Evaluation of ventricular geometry and cardiac functions in obese adolescents with echocardiography

Abstract

Objective: Obesity is a serious condition associated with increased blood volume and left ventricular hypertrophy, with diastolic dysfunction being particularly prominent during childhood. In adulthood, systolic dysfunction is more commonly observed. The aim of this study is to examine the relationship between body mass index (BMI), waist/hip ratio, and the structural changes in the heart, as well as systolic and diastolic functions, in obese adolescents. Methods: The study included 80 obese and 60 normal-weight adolescents aged between 12-18 years. The body mass index (BMI) of all participants was calculated, and their systolic and diastolic blood pressures were measured. Lipid profile and insulin resistance assessments were conducted for the obese adolescents, and waist/hip ratio was calculated. M-mode echocardiography, pulsed Doppler, and tissue Doppler echocardiography were performed on all subjects to evaluate cardiac functions. Results: The results showed that systolic and diastolic blood pressure were higher in obese adolescents compared to the control group. Left ventricular mass index (LVMI), epicardial adipose tissue (EAT), and carotid intima-media thickness (CIMT) were also found to be higher in the obese group. Additionally, a significant decrease was detected in markers of diastolic dysfunction. No systolic dysfunction was observed; however, the left ventricular Tei index (LVTEI), which reflects both systolic and diastolic dysfunction, was significantly higher in the obese group. Conclusion: This study demonstrates that cardiac dysfunction can be detected in obese adolescents before symptoms appear, providing an opportunity for early intervention

Keywords

• Obesity
• Adolescent
• Echocardiography diastolic disfunction

Obez adolesanlarda ventrikül geometrisi ve kardiyak fonksiyonların ekokardiyografi ile değerlendirilmesi

Abstract

Amaç: Obezite, artmış kan hacmi ve sol ventrikül hipertrofisi ile ilişkili ciddi bir durum olup, çocukluk çağında özellikle diyastolik disfonksiyon belirgin iken, yetişkinlikte daha yaygın olarak sistolik disfonksiyon gözlenir. Bu çalışmanın amacı, obez adolesanlarda vücut kitle indeksi, bel/kalça oranı ile kalpteki yapısal değişiklikler ve sistolik ile diyastolik fonksiyonlar arasındaki ilişkiyi incelemektir. Gereç ve Yöntem: Çalışmaya 12-18 yaş arasındaki 80 obez ve 60 normal kilolu sağlıklı adolesan dahil edilmiştir. Tüm katılımcıların vücut kitle indeksi hesaplanmış ve sistolik ile diyastolik kan basınçları ölçülmüştür. Obez adolesanların lipid profili ve insülin direnci değerlendirmesi yapılmış olup bel/kalça oranı hesaplanmıştır. Tüm katılımcılara kardiyak fonksiyonları değerlendirmek amacıyla M-mode ekokardiyografi, pulsed Doppler ve doku Doppler ekokardiyografi değerlendirmesi yapılmıştır. Bulgular: Sonuçlar, obez adolesanlarda sistolik ve diyastolik kan basıncının kontrol grubuna göre daha yüksek olduğunu göstermiştir. Sol ventrikül kitle indeksi, epikardiyal yağ dokusu ve karotis intima-media kalınlığı da obez grupta daha yüksek bulunmuştur. Ayrıca diyastolik disfonksiyon belirteçlerinde anlamlı bir azalma tespit edilmiştir. Sistolik disfonksiyon gözlenmemiştir; ancak hem sistolik hem diyastolik disfonksiyonu yansıtan sol ventrikül Tei indeksi obez grupta anlamlı derecede yüksek bulunmuştur. Sonuç: Bu çalışma, obez adolesanlarda semptomlar ortaya çıkmadan önce kardiyak disfonksiyonun tespit edilebileceğini göstererek erken müdahale için bir fırsat sunmaktadır.

Keywords

• Obezite
• Adolesan
• Ekokardiyografik diyastolik disfonksiyon

References

1. 1. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. 2. Lobstein T, Brinsden H. Atlas of childhood obesity. London: World Obesity Federation, 2019.
3. 3. WHO.Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organisation; 2016.
4. 4. Dundar C, Arslan HN, Terzi Ö. How close are children with obesity to becoming an adult with chronic illnesses? Chronic Illn. 2024;20(3):535-544
5. 5. Alp H, Karaarslan S, Eklioğlu BS, Atabek ME, Baysal T. The effect of hypertension and obesity on left ventricular geometry and cardiac functions in children and adolescents. J Hypertens. 2014 Jun;32(6):1283-92.
6. 6. Turkbey EB, McClelland RL, Kronmal RA, Burke GL, Bild DE, Tracy RP et al. The impact of obesity on the left ventricle: the multi-ethnic study of atherosclerosis (MESA). JACC Carsiovasc Imaging 2010;3:266-74.
7. 7. Yang L, Li M, Wang H, Shu W, Zhao M, Magnussen CG, Hu Y, Xi B. Metabolically healthy obesity and left ventricular geometric remodelling in Chinese children. Diabetes Obes Metab. 2024;26(10):4629-38.
8. 8. Alp H, Eklioğlu BS, Atabek ME, Karaarslan S, Baysal T, Altın H, Karataş Z, Sap F. Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents. J Pediatr Endocrinol Metab. 2014;27(9-10):827-35.

9. 9. Saleh C. Carotid Intima-Media Thickness and Cardiovascular Risk in Adolescents with Overweight or Obesity: Are There Gender-Related Differences? Rev Cardiovasc Med. 2024;25(10):352.
10. 10. Hong YM. Atherosclerotic cardiovascular disease beginning in childhood. Korean Circ J. 2010;40(1):1-9.
11. 11. Farello G, Iapadre G, Lizzi M, Gentile C, Altobelli E, Ciocca F, Verrotti A. Carotid intima media-thickness is increased in obese children metabolically healthy, metabolically unhealthy, and with metabolic syndrome, compared to the non-obese controls. Eur Rev Med Pharmacol Sci. 2021;25(1):241-9.
12. 12. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709-57.
13. 13. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005;115(4): e500-3.
14. 14. Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003;11:304–10.
15. 15. Iacobellis G, Lonn E, Lamy A, Singh N, Sharma AM. Epicardial fat thickness and coronary artery disease correlate independently of obesity. Int J Cardiol 2011;146:452–4.
16. 16. Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003;88:5163–8.
17. 17. Lang RM, Badano LP, MorAvi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of cardiovascular ımaging. J Am Soc Echocardiogr 2015;28:139.e14.
18. 18. Abarca-Gómez L, Abdeen ZA, Hamid ZA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 populationbased measurement studies in 128•9 million children, adolescents, and adults. The Lancet. 2017;390(10113):2627-42.
19. 19. Lindberg, L.; Danielsson, P.; Persson, M.; Marcus, C.; Hagman, E. Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study. PLoS Med. 2020; 17(3):e1003078.
20. 20. Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities. Pediatrics. 2023;151(2):e2022060643.
21. 21. Xi B, Zong X, Kelishadi R, Litwin M, Hong YM, Poh BK et al. International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years. J Clin Endocrinol Metab. 2020;105(4):e1569–83.
22. 22. Alpsoy S, Akyüz A, Akkoyun DC, Nalbantoğlu B, Topçu B, Değirmenci H, Ozdilek B, Donma MM. Effect of overweight on cardiac function in children. Turk Kardiyol Dern Ars. 2013;41(8):714-23.
23. 23. Bjelakovic L, Vukovic V, Stankovic S, Ciric M, Lukic S, Bratic M, Pantelic S, Saranac L, Bjelakovic B. Insulin resistance surrogates and left ventricular hypertrophy in normotensive obese children. Cardiol Young. 2021;31(12):1901-6.
24. 24. Thota P, Perez-Lopez FR, Benites-Zapata VA, Pasupuleti V, Hernandez AV. Obesity-related insulin resistance in adolescents: a systematic review and meta-analysis of observational studies. Gynecol Endocrinol. 2017;33(3):179-84.
25. 25. Gómez-Díaz RA, Wacher-Rodarte NH. Childhood obesity and dyslipidemia. Rev Med Inst Mex Seguro Soc. 2014;52:102-8.
26. 26. Jayawardene WP, Lohrmann D, Dickinson S, Talagala S, Torabi M. Clinical measures of obesity and cumulative cardiometabolic risk in adolescents. Clin Obes. 2017;7(1):11-21.
27. 27. Simşek E, Balta H, Balta Z, Dallar Y. Childhood obesity-related cardiovascular risk factors and carotid intima-media thickness. Turk J Pediatr. 2010;52(6):602-11.
28. 28. Freedman DS, Dietz WH, Tang R, Mensah GA, Bond MG, Urbina EM. The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study. International Journal of Obesity. 2003;28:159-66.
29. 29. Yang MC, Liu HK, Tsai CC, Su YT, Wu JR. Epicardial Adipose Tissue Was Highly Associated with Reduction in Left Ventricular Diastolic Function as Early as in Adolescence. Acta Cardiol Sin. 2022;38(5):601-11.
30. 30. Sade LE, Eroglu S, BozbaH, et al. Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. Atherosclerosis 2009;204:580-5.
31. 31. Brady TM, Appel LJ, Holmes KW, Fivush B, Miller ER 3rd. Association Between Adiposity and Left Ventricular Mass in Children With Hypertension. J Clin Hypertens (Greenwich). 2016;18(7):625-33.
32. 32. Porcar-Almela M, Codoñer-Franch P, Tuzón M, Navarro-Solera M, Carrasco-Luna J, Ferrando J. Left ventricular diastolic function and cardiometabolic factors in obese normotensive children. Nutr Metab Cardiovasc Dis. 2015;25(1):108-15.
33. 33. Bartkowiak J, Spitzer E, Kurmann R, Zürcher F, Krähenmann P, Garcia-Ruiz V, et al. The impact of obesity on left ventricular hypertrophy and diastolic dysfunction in children and adolescents. Sci Rep. 2021;11(1):13022.
34. 34. Mangner N, Scheuermann K, Winzer E, Wagner I, Hoellriegel R, Sandri M, et al. Childhood obesity: impact on cardiac geometry and function. JACC Cardiovasc Imaging. 2014;7(12):1198-205.
35. 35. Dhuper S, Abdullah RA, Weichbrod L, et al. Association of obesity and hypertension with left ventricular geometry and function in children and adolescents. Obesity (Silver Spring) 2011; 19:128–33.
36. 36. Saritas T, Tascilar E, Abaci A, et al. Importance of plasma N-terminal pro Btype natriuretic peptide, epicardial adipose tissue, and carotid intima-media thicknesses in asymptomatic obese children. Pediatr Cardiol 2010; 31:792–9.
37. 37. Ünsal H, Ekici E. The Effect of Childhood Obesity on Left Ventricular Diastolic Function. Türkiye Çocuk Hast Derg/Turkish J Pediatr Dis / 2015; 4: 264-70.