Blog
About

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study

Read this article at

Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Abstract

      Background

      It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clinical indices and via LV geometric patterns (more commonly used in research settings). Importantly, our sample consisted of hypertensive patients that are routinely screened for LVH via echocardiography and normotensive patients that would normally be deemed low risk with no further action required.

      Methods

      This cross sectional study comprised a total of 353 Caucasian patients, grouped based on diagnosis of obesity, T2D and hypertension, with normotensive obese patients further separated based on metabolic health. Basic metabolic parameters were collected and LV structure and function were assessed via transthoracic echocardiography. Multivariable logistic and linear regression analyses were used to identify predictors of LVH and diastolic dysfunction.

      Results

      Metabolically healthy normotensive obese patients exhibited relatively low risk of LVH. However, normotensive metabolically non-healthy obese, T2D and obese/T2D patients all presented with reduced normal LV geometry that coincided with increased LV concentric remodelling. Furthermore, normotensive patients presenting with both obesity and T2D had a higher incidence of concentric hypertrophy and grade 3 diastolic dysfunction than normotensive patients with either condition alone, indicating an additive effect of obesity and T2D. Alarmingly these alterations were at a comparable prevalence to that observed in hypertensive patients. Interestingly, assessment of LVPWd, a traditional index of LVH, underestimated the presence of LV concentric remodelling. The implications for which were demonstrated by concentric remodelling and concentric hypertrophy strongly associating with grade 1 and 3 diastolic dysfunction respectively, independent of sex, age and BMI. Finally, pulse pressure was identified as a strong predictor of LV remodelling within normotensive patients.

      Conclusions

      These findings show that metabolically non-healthy obese, T2D and obese/T2D patients can develop LVH independent of hypertension. Furthermore, that LVPWd may underestimate LV remodelling in these patient groups and that pulse pressure can be used as convenient predictor of hypertrophy status.

      Electronic supplementary material

      The online version of this article (doi:10.1186/s12933-017-0504-z) contains supplementary material, which is available to authorized users.

      Related collections

      Most cited references 31

      • Record: found
      • Abstract: found
      • Article: not found

      Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

      The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
        Bookmark
        • Record: found
        • Abstract: not found
        • Article: not found

        Recommendations for the evaluation of left ventricular diastolic function by echocardiography.

          Bookmark
          • Record: found
          • Abstract: not found
          • Article: not found

          Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

            Bookmark

            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, Metabolic Research Unit, Metabolic Reprogramming Laboratory, School of Medicine, , Deakin University, ; Waurn Ponds, VIC Australia
            [2 ]ISNI 0000 0001 2176 9917, GRID grid.411327.2, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, , Heinrich-Heine University, ; c/o Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
            [3 ]GRID grid.452622.5, , German Center of Diabetes Research, ; Ingolstädter Landstraße 1, 85764 München-Neuherberg, Germany
            [4 ]GRID grid.17089.37, Department of Pediatrics, , University of Alberta, ; Edmonton, AB T6G 2H7 Canada
            [5 ]GRID grid.17089.37, Department of Pharmacology, , University of Alberta, ; Edmonton, AB T6G 2H7 Canada
            [6 ]Cardiology Department, Barwon Health, University Hospital Geelong, Victoria, Australia
            [7 ]Geelong Endocrinology and Diabetes Centre, Geelong, VIC Australia
            [8 ]Endocrinology Department, Barwon Health, University Hospital, Geelong, VIC Australia
            [9 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, School of Medicine, , Deakin University, ; Waurn Ponds, VIC Australia
            [10 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, Melbourne Medical School-Western Precinct, , The University of Melbourne, ; Victoria, Australia
            Contributors
            ORCID: http://orcid.org/0000-0003-3249-1628, kgraham@deakin.edu.au
            jujuczeczor@gmail.com
            ssithara@deakin.edu.au
            kahm@deakin.edu.au
            glopasch@ualberta.ca
            APPELBE@BarwonHealth.org.au
            kimberlyc@geelongendo.com.au
            MARKK@BarwonHealth.org.au
            sean.mcgee@deakin.edu.au
            Journal
            Cardiovasc Diabetol
            Cardiovasc Diabetol
            Cardiovascular Diabetology
            BioMed Central (London )
            1475-2840
            8 February 2017
            8 February 2017
            2017
            : 16
            28178970 5299776 504 10.1186/s12933-017-0504-z
            © The Author(s) 2017

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Categories
            Original Investigation
            Custom metadata
            © The Author(s) 2017

            Comments

            Comment on this article