow us to establish subgroups with different levels of EC.
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Affiliation(s)
- Angel M Alonso-Gómez
- Department of Cardiology, Organización Sanitaria Integrada (OSI) ARABA, University Hospital Araba, Vitoria-Gasteiz, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Lucas Tojal Sierra
- Department of Cardiology, Organización Sanitaria Integrada (OSI) ARABA, University Hospital Araba, Vitoria-Gasteiz, Spain
| | - Elena Fortuny Frau
- Department of Cardiology, University Hospital Son Espases, Palma de Mallorca, Islas Baleares, Spain
| | - Leire Goicolea Güemez
- Department of Cardiology, Organización Sanitaria Integrada (OSI) ARABA, University Hospital Araba, Vitoria-Gasteiz, Spain
| | - Ane Aboitiz Uribarri
- Department of Cardiology, Organización Sanitaria Integrada (OSI) ARABA, University Hospital Araba, Vitoria-Gasteiz, Spain
| | - María P Portillo
- Nutrition and Obesity Group, Department of Nutrition and Food Science, Faculty of Pharmacy and Lucio Lascaray Research Institute, University of País Vasco (UPV/EHU), 01006 Vitoria, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Estefanía Toledo
- University of Navarra, Department of Preventive Medicine and Public Health, Faculty of Medicine, IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Arós Borau
- Department of Cardiology, Organización Sanitaria Integrada (OSI) ARABA, University Hospital Araba, Vitoria-Gasteiz, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,University of the Basque Country/Euskal Herriko Univertsitatea (UPV/EHU), Department of Medicine, Medical Education Unit, Teaching Unit of Medicine, Vitoria-Gasteiz, Álava, Spain
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9
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Exercise impedance cardiography reveals impaired hemodynamic responses to exercise in hypertensives with dyspnea. Hypertens Res 2018; 42:211-222. [PMID: 30504821 DOI: 10.1038/s41440-018-0145-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 12/28/2022]
Abstract
Patients with arterial hypertension (AH), especially women, often report exercise intolerance and dyspnea. However, these symptoms are not frequently reflected in standard assessments. The aim of the study was to evaluate the clinical value of impedance cardiography (ICG) in the hemodynamic assessment of patients with AH during exercise, particularly the differences between subgroups based on sex and the presence of dyspnea. Ninety-eight patients with AH (52 women; 54.5 ± 8.2 years of age) were evaluated for levels of N-terminal pro-B-type brain natriuretic peptide (NT-proBNP), exercise capacity (cardiopulmonary exercise testing (CPET) and the 6-min walk test (6MWT)), and exercise ICG. Patients with AH were stratified into the following four subgroups: males without dyspnea (MnD, n = 38); males with dyspnea (MD, n = 8); females without dyspnea (FnD, n = 27); and females with dyspnea (FD, n = 25). In comparison with the MnD subgroup, the FnD subgroup demonstrated significantly higher NT-proBNP levels; lower exercise capacity (shorter 6MWT distance, lower peak oxygen uptake (VO2), lower O2 pulse); higher peak stroke volume index (SVI); and higher SVI at the anaerobic threshold (AT). In comparison with the other subgroups, the FD subgroup walked a shorter distance during the 6MWT distance; had a steeper VE/VCO2 slope; had lower values of peak stroke volume (SV) and peak cardiac output (CO); and had a smaller change in CO from rest to peak. However, no other differences were identified (NT-proBNP, left ventricular diastolic dysfunction, or CPET parameters). Exercise impedance cardiography revealed an impaired hemodynamic response to exercise in hypertensive females with dyspnea. In patients with unexplained exercise intolerance, impedance cardiography may complement traditional exercise tests.
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Oh GC, Kang KS, Park CS, Sung HK, Ha KH, Kim HC, Park S, Ihm SH, Lee HY. Metabolic syndrome, not menopause, is a risk factor for hypertension in peri-menopausal women. Clin Hypertens 2018; 24:14. [PMID: 30349737 PMCID: PMC6191993 DOI: 10.1186/s40885-018-0099-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background It has been long debated whether menopause itself is a risk factor for hypertension in peri-menopausal women. We aimed to assess the association between menopause and hypertension, and whether metabolic syndrome (MetS) has an influence on its effect. Methods Data for 1502 women aged 42 to 53 from the Korean Genome and Epidemiology Study (KoGES) database were retrospectively analyzed. The KoGES database consists of 10,038 participants, of which 52.6% (5275) were female. Subjects were followed up for 4 years, and compared according to menopausal status. Additionally, 1216 non-hypertensive subjects were separately analyzed to assess whether a change in menopausal status was associated with development of hypertension. Results The prevalence of hypertension, diabetes, and MetS for menopausal and non-menopausal subjects at baseline was 24.4% vs. 16.7%, 5.8% vs. 2.9%, and 25.4% vs. 16.6%, respectively (p < 0.01 for all comparisons). Among non-hypertensive subjects at baseline, prevalence of hypertension at 4-year follow-up was 9.4%, 19.7%, and 13.1% for non-menopausal, those who became menopause during follow-up, and those who were menopause at baseline, respectively. Development of hypertension was positively correlated with MetS (HR 3.90, 95% CI 2.51-6.07) and increased BMI (HR 1.09, 95% CI 1.03-1.16), while association with menopause was not significant. Conclusions Menopause is closely associated with increased incidence of hypertension, but the increase may not be attributable to menopause itself but to increased prevalence of MetS.
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Affiliation(s)
- Gyu Chul Oh
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,2Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Kee Soo Kang
- 3Seoul National University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,2Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Ho Kyung Sung
- 4Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Hwa Ha
- 5Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Hyeon Chang Kim
- 6Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- 7Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Ihm
- 8Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Hae-Young Lee
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,2Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
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Beneficial Effects of Bariatric Surgery on Cardiac Structure and Function in Obesity. Obes Surg 2016; 27:620-625. [DOI: 10.1007/s11695-016-2330-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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