Echocardiographic Evaluation of Aortic Elasticity Parameters in Obesity-Prone Young Adults

Öz

Objective: Arterial stiffness reflects the viscoelastic properties of the vessel wall. In this study, we aimed to evaluate the relationship between aortic strain, elasticity, stiffness, and left ventricle functions in obese and obesity-prone young adults. Materials and Methods: The participants were classified as obese, overweight, normal-weight, and underweight, according to the BMI. There were 28 underweight, 84 normal weight, 89 overweight, and 22 obese individuals. Physical examinations, findings and medical history of patients were recorded. Left and right ventricle functions were evaluated with 2D transthoracic echocardiography. Parameters of aortic elasticity including aortic strain, elasticity, and stiffness index were calculated according to the predefined formula. Results: Baseline clinical and demographic findings were similar, except age and weight. In the comparison of echocardiographic measurements, left ventricular end-systolic and end-diastolic diameters, interventricular septum and posterior wall diastolic diameters, left atrial diameter, left ventricular mass and mass index were significantly higher between groups as consistent with the increase in BMI, mitral early diastolic filling velocities, mitral early and late diastolic filling velocity ratio and mitral lateral early diastolic relaxation were significantly lower between groups as conversely with the increase in BMI (p < 0.05, for all). Statistically significant differences were observed between groups regarding aortic strain, elasticity, and stiffness values. Aortic strain were significantly higher between groups as consistent with the increase in BMI, aortic strain and elasticity were significantly lower between groups as conversely with the increase in BMI (p < 0.05, for all). BMI, systolic blood pressure, pulse pressure, and myocardial performance index (MPI) were found as independent variables affecting the aortic stiffness index (β). Conclusion: Aortic stiffness index (β), which might have a prognostic value in determining the risk of future CV disease, tends to be increased in obese and obesity-prone young adults, and correlated with the increase in BMI, systolic blood pressure, and left ventricle MPI.

Anahtar Kelimeler

• aortic elasticity properties
• obesity
• young adults
• Aortun elastikiyet özellikleri
• obezite
• genç erişkinler

Obeziteye Yatkın Genç Erişkinlerde Aort Elastisite Parametrelerinin Ekokardiyografik Değerlendirilmesi

Öz

Amaç: Arter sertliği damar duvarının viskoelastik özelliklerini yansıtır. Bu çalışmada obez ve obeziteye yatkın genç erişkinlerde aort strain, elastikiyet, sertlik ve sol ventrikül fonksiyonları arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Katılımcılar VKİ'ye göre obez, fazla kilolu, normal kilolu ve zayıf olarak sınıflandırıldı. 28 zayıf, 84 normal, 89 fazla kilolu ve 22 obez birey vardı. Hastaların fizik muayeneleri, bulguları ve tıbbi öyküleri kaydedildi. Sol ve sağ ventrikül fonksiyonları 2D transtorasik ekokardiyografi ile değerlendirildi. Aortik strain, elastikiyet ve sertlik indeksini içeren aort elastikiyet parametreleri, önceden tanımlanmış formüle göre hesaplandı. Bulgular: Temel klinik ve demografik bulgular, yaş ve ağırlık dışında benzerdi. Ekokardiyografik ölçümlerin karşılaştırılmasında, sol ventrikül sistol sonu ve diyastol sonu çapları, interventriküler septum ve arka duvar diyastol çapları, sol atriyum çapı, sol ventrikül kitle ve kitle indeksi, VKİ'deki artışla uyumlu olarak gruplar arasında anlamlı olarak yüksekti, mitral erken diyastolik dolum hızları, mitral erken ve geç diyastolik dolum hızı oranı ve mitral lateral erken diyastolik gevşeme, VKİ'deki artışın tersine, gruplar arasında anlamlı olarak daha düşüktü (tümü için p < 0.05). Aortik strain, elastikiyet ve sertlik değerleri açısından gruplar arasında istatistiksel olarak anlamlı farklılıklar gözlendi. Aortik sertlik, VKİ'deki artışla uyumlu olarak gruplar arasında anlamlı olarak daha yüksekti, aort strain ve elastikiyeti, VKİ'deki artışa zıt olarak gruplar arasında anlamlı olarak daha düşüktü (tümü için p < 0.05). VKİ, sistolik kan basıncı, nabız basıncı ve miyokardiyal performans indeksi (MPI), aort sertliği indeksini (β) etkileyen bağımsız değişkenler olarak bulundu. Sonuç: Gelecekteki kardiyovasküler hastalık riskini belirlemede prognostik bir değeri olabilecek aort sertliği indeksi (β), obez ve obeziteye yatkın genç erişkinlerde artma eğilimindedir ve VKİ, sistolik kan basıncı ve sol ventrikül MPI ile korele olduğu gözlenmiştir.

Anahtar Kelimeler

• Aortun elastikiyet özellikleri
• obezite
• genç erişkinler

Kaynakça

1. 1. Members: ATF, Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, et al. European Guidelines on CV disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on CV Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Developed with the special contribution of the European Association for CV Prevention & Rehabilitation (EACPR). European heart journal. 2012;33(13):1635-701.
2. 2. Marik P, Varon J. The obese patient in the ICU. Chest. 1998;113(2):492-8.
3. 3. Mertens I, Gaal LV. Obesity, haemostasis and the fibrinolytic system. Obesity reviews. 2002;3(2):85-101.
4. 4. Haffner S, Taegtmeyer H. Epidemic obesity and the metabolic syndrome. Circulation. 2003;108(13):1541-5.
5. 5. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for CV disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67(5):968-77.
6. 6. Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension. 2002;40(4):441-7.
7. 7. Stamler R, Stamler J, Riedlinger WF, Algera G, Roberts RH. Weight and blood pressure: findings in hypertension screening of 1 million Americans. Jama. 1978;240(15):1607-10.
8. 8. Stamler R, Ford CE, Stamler J. Why do lean hypertensives have higher mortality rates than other hypertensives? Findings of the Hypertension Detection and Follow-up Program. Hypertension. 1991;17(4):553-64.

9. 9. Wang TJ, Parise H, Levy D, D’Agostino RB, Wolf PA, Vasan RS, et al. Obesity and the risk of new-onset atrial fibrillation. Jama. 2004;292(20):2471-7.
10. 10. Czernichow S, Mennen L, Bertrais S, Preziosi P, Hercberg S, Oppert J. Relationships between changes in weight and changes in CV risk factors in middle-aged French subjects: effect of dieting. International journal of obesity. 2002;26(8):1138-43.
11. 11. McGee DL, Collaboration DP. Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Annals of epidemiology. 2005;15(2):87-97.
12. 12. Mikael LdR, Paiva AMGd, Gomes MM, Sousa ALL, Jardim PCBV, Vitorino PVdO, et al. Vascular aging and arterial stiffness. Arquivos brasileiros de cardiologia. 2017;109:253-8.
13. 13. Safar ME. Arterial stiffness as a risk factor for clinical hypertension. Nature Reviews Cardiology. 2018;15(2):97-105.
14. 14. Zanoli L, Lentini P, Briet M, Castellino P, House AA, London GM, et al. Arterial stiffness in the heart disease of CKD. Journal of the American Society of Nephrology. 2019;30(6):918-28.
15. 15. Safar ME, Czernichow S, Blacher J. Obesity, arterial stiffness, and CV risk. Journal of the American Society of Nephrology. 2006;17(4 suppl 2):S109-S11.
16. 16. Lacombe F, Dart A, Dewar E, et al: Arterial elastic properties in man: A comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992;13:1040–5
17. 17. Liao D, Arnett DK, Tyroler HA, Riley WA, Chambless LE, Szklo M, et al. Arterial stiffness and the development of hypertension: the ARIC study. Hypertension. 1999;34(2):201-6.
18. 18. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and CV mortality in hypertensive patients. Hypertension. 2001;37(5):1236-41.
19. 19. Nemes A, Gavallér H, Csajbók É, Forster T, Csanády M. Obesity is associated with aortic enlargement and increased stiffness: an echocardiographic study. The international journal of CV imaging. 2008;24(2):165-71.
20. 20. Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. European heart journal. 1990;11(11):990-6.
21. 21. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. New England Journal of Medicine. 1990;322(22):1561-6.
22. 22. Gerdts E, Cramariuc D, De Simone G, Wachtell K, Dahlöf B, Devereux RB. Impact of left ventricular geometry on prognosis in hypertensive patients with left ventricular hypertrophy (the LIFE study). European Journal of Echocardiography. 2008;9(6):809-15.
23. 23. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiological reviews. 2008;88(2):389-419.
24. 24. Lehmann E, Gosling R, Sönksen P. Arterial wall compliance in diabetes. Diabetic medicine. 1992;9(2):114-9.
25. 25. Gudbrandsson T, Julius S, Krause L, Jamerson K, Randall OS, Schork N, et al. Correlates of the estimated arterial compliance in the population of Tecumseh, Michigan. Blood Pressure. 1992;1(1):27-34.
26. 26. Stefanadis C, Dernellis J, Toutouzas P. Mechanical properties of the aorta determined by the pressure-diameter relation. Pathologie-biologie. 1999;47(7):696-704.
27. 27. Kool MJ, Hoeks AP, Boudier HAS, Reneman RS, Van Bortel LM. Short and long-term effects of smoking on arterial wall properties in habitual smokers. Journal of the American College of Cardiology. 1993;22(7):1881-6.
28. 28. Stefanadis C, Tsiamis E, Vlachopoulos C, Stratos C, Toutouzas K, Pitsavos C, et al. Unfavorable effect of smoking on the elastic properties of the human aorta. Circulation. 1997;95(1):31-8.