Abnormal myocardial deformation properties in obese, non-hypertensive children:: an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study
Abnormal myocardial deformation properties in obese, non-hypertensive children:: an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study
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DOI：
10.1093/eurheartj/ehl163
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发表时间：
2006-11-01
影响因子：
39.3
通讯作者：
Calabro, Raffaele
中科院分区：
文献类型：
--
作者：
Di Salvo, Giovanni;Pacileo, Giuseppe;Calabro, Raffaele
目标发达国家儿童肥胖症的患病率正在增加。肥胖与心功能异常的关系仍有争议。报告的变化可能反映了导致心室功能障碍的合并症的作用。肥胖儿童，没有动脉高血压，可能是一个独特的临床机会，以评估肥胖的影响，本身，对心肌功能，排除可能的合并症的影响。我们试图定义肥胖对心血管系统的临床前影响，超重的健康儿童没有其他临床上可感知的心脏病原因，使用更敏感的超声衍生的应变和应变率（SR）imaging.Methods and results我们研究了300名受试者分为两组：（i）肥胖儿童（O组：n=150;年龄，12 +/- 3岁）;（ii）年龄、性别和青春期阶段相当的健康瘦型儿童（参考：n=150;平均年龄，12 +/- 3岁）。两组间收缩压（SBP）和舒张压（DBP）以及24 h SBP和24 h DBP相当。与参考组（31 +/- 14 gm（2.7））相比，O组（46 +/- 12 g/m（2.7））的左心室（LV）质量/高度（2.7）增加（P < 0.0001）。两组的标准超声心动图整体收缩功能指数相似。与对照组（0.45 +/- 0.07 mm）相比，肥胖儿童（0.46 +/- 0.09 mm）的颈总动脉内膜-中层厚度无显著差异（P=0.4）。肥胖儿童左、右心室局部纵向收缩期峰值心肌变形特性（SR=-1.4 +/-0.7 s（-1））均低于对照组（SR=-2.2 +/-0.5）（P < 0.0001）。在多变量分析中，平均收缩期峰值SR与稳态模型评估的胰岛素抵抗（P < 0.01;系数，0.02; SE，0.011）和血清胰岛素浓度（P < 0.01;系数，0.05; SE，0.023）显著相关。平均左室收缩期峰值应变与体重指数显著相关（P=0.0001;系数，0.06; SE，0.016），左心室质量/H-2.7（P=0.006，相关系数0.016;结论我们的研究表明，在没有高血压的情况下，与已经在儿童期涉及右心室和左心室的收缩期心肌变形特性的显著降低相关。肥胖不仅是日后心血管疾病的危险因素，而且与心肌纵向变形特性的同时和显著损害有关。
Aims The prevalence of obesity is increasing among children in the developed world. The association of obesity and abnormal cardiac function is still debated. The reported changes may reflect the role of comorbidities that contribute to ventricular dysfunction. Obese children, without arterial hypertension, may be a unique clinical opportunity to evaluate the effect of obesity, per se, on myocardial function, excluding the influence of possible comorbidities. We sought to define the preclinical effects of obesity on the cardiovascular system, of healthy children with excess weight who have no other clinically appreciable cause of heart disease, using the more sensitive ultrasonic-derived strain and strain rate (SR) imaging.Methods and results We studied 300 subjects divided into two groups: (i) obese children (Group O: n=150; age, 12 +/- 3 years); (ii) healthy lean children comparable for age, sex, and pubertal stage (Referents: n=150; mean age, 12 +/- 3 years). Systolic (SBP) and diastolic blood pressure (DBP), as well as 24 h-SBP and 24 h-DBP were comparable between groups. Left ventricular (LV) mass/height(2.7) was increased (P < 0.0001) in Group O (46 +/- 12 g/m(2.7)) when compared with Referents (31 +/- 14 gm(2.7)). Standard echocardiographic indices of global systolic function were similar in the two groups. Intima-media thickness measured at the common carotid artery was not significantly different (P=0.4) in obese children (0.46 +/- 0.09 mm) when compared with Referents (0.45 +/- 0.07 mm). Obese children showed regional longitudinal peak systolic myocardial deformation properties (SR=-1.4 +/- 0.7 s(-1)) lower (P < 0.0001) than those of Referents (SR=-2.2 +/- 0.5) in both left and right ventricle. In multivariable analysis, average peak systolic SR was significantly correlated with homeostasis model assessment of insulin resistance (P < 0.01; coefficient, 0.02; SE, 0.011), and insulin serum concentration (P < 0.01; coefficient, 0.05; SE, 0.023). Average LV peak systolic strain was significantly correlated with body mass index (P=0.0001; coefficient, 0.06; SE, 0.016), LVM/H-2.7 (P=0.006; coefficient, 0.016; SE, 0.018).Conclusions Our study demonstrated that obesity, in absence of hypertension, is associated with significant reduction in systolic myocardial deformation properties already in childhood involving both right and left ventricle. Obesity not only is a risk factor for later cardiovascular disease, but also is associated with contemporaneous and significant impairment of longitudinal myocardial deformation properties.