Case Report

Improvement in Hypertrophic Cardiomyopathy after Significant Weight Loss: Case Report

Authors: Gabriel I. Uwaifo, MD, Erica M. Fallon, BS, Karim A. Calis, PharMD, MPh, Bart Drinkard, PT, MSPT, CCS, Jennifer R. McDuffie, PhD, Jack A. Yanovski, MD, PhD

Abstract

A 17-year-old obese boy found to have familial apical hypertrophic cardiomyopathy on routine screening was enrolled in a weight loss program on the basis of the hypothesis that significant weight loss would improve his cardiac status. He was followed with serial dual-energy x-ray absorptiometry, electrocardiography, echocardiography, and blood pressure and pulse rate measurements. Within 1 year, he lost 49 kg, with a body mass index reduction from 43.6 to 28.1 kg/m2 and associated reductions in systolic blood pressure, diastolic blood pressure, pulse pressure, mean heart rate, rate pressure product, and echocardiographic indices of left ventricular mass that resulted in a change from the initial geometric finding of eccentric left ventricular hypertrophy to a “normal” left ventricular mass with minimal asymmetric apical left ventricular thickening. Significant weight loss in an obese adolescent with presumed familial apical hypertrophic cardiomyopathy was associated with striking improvement in cardiac functional indices, which could have profound implications for long-term cardiovascular risk.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Bray GA. Pathophysiology of obesity. Am J Clin Nutr 1992; 55( 2 Suppl): 488S–494S.
2. Alexander JK. The cardiomyopathy of obesity. Prog Cardiovasc Dis 1985; 27: 325–334.
3. Bharucha DB, Kowey PR, Marinchak RA. Arrhythmias and the athlete: Risk for sudden death. UpToDate Version 9.3. Wellesley, MA, UpToDate, 2001 (on-line information service). Available at: http://www.uptodate.com/index.asp
4. McKenna WJ. Genetics of hypertrophic cardiomyopathy. UpToDate Version 9.3. Wellesley, MA, UpToDate, 2001 (on-line information service). Available at: http://www.uptodate.com/index.asp
5. Bonne G, Carrier L, Richard P, Hainque B, Schwartz K. Familial hypertrophic cardiomyopathy: From mutations to functional defects. Circ Res 1998; 83: 580–593.
6. McKenna WJ. Pathophysiology of obstructive hypertrophic cardiomyopathy. UpToDate Version 9.3. Wellesley, MA, UpToDate, 2001 (on-line information service). Available at: http://www.uptodate.com/index.asp
7. de Simone G, Verdecchia P, Schillaci G, Devereux RB. Clinical impact of various geometric models for calculation of echocardiographic left ventricular mass. J Hypertens 1998; 16: 1207–1214.
8. Liao Y, Cooper RS, Durazo-Arvizu R, Mensah GA, Ghali JK. Prediction of mortality risk by different methods of indexation for left ventricular mass. J Am Coll Cardiol 1997; 29: 641–647.
9. Alaud-din A, Meterissian S, Lisbona R, MacLean LD, Forse RA. Assessment of cardiac function in patients who were morbidly obese. Surgery 1990; 108: 809–820.
10. Schiller NB. Echocardiographic recognition of cardiomyopathies. UpToDate Version 9.3. Wellesley, MA, UpToDate, 2001 (on-line information service). Available at: http://www.uptodate.com/index.asp
11. Sakamoto T. Apical hypertrophic cardiomyopathy (apical hypertrophy): An overview. J Cardiol 2001; 37: 161–178.
12. Alpert MA. Obesity cardiomyopathy: Pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001; 321: 225–236.
13. Lavie CJ, Amodeo C, Ventura HO, Messerli FH. Left atrial abnormalities indicating diastolic ventricular dysfunction in cardiopathy of obesity. Chest 1987; 92: 1042–1046.
14. Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet 1982; 1: 1165–1168.
15. Messerli FH, Nunez BD, Ventura HO, Snyder DW. Overweight and sudden death: Increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med 1987; 147: 1725–1728.
16. Alpert MA, Hashimi MW. Obesity and the heart. Am J Med Sci 1993; 306: 117–123.
17. Herrera MF, Oseguera J, Gamino R, Gutiérrez-Cirlos C, Vargas-Vorackova F, González-Barranco J, et al. Cardiac abnormalities associated with morbid obesity. World J Surg 1998; 22: 993–937.
18. Alpert MA. Management of obesity cardiomyopathy. Am J Med Sci 2001; 321: 237–241.
19. Unger RH. Lipotoxic diseases. Annu Rev Med 2002; 53: 319–336.
20. Olutade BO, Gbadebo TD, Porter VD, Wilkening B, Hall WD. Racial differences in ambulatory blood pressure and echocardiographic left ventricular geometry. Am J Med Sci 1998; 315: 101–109.
21. Benotti PN, Bistrain B, Benotti JR, Blackburn G, Forse RA. Heart disease and hypertension in severe obesity: The benefits of weight reduction. Am J Clin Nutr 1992; 55( 2 Suppl): 586S–590S.
22. De Scheerder I, Cuvelier C, Verhaaren R, De Buyzere M, De Backer G, Clement D. Restrictive cardiomyopathy caused by adipositas cordis. Eur Heart J 1987; 8: 661–663.
23. Basu S, Folliguet T, Anselmo M, Greengart A, Sabado M, Cunningham JN Jr, et al. Lipomatous hypertrophy of the interatrial septum. Cardiovasc Surg 1994; 2: 229–231.
24. Agbamu DA, McMahon RF. Lipomatous hamartoma of the interatrial septum. Am J Cardiovasc Pathol 1993; 4: 371–373.
25. Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol 2000; 36: 130–138.
26. White WB. Heart rate and the rate-pressure product as determinants of cardiovascular risk in patients with hypertension. Am J Hypertens 1999; 12: 50S–55S.
27. Smahel Z, Gregor P. Somatometric characteristics of patients with hypertrophic cardiomyopathies [in Czech]. Vnitr Lek 1990; 36: 52–58.
28. Bezborod'ko BN, Mochalova TI. A case of Pickwickian syndrome associated with hypertrophic cardiomyopathy [in Russian]. Vrach Delo 1988May; 5: 47–48.
29. Dwyer EM, Asif M, Ippolito T, Gillespie M. Role of hypertension, diabetes, obesity, and race in the development of symptomatic myocardial dysfunction in a predominantly minority population with normal coronary arteries. Am Heart J 2000; 139: 297–304.
30. Korner PI, Jennings GL. Assessment of prevalence of left ventricular hypertrophy in hypertension. J Hypertens 1998; 16: 715–723.

There is actually one thing worse than evil itself, and that is indifference to evil. —Joseph Fletcher