Gender-specific differences in left ventricular remodelling in obesity: insights from cardiovascular magnetic resonance imaging
Gender-specific differences in left ventricular remodelling in obesity: insights from cardiovascular magnetic resonance imaging
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DOI：
10.1093/eurheartj/ehs341
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发表时间：
2013-01-01
影响因子：
39.3
通讯作者：
Neubauer, Stefan
中科院分区：
文献类型：
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作者：
Rider, Oliver J.;Lewandowski, Adam;Neubauer, Stefan
由于肥胖相关的心血管死亡率，尽管与正常体重相比有所升高，但在每个体重指数（BMI）水平上，女性的心血管死亡率均低于男性，因此我们旨在研究肥胖患者左心室（LV）肥大的性别特异性差异，这些差异本身已被证明具有不同的预后价值。（女性，n 399）无可识别的心血管危险因素（BMI 15.759.2 kg/m2），进行心血管磁共振（1.5 T），以确定LV质量、舒张末期容积（EDV，mL）和LV质量/容积比（LVM/VR）。在两种性别中，BMI与LV质量之间存在强正相关性（男性r 0.44，女性r 0.57，均P 0.001），男性显示出更大的LV肥大反应（男性2.3 g/BMI点增加，女性1.6 g/BMI点增加，P 0.001）。两种性别均存在向心性肥大，线性回归分析显示，LVM/VR与BMI呈正相关（男性r 0.45，女性r 0.29，均P 0.001）。然而，男性的向心性肥大程度更大（BMI每增加1分，男性0.13 vs女性0.06 LVM/VR增加，P 0.001）。另一方面，女性显示出更大的LV腔扩张反应（女性1.1 vs.男性0.3 mL/BMI点增加，P 0.001）。事实上，与女性相比，BMI和LV-EDV呈正相关（r 0.38，P 0.001），男性BMI与EDV无关（r 0.03，P 0.62）。在缺乏传统心血管危险因素的情况下，肥胖男性主要表现为向心性肥大，而肥胖女性同时表现为离心性和向心性肥大。由于向心性肥大与心血管死亡率的相关性比离心性肥大更强，我们的观察结果可能解释了肥胖相关死亡率的性别差异。
As obesity-related cardiovascular mortality, although elevated when compared with normal weight, is lower in females than in males at every body mass index (BMI) level, we aimed to investigate gender-specific differences in left ventricular (LV) hypertrophy in obesity, which themselves have been shown to have varying prognostic value.In total, 741 subjects (female, n 399) without identifiable cardiovascular risk factors (BMI 15.759.2 kg/m(2)) underwent cardiovascular magnetic resonance (1.5 T) to determine LV mass, end-diastolic volume (EDV, mL), and LV mass/volume ratio (LVM/VR). Across both sexes, there was a strong positive correlation between BMI and LV mass (male r 0.44,female r 0.57, both P 0.001), with males showing a greater LV hypertrophic response (male 2.3 vs. female 1.6 g per BMI point increase, P 0.001). Concentric hypertrophy was present in both sexes and LVM/VR positively correlated to BMI (male r 0.45, female r 0.29, both P 0.001) on linear regression analysis. However, the degree of concentric hypertrophy was greater in males (male 0.13 vs. female 0.06 LVM/VR increase per BMI point increase, P 0.001). On the other hand, females showed a greater LV cavity dilatory response (female 1.1 vs. male 0.3 mL per BMI point increase, P 0.001). Indeed, in contrast to females, where BMI and LV-EDV were positively correlated (r 0.38, P 0.001), BMI did not correlate with EDV in men (r 0.03, P 0.62).In the absence of traditional cardiovascular risk factors, obese men show predominantly concentric hypertrophy, whereas obese women exhibit both eccentric and concentric hypertrophy. As concentric hypertrophy is more strongly related to cardiovascular mortality than eccentric hypertrophy, our observations may explain the observed gender difference in obesity-related mortality.