Abstract
Amaç: Çalışmada, obez çocuklarda sol ventrikül diyastolik fonksiyonlarının incelenmesi ve bu incelemelerin asemptomatik olguların erken dönemde tespitine katkısının değerlendirilmesi amaçlandı.Gereç ve Yöntemler: Çalışmaya obezite tanısı ile izlenen 50 obez hasta (vücut kitle indeksi (VKİ) persantili > 95) ve benzer yaş / cinsiyetteki 50 sağlıklı çocuk ile adolesan alındı. Sol ventrikül fonksiyonlarını değerlendirilmesi için tüm hastalara iki boyutlu, M-Mod, Pulse Wave Doppler ve Doku Doppler tekniklerini içerecek şekilde ekokardiyografik incelemeler yapıldı.Bulgular: Obezlerin sol ventrikül yapısında anlamlı değişiklikler mevcuttu. Sol ventrikül enddiyastolik çap (LVED) ve sol atriyum çapı, interventriküler septum (İVS) ve sol ventrikül arka duvar kalınlıkları (LVPW ) obez hastalarda artmıştı (sırasıyla p:0.00001, p:0.00001, p:0.00001, p:0.00001). Sol ventrikül kütlesi ve kütle indeksi anlamlı şekilde yüksekti (sırasıyla p=0.001, p=0.04). Obez grupta doppler parametreleri de diyastolik disfonksiyonu destekliyordu. Mitral A değeri yüksek, transmitral E/A oranı düşük ve deselerasyon zamanı uzamıştı (sırasıyla p:0.00001, p:0.00001, p:0.00001). Pulmoner venöz akım örnekleri (PVa, PVd, PVs) sol ventrikül diyastol sonu basıncının arttığını göstermekteydi. Doku Doppler parametreleri de obez grupta diyastolik disfonsiyon ile uyumluydu. İzovolumik relaksasyon zamanı (İVRT), izovolumik kontraksiyon zamanı (İCT) uzun ve ejeksiyon zamanı (ET) obezlerde belirgin olarak azalmış bulundu. Dolayısıyla miyokard performans indeksi (MPİ) obez grupta kontrol grubu ile karşılaştırıldığında anlamlı derecede artmıştı (p=0.001).Sonuç: Sonuç olarak, obezite asemptomatik dönemde sistolik fonksiyonlar bozulmadan diyastolik fonksiyonları etkileyebilmektedir ve bu dönemde kardiyak değerlendirme yapılırken konvansiyonel yöntemler yetersiz kalabilmektedir. Bu nedenle, obez hastaların değerlendirmesinde subklinik miyokardiyal bozulmayı gösterebilmesi nedeniyle doku Doppler incelemesine de gereksinim olacağı akılda tutulmalıdır.
References
- Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr 2007;150:12-7.
- Di Bello V, Santini F, Di Cori A, Pucci A, Palagi C, Delle Donne MG, et al. Obesity cardiomyopathy: Is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr 2006;19:1063-71.
- Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006;95:194-8.
- Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, et al. Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet 2009;373:1083-96.
- Alpert MA. Management of obesity cardiomyopathy. Am J Med Sci 2001;321:237-41.
- Alpert MA. Obesity cardiomyopathy: Pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001;321:225-36.
- Yazıcı HU, Şen N, Tavil Y, Hizal F, Turfan M, Poyraz F, et al. Left ventricular functions in patient with cardiac syndrome X: Tissue Doppler study. Anadolu Kardiyol Derg 2009;9:467-72.
- Wong C, Marwick TH. Alterations in myocardial characteristics associated with obesity: Detection, mechanisms, and implications. Trends Cardiovasc Med 2007;17:1-5.
- 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;43:1399-404.
- 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.
- Kibar AE, Paç A, Oflaz MB, Ballı Ş, Ece I. Echocardiographic evaluation of left ventricular function in normotensive obese children: A comparative analysis according to body mass index. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2012;40:337-46.
- Kono Y, Yoshinaga M, Oku S, Nomura Y, Nakamura M, Aihoshi S. Effect of obesity on echocardiographic parameters in children. Int J Cardiol 1994;46:7-13.
- Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol 2003;91:780-4.
- Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography (Guidelines and Standards). J Am Soc Echocardiogr 2009;22:107-33.
- Harjai KJ, Scott L, Vivekananthan K, Nunez E, Edupuganti R. The Tei index: A new prognostic index for patients with symptomatic heart failure. J Am Soc Echocardiogr 2002;15:864-8.
- Rojo EC, Rodrigo JL, Perez de Isla L, Almeria C, Gonzalo N, Aubele A, et al. Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index. Eur J Echocardiogr 2006;7: 356- 64.
- pressures: A comparative doppler-catheterization study. Circulation 2000;102:1788-94.
Abstract
Objective: The aim of this study was to examine left ventricular (LV) diastolic function in obese patients and to evaluate the benefits of these findings in the early detection of asymptomatic cases.Material and Methods: Fifty children diagnosed with obesity (body mass index (BMI) > 95th percentile) and fifty healthy children and adolescents of similar age and gender were evaluated. Complete echocardiographic examination including two-dimensional, M-Mode, Pulse Wave Doppler and tissue Doppler techniques were used to evaluate left ventricular functions.results: Obese patients had significant differences in LV structure. Left ventricule end-diastolic diameter and left atrium diameter, and left ventricle septal and posterior wall thicknesses were higher in the obese group compared to the nonobese group (p:0.00001, p:0.00001, p:0.00001, p:0.00001 respectively). Left ventricular mass and mass index were significantly increased (p=0,001 and p=0,04). In addition, Doppler echocardiography parameters of the left ventricle demonstrated left ventricular diastolic dysfunction in the obese group. Pulmonary venous flow Doppler parameters and tissue Doppler parameters of the mitral annulus’ septal and lateral parts revealed diastolic dysfunction in the obese group. Isovolumetric relaxation time (IVRT) and isovolumetric contraction time (ICT) were prolonged, ejection time (ET) was significantly decreased and myocardial performance index (MPI) was increased in the obese group compared to the controls (p=0.0001)
References
- Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr 2007;150:12-7.
- Di Bello V, Santini F, Di Cori A, Pucci A, Palagi C, Delle Donne MG, et al. Obesity cardiomyopathy: Is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr 2006;19:1063-71.
- Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006;95:194-8.
- Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, et al. Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet 2009;373:1083-96.
- Alpert MA. Management of obesity cardiomyopathy. Am J Med Sci 2001;321:237-41.
- Alpert MA. Obesity cardiomyopathy: Pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001;321:225-36.
- Yazıcı HU, Şen N, Tavil Y, Hizal F, Turfan M, Poyraz F, et al. Left ventricular functions in patient with cardiac syndrome X: Tissue Doppler study. Anadolu Kardiyol Derg 2009;9:467-72.
- Wong C, Marwick TH. Alterations in myocardial characteristics associated with obesity: Detection, mechanisms, and implications. Trends Cardiovasc Med 2007;17:1-5.
- 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;43:1399-404.
- 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.
- Kibar AE, Paç A, Oflaz MB, Ballı Ş, Ece I. Echocardiographic evaluation of left ventricular function in normotensive obese children: A comparative analysis according to body mass index. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2012;40:337-46.
- Kono Y, Yoshinaga M, Oku S, Nomura Y, Nakamura M, Aihoshi S. Effect of obesity on echocardiographic parameters in children. Int J Cardiol 1994;46:7-13.
- Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol 2003;91:780-4.
- Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography (Guidelines and Standards). J Am Soc Echocardiogr 2009;22:107-33.
- Harjai KJ, Scott L, Vivekananthan K, Nunez E, Edupuganti R. The Tei index: A new prognostic index for patients with symptomatic heart failure. J Am Soc Echocardiogr 2002;15:864-8.
- Rojo EC, Rodrigo JL, Perez de Isla L, Almeria C, Gonzalo N, Aubele A, et al. Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index. Eur J Echocardiogr 2006;7: 356- 64.
- pressures: A comparative doppler-catheterization study. Circulation 2000;102:1788-94.
Details
| Other ID | JA93NN48HB |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 1, 2015 |
| Submission Date | December 1, 2015 |
| Published in Issue | Year 2015 Volume: 9 Issue: 4 |
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