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The relevance of left ventricular functions to clinical and metabolic characteristics of prepubertal children with obesity. Cardiol Young 2022; 32:1246-1253. [PMID: 34585656 DOI: 10.1017/s1047951121003991] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Paediatric obesity is a worldwide health burden, with growing evidence linking obesity to myocardial function impairments. The study aims to evaluate left ventricular functions among prepubertal obese children to obesity-related clinical and metabolic parameters. METHODS Between June 2019 and March 2020, 40 prepubertal children with obesity were recruited and compared to 40 healthy controls. Patients were assessed for body mass index z scores, waist circumference, body adiposity by bioimpedance analysis, and obesity-related laboratory tests, for example, serum chemerin. Left ventricular functions were assessed using variable echocardiographic modalities, such as M-mode, tissue Doppler, and two-dimensional speckle tracking. RESULTS Mean patients' age was 9.25 ± 1.05 years. Left ventricular mass index, E/E', and myocardial performance index were significantly increased in obese children than controls. Although M-mode-derived ejection fraction was comparable in both groups, two-dimensional speckle tracking-derived ejection fraction, global longitudinal strain, and global circumferential strain were significantly lower in cases than controls. Left ventricular mass index displayed a positive correlation with body mass index z score (p = 0.003), fat mass index (p = 0.037), and trunk fat mass (p = 0.021). Global longitudinal strain was negatively correlated with body mass index z score (p = 0.015) and fat mass index (p = 0.016). Serum chemerin was positively correlated with myocardial performance index (p = 0.01). CONCLUSION Alterations of left ventricular myocardial functions in prepubertal obese children could be detected using different echocardiographic modalities. Chemerin, body mass index z score, fat mass index, and trunk fat mass were correlated with subclinical left ventricular myocardial dysfunction parameters before puberty. Our results reinforce early and strict management of childhood obesity upon detection of changes in anthropometric and body adiposity indices.
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Price JJ, Urbina EM, Carlin K, Becker R, Daniels SR, Falkner BE, Ferguson M, Hanevold C, Hooper SR, Ingelfinger JR, Lande MB, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels J, Flynn JT. Cardiovascular Risk Factors and Target Organ Damage in Adolescents: The SHIP AHOY Study. Pediatrics 2022; 149:186966. [PMID: 35502610 PMCID: PMC9648121 DOI: 10.1542/peds.2021-054201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Development of cardiovascular disease in adults has been directly linked to an adverse metabolic phenotype. While there is evidence that development of these risk factors in childhood persists into adulthood and the development of cardiovascular disease, less is known about whether these risk factors are associated with target organ damage during adolescence. METHODS We collected data from 379 adolescents (mean age 15.5, 60% male) with blood pressure between the 75th and 95th percentile to determine if there is a metabolic phenotype that predicts cardiovascular changes (left ventricular mass, systolic and diastolic function, pulse wave velocity, and renal function). We determined the number of risk factors for cardiovascular disease (hypertension, dyslipidemia, obesity, and insulin resistance) present in each participant. Generalized linear models were constructed to determine if the number of cardiovascular risk factors (CVRFs) were associated with measures of target organ damage. RESULTS The number of CVRFs present were associated with statistically significant differences in increased left ventricular mass index, increased pulse wave velocity, decreased peak longitudinal strain, urine albumin to creatine ratio and echocardiographic parameters of diastolic dysfunction. Generalized linear models showed that dyslipidemia and insulin resistance were independently associated with markers of diastolic dysfunction (P ≤ .05) while increased blood pressure was associated with all makers of target organ damage (P ≤ .03). CONCLUSIONS These data suggest the of the number of CVRFs present is independently associated with early changes in markers of target organ damage during adolescence.
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Affiliation(s)
| | | | | | | | | | - Bonita E Falkner
- Departments of Pediatrics and Medicine, Thomas Jefferson
University, Philadelphia, Pennsylvania
| | | | | | - Stephen R Hooper
- School of Medicine, University of North Carolina, Chapel
Hill, North Carolina
| | | | - Marc B. Lande
- Department of Pediatrics, University of Rochester Medical
Center, Rochester, New York
| | | | - Kevin Meyers
- Childrens Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Bernard Rosner
- Department of MedicineHarvard University, Boston,
Massachusetts
| | - Joshua Samuels
- University of Texas Health Sciences Center, Houston,
Texas
| | - Joseph T. Flynn
- Seattle Children’s Hospital, Seattle,
Washington,Address correspondence to Joseph T. Flynn, MD, 4800 Sandpoint Way
NE Seattle, WA 98105. E-mail:
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Anthropometric and Biochemical Markers as Possible Indicators of Left Ventricular Abnormal Geometric Pattern and Function Impairment in Obese Normotensive Children. Diagnostics (Basel) 2020; 10:diagnostics10070468. [PMID: 32664439 PMCID: PMC7400506 DOI: 10.3390/diagnostics10070468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023] Open
Abstract
Εmerging data indicate that various effects of obesity on the cardiovascular system can be evident during childhood. The aim of this study was to detect early changes in left ventricular structure and function in obese normotensive children and explore possible associations of these changes with anthropometric and biochemical parameters. Normotensive 8–11-year-old obese and normal weight children were included in the study. They all underwent anthropometric measurements, laboratory tests, and echocardiography study by conventional and tissue Doppler to assess geometric pattern and function of left ventricle. Statistically significant differences in most anthropometric and metabolic parameters were noticed between groups. Obese children showed higher left ventricular mass index (LVMI) (40.05 ± 9.44 vs. 28.31 ± 6.22), lower E/A ratio (1.76 ± 0.33 vs. 2.08 ± 0.56), and higher E/e’ (6.04 ± 1.13 vs. 5.43 ± 0.96) compared to lean peers. Waist-to-height ratio and hs-CRP correlated significantly with E/A in the obese group. Left ventricular hypertrophy was present in 47.2% of obese children and eccentric was the prominent type. Waist-to-height ratio and serum cortisol levels in plasma increased the odds of having any type of abnormal ventricular geometric pattern. Echocardiographic evaluation of left ventricle and diastolic function could be considered for obese normotensive children based on waist-to-height ratio, hs-CRP, and serum cortisol.
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Hemati M, Gholoobi A, Eshraghi A, Sadeghi Allah Abadi J, Ghaderi F. The Relationship between Left Ventricular Function Indices in Tissue Doppler Imaging and Exaggerated Blood Pressure Response During the Exercise Stress Test. Galen Med J 2020; 9:e1323. [PMID: 34466545 PMCID: PMC8343616 DOI: 10.31661/gmj.v0i0.1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/09/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022] Open
Abstract
Background: Studies have indicated that exaggerated hypertension during activity and stress can be a good predictor of the incidence of hypertension. This study tries to evaluate left ventricular (LV) function by tissue Doppler to assess early changes in ventricular compliance before the onset of Hypertension (HTN) in patients with exaggerated blood pressure response during the exercise test. Materials and Methods: In this case-control study, 40 patients without a history of hypertension with systolic blood pressure less than 140/90 which referred for exercise test, were included. The exercise test was performed for all patients. Patients who had exaggerated blood pressure during the stress test were considered as cases and the controls with normal blood pressure responses. Then standard echocardiography and Tissue Doppler imaging performed and indices of LV systolic and diastolic were recorded. Results: The LV mass in cases and controls were 174.9±50.78 and 152.9±33.59, respectively (P=0.114), and LV mass index in cases and controls were 127.4±13.5 and 79.8±15.75, respectively (P=0.023). Moreover, the LV Myocardial Performance Index were 0.68±0.11 and 0.48±0.06 in cases and controls, respectively (P<0.001). The heart rate, E/A, EE, E Velocity and S velocity were measuremented. Except E/A (P=0.009), there was no significant difference between the other variables measured between the cases and controls (P>0.05). Conclusion: The results of this study showed that using 2D conventional echocardiography as a noninvasive method if performed in prestigious centers can evaluate systolic and diastolic function Tissue Doppler parameters very well in the early stages of heart disease caused by HTN.
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Affiliation(s)
- Milad Hemati
- Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arash Gholoobi
- Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Eshraghi
- Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Fereshteh Ghaderi
- Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Correspondence to: Fereshteh Ghaderi, Assistant Professor of Cardiology, Fellowship of Echocardiography, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Telephone Number: +985131802052 Email Address:
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Imerbtham T, Thitiwuthikiat P, Jongjitwimol J, Nuamchit T, Yingchoncharoen T, Siriwittayawan D. Leptin Levels are Associated with Subclinical Cardiac Dysfunction in Obese Adolescents. Diabetes Metab Syndr Obes 2020; 13:925-933. [PMID: 32273744 PMCID: PMC7108875 DOI: 10.2147/dmso.s245048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/11/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The purposes of this study were to use speckle tracking echocardiography to confirm the influence of obesity on cardiac functions and to assess their relationships with leptin and uric acid levels in obese adolescents. METHODS Eighty-one participants aged 16-19 years were recruited and classified as either non-obese (n = 30) or obese (n = 51). Global longitudinal strain (GLS), leptin and uric acid levels for each group were assessed and compared. The data from obese participants were then compared based on their leptin levels and analyzed for correlation using regression analysis. RESULTS The obese group had significantly lower absolute GLS compared to the non-obese group (19.10 ± 0.30 versus 21.10 ± 0.30%, p < 0.001). In obese group, subclinical cardiac dysfunction was worse in the hyperleptinemic group than that of the normoleptinemic group (p = 0.03). Multivariate regression analysis showed that leptin and triglyceride levels were negatively associated with absolute GLS. Leptin could predict the absolute GLS with β = -0.35 (p = 0.02). CONCLUSION Subclinical left ventricular systolic dysfunction was found in obese adolescents, while GLS was worse in the hyperleptinemic subjects. Leptin, but not uric acid, levels were associated with a worsening of GLS.
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Affiliation(s)
- Thamonwan Imerbtham
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyanuch Thitiwuthikiat
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Jirapas Jongjitwimol
- Department of Medical Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Teonchit Nuamchit
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | | | - Duangduan Siriwittayawan
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
- Correspondence: Duangduan Siriwittayawan Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok65000, ThailandTel +66 55 966 417Fax +66 55 966 234 Email
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Yıldırım Ö, Demircan T, Tüfekçi Ö, Kızılca Ö, Kuyum P, Kır M, Abacı A, Ünal N, Arslan N, Böber E, Yılmaz Ş, Ören H. Anemia and Its Effect on Cardiovascular Findings in Obese Adolescents. Turk J Haematol 2018; 35:192-196. [PMID: 29666035 PMCID: PMC6110443 DOI: 10.4274/tjh.2018.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 12/01/2022] Open
Abstract
Objective We assessed the effect of anemia on cardiovascular findings in obese adolescents. Materials and Methods We studied 29 anemic and 33 nonanemic obese adolescents, and 33 nonobese healthy adolescents. These three groups were investigated for clinical and laboratory features of anemia and obesity. Echocardiography was used to examine cardiac functions. Results The anemia was mild (mean hemoglobin: 11.67±0.79g/dL), ferritin level was significantly low, and C-reactive protein and fibrinogen levels were significantly high in anemic obese patients. Increased cardiac pulse and echocardiographic findings, which may be indicative of early left ventricular diastolic dysfunction, were present in these patients. Conclusion Anemia may develop due to iron deficiency and chronic inflammation in obese adolescents. Even mild anemia may cause increased heart rate and affect left ventricular diastolic functions. Diet programs for obese children should be carefully planned to avoid iron deficiency anemia, which may worsen the cardiac events in long-term follow-up.
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Affiliation(s)
- Öner Yıldırım
- Dokuz Eylül University Faculty of Medicine, Department of Pediatrics, İzmir, Turkey
| | - Tülay Demircan
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Cardiology, İzmir, Turkey
| | - Özlem Tüfekçi
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Özgür Kızılca
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Cardiology, İzmir, Turkey
| | - Pınar Kuyum
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Gastroenterology and Metabolism, İzmir, Turkey
| | - Mustafa Kır
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Cardiology, İzmir, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Nurettin Ünal
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Cardiology, İzmir, Turkey
| | - Nur Arslan
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Gastroenterology and Metabolism, İzmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Şebnem Yılmaz
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Hale Ören
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
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