Effect of Obesity on Left Ventricular Longitudinal Myocardial Strain by Speckle Tracking Echocardiography in Children and Adolescents

Abstract

Background: Impaired subclinical ventricular function may contribute to the risk of cardiovascular disease in obesity. Aims: The aim of this study was to determine the influence of obesity on left ventricular (LV) longitudinal myocardial function in normotensive obese children using two-dimensional (2D) speckle tracking echocardiography (STE). Study Design: Case-control study. Methods: Sixty normotensive obese children aged 10-16 years (mean age, 13.9±2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)≥95th percentile. Regional strain/strain rate (SR) values were compared with left ventricular (LV) parameters. The correlation was studied by linear regression analysis. Results: Obese subjects exhibited a significantly higher LV end-diastolic diameter, left atrium/aortic diameter ratio, and LV mass/index when compared to controls (p<0.001). Left ventricular ejection fraction and regional systolic myocardial velocities were similar in the obese and control groups. By 2D STE, regional strain of both the septal wall (average strain: -16.0±3.9% vs-21.9±2.4%, p<0.001) and lateral wall (average strain: -15.6±2.3% vs -22.9±3.5%, p<0.001); regional SR of both the septal wall (average SRsys: -0.7±0.22 s-1 vs -1.3±0.32 s-1, p<0.001) and lateral wall (average SRsys: -0.67±0.19 s-1 vs-1.33±0.31 s-1, p<0.001); regional SRE/A of both the septal wall (average SRE/A: 1.8±0.83 vs. 2.2±0.91, p: 0.004) and lateral wall (average SRE/A: 1.4±0.43 vs. 2.4±1.21, p<0.001); and global strain (-14.6±7.34% vs -20.9±3.24%, p<0.001) were lower in the obese group compared with the controls. These strain imaging parameters appear to be related to the severity of obesity and can contribute to increased BMI. Left ventricular mass was found to be correlated with a decrease in global LV strain. Conclusion: Our study showed that childhood obesity is associated with an alteration in the longitudinal LV function. Segmental analysis of the LV can provide subtle markers for the emergence of future obesity-related cardiac disease.

Keywords

• Childhood obesity, left ventricular function, strain, two-dimensional speckle tracking echocardiography

References

1. 1. Yildirimturk O, Tayyareci Y, Aytekin S.The impact of body mass index on right ventricular systolic functions in normal and mildly obese healthy patients: a velocity vector imaging study. Echocardiography 2011;28:746-52. [CrossRef]
2. 2. Lorch SM, Sharkey A. Myocardial velocity, strain, and strain rate abnormalities in healthy obese children. J Cardiometab Syndr 2007;2:30-4. [CrossRef]
3. 3. Batalli-Këpuska A, Bajraktari G, Zejnullahu M, Azemi M, Shala M, Batalli A, et al. Abnormal systolic and diastolic myocardial function in obese asymptomatic adolescents. Int J Cardiol. 2013;14:S0167-5273. [Epub ahead of print]
4. 4. Ozturk A, Mazicioglu MM, Hatipoglu N, Budak N, Keskin G, Yazlak Z, et al. Reference body mass index curves for Turkish children 6 to 18 years of age. J Pediatr Endocrinol Metab 2008;21:827-36. [CrossRef]
5. 5. Pinnas-Hamiel O,lerner-Geva L, Copperman N, Jacobson MS. Insulin resistance and parental obesity as predictors to response to therapeutic life style change in obesechildren and adolescents 10-18 years old. J Adolesc Health 2008;43:437-43. [CrossRef]
6. 6. Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, et al. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol 2011 Mar 22;57:1368-74. [CrossRef]
7. 7. Barbosa JA, Mota CC, Simões E, Silva AC, Nunes Mdo C, Barbosa MM. Assessing pre-clinical ventricular dysfunction in obese children and adolescents: the value of speckle tracking imaging. Eur Heart J Cardiovasc Imaging 2013;14:882-9. [CrossRef]
8. 8. Koopman LP, McCrindle BW, Slorach C, Chahal N, Hui W, Sarkola T, et al. Interaction between myocardial and vascular changes in obese children: a pilot study. J Am Soc Echocardiogr 2012;25:401-10. [CrossRef]

9. 9. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240-3. [CrossRef]
10. 10. Movahed MR, Saito Y. Obesity is associated with left atrial enlargement, E/A reversal and left ventricular hypertrophy. Exp Clin Cardiol 2008;13:89-91.
11. 11. Di Salvo G, Pacileo G, Del Giudice EM, Natale F, Limongelli G, Verrengia M, et al. Abnormal myocardial deformation properties in obese, non-hypertensive children: an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study. Eur Heart J 2006;27:2689-95. [CrossRef]
12. 12. Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001;321:225- 36. [CrossRef]
13. 13. Barbosa MM, Beleigoli AM, de Fatima Diniz M, Freire CV, Ribeiro AL, Nunes MC.Strain imaging in morbid obesity: insights into subclinical ventricular dysfunction. Clin Cardiol 2011;34:288-93. [CrossRef]
14. 14. Bussadori C, Moreo A, Di Donato M, De Chiara B, Negura D, Dall’Aglio E, et al. A new 2D-based method for myocardial velocity strain and strain rate quantification in a normal adult and paediatric population: assessment of reference values. Cardiovasc Ultrasound 2009;13:7-8.
15. 15. Dogan V, Öcal B, Orun UA, Ozgur S, Yılmaz O, Keskin M, et al. Strain and strain rate echocardiography findings in children with symptomatic congenital aortic stenosis. Pediatr Cardiol 2013; 34:1152-8. [CrossRef]
16. 16. Lorch SM, Ludomirsky A, Singh GK. Maturational and growthrelated changes in left ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population. J Am Soc Echocardiogr 2008;21:1207-15. [CrossRef]
17. 17. Wong CY, O’Moore-Sullivan T, Leano R, Hukins C, Jenkins C, Marwick TH. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol 2006;47:611-6. [CrossRef]
18. 18. Wong CY, O’Moore-Sullivan T, Leano R, Byrne N, Beller E, Marwick TH. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 2004;110:3081-7. [CrossRef]
19. 19. Wong CY, O’Moore-Sullivan T, Fang ZY, Haluska B, Leano R, Marwick TH. Myocardial and vascular dysfunction and exercise capacity in the metabolic syndrome. Am J Cardiol 2005;96:1686-91. [CrossRef]
20. 20. Gong HP, Tan HW, Fang NN, Song T, Li SH, Zhong M, et al. Impaired left ventricular systolic and diastolic function in patients with metabolic syndrome as assessed by strain and strain rate imaging. Diabetes Res Clin Pract 2009;83:300-7. [CrossRef]