| Abstrakt: |
As a part of a project designed to assess mechanisms underlying heart failure in obesity, 38 normotensive, uncomplicated, white obese subjects [14 men, 24 women; age 35±13 years; body mass index (BMI)=36±6; blood pressure (BP)=124,5±14.2/79.3±9.3mmHg) have been studied by Doppler Echocardiography and compared with a group of 39 normotensive, normal-weight. white volunteers (16 men, 23 women, mean age 36±12 years; BMI=22±3; BP-119.8±14.5/71.8±9.8). Left ventricular (LV) mass (M) normalized by height2.7 (LVMI), fractional shortening (FS) and several measurements of diastolic function were compared by ANOVA after adjusting (ANCOVA) for potential confounders (sex, age, systolic and diastolic BP) identified by a correlation matrix. FS was comparable between groups (obese=29±5%; normal-weight=30±7%). Obese patients exhibited higher LVMI than normal-weight subjects (38±11 vs 26±8g/m2.7; p<0.0001), lower transmitral peak E wave velocity (E) (64.4 vs 73.6 em/sec; p<0.0001). prolonged isovolumic relaxation time (IVRT) (81.6 vs 59.6 msec: p<00001) and deceleration time of E wave (DTE) (172.4 vs 147.2 msec: p<0.0002), normal transmitral peak A velocity (A). E/A flow velocity ratio was lower in obese than in normal-weight subjects (1.16 vs 1.40; P<0.03) and atrial filling fraction (AFF) was higher (34±1% vs 30±1%; P<0.05). While with univariate analysis LVMI was related directly to DTE (r=0.50; P0.0001), and IVRT (r=0.35; P<0.004) and inversely to E(r=–0.45; P<0.0001) and E/A ratio (r=–0.36; P<0.001) with ANCOVA between group differences in IVRT and E velocity were independent of LVMI. Differences in DTE, E/A and AFF disappeared when controlling for LVMI. Thus, even uncomplicated obesity is associated with impairment of the early active relaxation phase, independently of levels of LVMI. paralleling abnormalities of early filling flow. Prolonged DTE and increased AFF might be compensatory mechanisms associated with increased LVM. |
