Original Article

Evaluation of the Effects of Obesity on Heart Functions Using Standard Echocardiography and Pulsed Wave Tissue Doppler Imaging

Authors: Hüseyin Sürücü, MD, Ersan Tatl, MD, Selnur Okudan MD, Ali Değirmenci, MD

Abstract

Objectives: This study aimed to investigate abnormalities in right and left ventricular function in older obese patients with no left ventricular (LV) hypertrophy.


Design: Subjects with normal coronary angiography were included in this study. They were divided into two groups according to their body mass index (BMI): Group I = BMI ≥27, and group II BMI = <27. Standard echocardiography and pulsed wave tissue Doppler imaging (PW-TDI) parameters were performed in all subjects.


Results: The obese patients had tachycardia (P = 0.017) and hypertension (P = 0.020). In the obese patients, there was evidence of altered LV geometry; an increase in the posterior wall thickness (P = 0.001), and larger aortic valve diameter (P = 0.007).


Conclusions: In obese patients of older ages, there is evidence of left and right ventricular dysfunction.


Key Points


* Obese patients had higher pulse rates and diastolic blood pressure.


* The posterior wall thickness and aortic valve diameter increased without a change in the left ventricle (LV) diameter and left ventricular mass index (LVMI).


* Right ventricle (RV) diastolic and systolic dysfunctions are evident enough to be detected by standard echocardiography (ECHO) parameters.


* But LV diastolic and systolic function impairments are not detected by standard ECHO parameters, especially in the elderly.


* In these patients, they can only be detected by PW-TDI parameters.


* Because the RV diastolic function impairments in obese patients were independent of hypertension, pulse rate, and pulmonary capillary wedge pressure in our study, we concluded that the RV functions in obese patients are impaired due to a great extent to the increase in preload, but not afterload.


* Our study also revealed that the diastolic and systolic functions in both ventricles are impaired due to obesity.

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References

1. Burton BT, Foster WR. Health implications of obesity: an NIH Consensus Development Conference. J Am Diet Assoc 1985;85:1117–1121.
 
2. Williams GH, Liliy LS, Seely EW. The heart in endocrine and nutritional disorders. In: Braunwald E, editor. Heart Disease. Philadelphia, PA: Saunders Company; 1997, pp 1905–1907.
 
3. Willens HJ, Chakko SC, Byers P, et al. Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging. Am J Cardiol 2005;95:1521–1524.
 
4. Willens HJ, Chakko SC, Lowery MH, et al. Tissue Doppler imaging of the right and left ventricle in severe obesity (body mass index >35 kg/m2). Am J Cardiol 2004;94:1087–1090.
 
5. Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995;26:135–136.
 
6. Zarich SW, Kowalchuk GJ, McGuire MP, et al. Left ventricular filling abnormalities in asymptomatic morbid obesity. Am J Cardiol 1991;68:377–381.
 
7. Stoddard MF, Tseuda K, Thomas M, et al. The influence of obesity on left ventricular filling and systolic function. Am Heart J 1992;124:694–699.
 
8. Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001;321:225–236.
 
9. Crisostomo LL, Araujo LM, Camara E, et al. Left ventricular mass and function in young obese women. Int J Obes Relat Metab Disord 2001;25:233–238.
 
10. Harada K, Orino T, Takada G. Body mass index can predict left ventricular diastolic filling in asymptomatic obese children. Pediatr Cardiol 2001;22:273–278.
 
11. Sökmen A, Tokaç M, Sökmen G, et al. The value of tissue Doppler echocardiography on the assessment of the left ventricle diastolic dysfunctions in young normotensive obese patients [in Turkish]. Arch Turkish Cardiol Assoc 2002;30:109.
 
12. Lavie CJ, Ventura HO, Messerli FH. Left ventricular hypertrophy: its relationship to obesity and hypertension. Postgrad Med 1992;91:131–132.
 
13. Alam M, Hoglund C. Assessment by echocardiogram of left ventricular diastolic function in healthy subjects using the atrioventricular plane displacement. Am J Cardiol 1992;69:565–568.
 
14. Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet 1982 22;1:1165–1168.
 
15. Powell BD, Redfield MM, Bybee KA, et al. Association of obesity with left ventricular remodeling and diastolic dysfunction in patients without coronary artery disease. Am J Cardiol 2006;98:116–120.
 
16. Peterson LR, Waggoner AD, Schechtman KB, 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;43:1399–1404.
 
17. Rigolin VH, Robiolio PA, Wilson JS, et al. The forgotten chamber: the importance of the right ventricle. Cathet Cardiovasc Diagn 1995;35:18–28.
 
18. Chakko S, Mayor M, Allison MD, et al. Abnormal left ventricular diastolic filling in eccentric left ventricular hypertrophy of obesity. Am J Cardiol 1991;68:95–98.
 
19. Warnes CA, Roberts WC. The heart in massive (more than 300 pounds or 136 kilograms) obesity: analysis of 12 patients studied at necropsy. Am J Cardiol 1984;54:1087–1091.
 
20. Nakajima T, Fujioka S, Tokunaga K, et al. Noninvasive study of left ventricular performance in obese patients: influence of duration of obesity. Circulation 1985;71:481–486.