Research Article
BibTex RIS Cite

COVID-19 ile Hastaneye Yatırılmayan Hastalarda Yüksek Vücut Kitle İndeksi ve Diyastolik Disfonksiyon İlişkisi: Bir COVID-19 Sonrası Ekokardiyografi Çalışması

Year 2022, Volume: 19 Issue: 1, 83 - 90, 28.04.2022
https://doi.org/10.35440/hutfd.988301

Abstract

Amaç: Çalışmalar, metabolik olarak sağlıklı bireylerde vücut kitle indeksi (VKİ) ile diyastolik fonksiyon arasında bir ilişki olduğunu bildirmektedir. Metabolik olarak sağlıklı olup hastaneye yatırılmadan COVID-19'dan iyileşen ve sonrasında efor dispnesi gelişenlerin VKİ ile diyastolik disfonksiyon (DD) arasındaki ilişki henüz yeterince araştırılmamıştır. Bu çalışmada, ejeksiyon fraksiyonu korunmuş komplike olmayan bir grupta VKİ ile diyastolik fonksiyon arasındaki ilişkiyi karakterize etmeyi amaçladık.
Materyal ve Metod: Çalışmaya 50 (17 erkek ve 33 kadın) hasta (HG) ve 50 (20 erkek ve 30 kadın) sağlıklı kontrol deneği (KG) dahil edildi. Tüm hastalara transtorasik ekokardiyogram uygulandı.
Bulgular: Gruplar arasında yaş (p=0,101), cinsiyet (p=0,534) ve VKİ (p=0,070) açısından anlamlı fark yoktu. HG'de C-reaktif protein (CRP) (p=0,005) ve D-dimer (p=0,009) anlamlı olarak daha yüksekti. Grade 1 DD, HG'de anlamlı olarak daha yüksekti (p<0,001). HG'de yaşın etkisi kontrol edildiğinde, VKİ ile E/A oranı arasında anlamlı negatif korelasyon bulunurken (r=-0,452; p=0,001) KG'de bu anlamlılık tespit edilmedi (r=0,122; p=0,404). DD'nin saptanması için VKİ’nin ROC eğrisi altındaki alan 0,806 idi (p<0.001;% 95 CI (0.716-0.896)). VKİ için optimal kesme puanı 28,91’di ve DD tanısı için duyarlılığı ve özgüllüğü sırasıyla %39,3 ve %93,1’di. İkili lojistik regresyon analizine göre, VKİ'nin DD tanısına ilişkin duyarlılığı %50,0 ve özgüllüğü %88,9’di.
Sonuç: Kardiyak fonksiyondaki bu erken anormallikler, daha yüksek VKİ'nin neden olduğu artmış kardiyopulmoner morbidite ile ilişkili DD'yi açıklamak için önemli sonuçlara sahip olabilir.

References

  • Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, et al. Obesity a risk factor for increased COVID 19 prevalence, severity and lethality (Review). Mol Med Rep. 2020; 22(1):9-19.
  • Finer N, Garnett SP, Bruun JM. COVID-19 and obesity. Clin Obes. 2020; 10(3):e12365.
  • Malik VS, Ravindra K, Attri SV, Bhadada SK, Singh M. Higher body mass index is an important risk factor in COVID-19 patients: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2020; 27(33):42115-23.
  • Peres KC, Riera R, Martimbianco ALC, Ward LS, Cunha LL. Body mass index and prognosis of COVID-19 infection. A systematic review. Front Endocrinol (Lausanne). 2020; 11:562.
  • Ni YN, Luo J, Yu H, Wang YW, Hu YH, Liu D, et al. Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis. Crit Care. 2017; 21(1):36.
  • Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. Obesity (Silver Spring). 2020; 28(6):1005.
  • Pranata R, Lim MA, Yonas E, Vania R, Lukito AA, Siswanto BB, et al. Body mass index and outcome in patients with COVID-19: A dose-response meta-analysis. Diabetes Metab. 2020: 101178.
  • Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020; 28(7):1195-9.
  • Chadha DS, Gupta N, Goel K, Pandey RM, Kondal D, Ganjoo RK, et al. Impact of obesity on the left ventricular functions and morphology of healthy Asian Indians. Metab Syndr Relat Disord. 2009; 7(2):151-8.
  • Yang J, Hu J, Zhu C. Obesity aggravates COVID-19: A systematic review and meta-analysis. J Med Virol. 2020 Jun 30:10.1002/jmv.26237.
  • Kronbichler A, Kresse D, Yoon S, Lee KH, Effenberger M, Shin JI. Asymptomatic patients as a source of COVID-19 infections: A systematic review and meta-analysis. Int J Infect Dis. 2020; 98:180-6.
  • Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81(6):e4-e6.
  • Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020; 324(6):603-5.
  • Davido B, Seang S, Tubiana R, de Truchis P. Post-COVID-19 chronic symptoms: a postinfectious entity? Clin Microbiol Infect. 2020; 26(11):1448-9.
  • Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7):581-6.
  • Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. Left atrial volume as an index of left atrial size: A population-based study. J Am Coll Cardiol. 2003; 41:1036-43.
  • Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: A consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the heart failure and echocardiography associations of the European society of cardiology. Eur Heart J. 2007; 28:2539-50.
  • Oh JK, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik AJ, et al. The noninvasive assessment of left ventricular diastolic function with two dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 1997; 10:246-70.
  • Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314.
  • Campbell ML. Dyspnea. Crit Care Nurs Clin North Am. 2017; 29(4):461-70.
  • Rozenbaum Z, Topilsky Y, Khoury S, Pereg D, Laufer-Perl M. Association of body mass index and diastolic function in metabolically healthy obese with preserved ejection fraction. Int J Cardiol. 2019; 277:147-52.
  • Peterson LR, Waggoner AD, Schechtman KB, Meyer T, Gropler RJ, Barzilai B, et al. Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol. 2004; 43(8):1399-404.
  • Iacobellis G, Ribaudo MC, Leto G, Zappaterreno A, Vecci E, Di Mario U, et al. Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes Res. 2002; 10(8):767-73.
  • Pascual M, Pascual DA, Soria F, Vicente T, Hernández AM, Tébar FJ, et al. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart. 2003; 89(10):1152-6.
  • De Lorenzo A, Soldati L, Sarlo F, Calvani M, Di Lorenzo N, Di Renzo L. New obesity classification criteria as a tool for bariatric surgery indication. World J Gastroenterol. 2016; 22(2):681-703.
  • Magoon R. Left-ventricular diastolic dysfunction in COVID-19: Opening the Pandora's Box! Korean J Anesthesiol. 2021. doi: 10.4097/kja.21010.
  • Chin JH, Lee EH, Kim WJ, Choi DK, Hahm KD, Sim JY, et al. Positive end-expiratory pressure aggravates left ventricular diastolic relaxation further in patients with pre-existing relaxation abnormality. Br J Anaesth. 2013; 111(3):368-73.
  • Li Y, Zhao K, Wei H, Chen W, Wang W, Jia L, et al. Dynamic relationship between D-dimer and COVID-19 severity. Br J Haematol. 2020; 190(1):e24-e27.
  • Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020; 13(11):1265-75.
  • Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020; 368:m1091.

Association of Higher Body Mass Index and Diastolic Dysfunction in Patients Non-Hospitalized with COVID-19: A Post-COVID-19 Echocardiography Study

Year 2022, Volume: 19 Issue: 1, 83 - 90, 28.04.2022
https://doi.org/10.35440/hutfd.988301

Abstract

Background: The studies reported an association between body mass index (BMI) and diastolic function in metabolically healthy individuals. The relationship between the BMI and diastolic dysfunction (DD) of those who are metabolically healthy who recovered from COVID-19 without hospitalization and who have effort dyspnea has not been adequately studied yet. In this study, we aimed to characterize the association between BMI and diastolic function in an uncomplicated group with preserved ejection fraction.
Materials and Methods: The study included 50 (17 males and 33 females) patients (PG) and 50 (20 males and 30 females) healthy control subjects (CG). Transthoracic echocardiogram was performed in all patients.
Results: There was no significant difference between the groups in terms of age (p=0.101), gender (p=0.534), and BMI (p=0.070). C-reactive protein (CRP) (p=0.005) and D-dimer (p=0.009) were significantly higher in the PG. Grade 1 DD was significantly higher in PG (p<0.001). When controlling for the effect of age in the PG, a significant negative correlation was found between BMI and E/A ratio (r=-0.452; p=0.001), while this significance was not detected in the CG (r=0.122; p=0.404). The area under the ROC curve of BMI for the detection of DD was 0.806 (p<0.001; 95% CI (0.716-0.896)). The optimal cut-off score for BMI was 28.91, and its sensitivity and specificity for the diagnosis of DD were 39.3% and 93.1%, respectively. According to the binary logistic regression analysis, the sensitivity of BMI related to the diagnosis of DD was 50.0% and the specificity was 88.9%.
Conclusions: These early abnormalities in cardiac function may have important implications for explaining the DD that is associated with increased cardiopulmonary morbidity caused by higher BMI.

References

  • Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, et al. Obesity a risk factor for increased COVID 19 prevalence, severity and lethality (Review). Mol Med Rep. 2020; 22(1):9-19.
  • Finer N, Garnett SP, Bruun JM. COVID-19 and obesity. Clin Obes. 2020; 10(3):e12365.
  • Malik VS, Ravindra K, Attri SV, Bhadada SK, Singh M. Higher body mass index is an important risk factor in COVID-19 patients: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2020; 27(33):42115-23.
  • Peres KC, Riera R, Martimbianco ALC, Ward LS, Cunha LL. Body mass index and prognosis of COVID-19 infection. A systematic review. Front Endocrinol (Lausanne). 2020; 11:562.
  • Ni YN, Luo J, Yu H, Wang YW, Hu YH, Liu D, et al. Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis. Crit Care. 2017; 21(1):36.
  • Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. Obesity (Silver Spring). 2020; 28(6):1005.
  • Pranata R, Lim MA, Yonas E, Vania R, Lukito AA, Siswanto BB, et al. Body mass index and outcome in patients with COVID-19: A dose-response meta-analysis. Diabetes Metab. 2020: 101178.
  • Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020; 28(7):1195-9.
  • Chadha DS, Gupta N, Goel K, Pandey RM, Kondal D, Ganjoo RK, et al. Impact of obesity on the left ventricular functions and morphology of healthy Asian Indians. Metab Syndr Relat Disord. 2009; 7(2):151-8.
  • Yang J, Hu J, Zhu C. Obesity aggravates COVID-19: A systematic review and meta-analysis. J Med Virol. 2020 Jun 30:10.1002/jmv.26237.
  • Kronbichler A, Kresse D, Yoon S, Lee KH, Effenberger M, Shin JI. Asymptomatic patients as a source of COVID-19 infections: A systematic review and meta-analysis. Int J Infect Dis. 2020; 98:180-6.
  • Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81(6):e4-e6.
  • Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020; 324(6):603-5.
  • Davido B, Seang S, Tubiana R, de Truchis P. Post-COVID-19 chronic symptoms: a postinfectious entity? Clin Microbiol Infect. 2020; 26(11):1448-9.
  • Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7):581-6.
  • Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. Left atrial volume as an index of left atrial size: A population-based study. J Am Coll Cardiol. 2003; 41:1036-43.
  • Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: A consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the heart failure and echocardiography associations of the European society of cardiology. Eur Heart J. 2007; 28:2539-50.
  • Oh JK, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik AJ, et al. The noninvasive assessment of left ventricular diastolic function with two dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 1997; 10:246-70.
  • Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314.
  • Campbell ML. Dyspnea. Crit Care Nurs Clin North Am. 2017; 29(4):461-70.
  • Rozenbaum Z, Topilsky Y, Khoury S, Pereg D, Laufer-Perl M. Association of body mass index and diastolic function in metabolically healthy obese with preserved ejection fraction. Int J Cardiol. 2019; 277:147-52.
  • Peterson LR, Waggoner AD, Schechtman KB, Meyer T, Gropler RJ, Barzilai B, et al. Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol. 2004; 43(8):1399-404.
  • Iacobellis G, Ribaudo MC, Leto G, Zappaterreno A, Vecci E, Di Mario U, et al. Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes Res. 2002; 10(8):767-73.
  • Pascual M, Pascual DA, Soria F, Vicente T, Hernández AM, Tébar FJ, et al. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart. 2003; 89(10):1152-6.
  • De Lorenzo A, Soldati L, Sarlo F, Calvani M, Di Lorenzo N, Di Renzo L. New obesity classification criteria as a tool for bariatric surgery indication. World J Gastroenterol. 2016; 22(2):681-703.
  • Magoon R. Left-ventricular diastolic dysfunction in COVID-19: Opening the Pandora's Box! Korean J Anesthesiol. 2021. doi: 10.4097/kja.21010.
  • Chin JH, Lee EH, Kim WJ, Choi DK, Hahm KD, Sim JY, et al. Positive end-expiratory pressure aggravates left ventricular diastolic relaxation further in patients with pre-existing relaxation abnormality. Br J Anaesth. 2013; 111(3):368-73.
  • Li Y, Zhao K, Wei H, Chen W, Wang W, Jia L, et al. Dynamic relationship between D-dimer and COVID-19 severity. Br J Haematol. 2020; 190(1):e24-e27.
  • Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020; 13(11):1265-75.
  • Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020; 368:m1091.
There are 30 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Sabri Abuş 0000-0003-2464-4970

Publication Date April 28, 2022
Submission Date August 29, 2021
Acceptance Date April 4, 2022
Published in Issue Year 2022 Volume: 19 Issue: 1

Cite

Vancouver Abuş S. Association of Higher Body Mass Index and Diastolic Dysfunction in Patients Non-Hospitalized with COVID-19: A Post-COVID-19 Echocardiography Study. Harran Üniversitesi Tıp Fakültesi Dergisi. 2022;19(1):83-90.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty