Pascual M, Pascual D A, Soria F, Vicente T, Hernández A M, Tébar F J, Valdés M
Endocrinology and Nutrition Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Heart. 2003 Oct;89(10):1152-6. doi: 10.1136/heart.89.10.1152.
Obesity is associated with increased cardiovascular morbidity and mortality. A direct effect of isolated obesity on cardiac function is not well established.
To determine the direct effect of different grades of isolated obesity on echocardiographic indices of systolic and diastolic left ventricular function.
48 obese and 25 normal weight women were studied. They had no other pathological conditions. Obesity was classed as slight (n = 17; body mass index (BMI) 25-29.9 kg/m2), moderate (n = 20; BMI 30-34.9 kg/m2), or severe (n = 11; BMI > or = 35 kg/m2). Echocardiographic indices of systolic and diastolic function were obtained, and dysfunction was assumed when at least two values differed by > or = 2 SD from the normal weight group.
Ejection fraction (p < 0.05), fractional shortening (p < 0.05), and mean velocity of circumferential shortening (p < 0.05) were increased in slight and moderate obesity. Left ventricular dimensions were increased (p < 0.001) but relative wall thickness was unchanged. No obese patients met criteria for systolic dysfunction. In obese subjects, the mitral valve pressure half time (p < 0.01) and the left atrial diameter (p < 0.001) were increased and the deceleration slope was decreased (p < 0.01); all other diastolic variables were unchanged. No differences were found between obesity subgroups. Subclinical diastolic dysfunction was more prevalent among obese subjects (p = 0.002), being present in two with slight obesity (12%), seven with moderate obesity (35%), and five with severe obesity (45%). BMI correlated significantly with indices of left ventricular function.
Subclinical left ventricular diastolic dysfunction is present in all grades of isolated obesity, correlates with BMI, and is associated with increased systolic function in the early stages of obesity.
肥胖与心血管疾病发病率和死亡率增加相关。单纯肥胖对心脏功能的直接影响尚未完全明确。
确定不同程度的单纯肥胖对左心室收缩和舒张功能超声心动图指标的直接影响。
对48名肥胖女性和25名体重正常女性进行研究。她们无其他病理状况。肥胖分为轻度（n = 17；体重指数（BMI）25 - 29.9 kg/m²）、中度（n = 20；BMI 30 - 34.9 kg/m²）或重度（n = 11；BMI≥35 kg/m²）。获取收缩和舒张功能的超声心动图指标，当至少两个值与体重正常组相差≥2个标准差时，判定为功能障碍。
轻度和中度肥胖患者的射血分数（p < 0.05）、缩短分数（p < 0.05）和圆周缩短平均速度（p < 0.05）增加。左心室尺寸增加（p < 0.001），但相对壁厚不变。无肥胖患者符合收缩功能障碍标准。肥胖受试者中，二尖瓣压力减半时间（p < 0.01）和左心房直径（p < 0.001）增加，减速斜率降低（p < 0.01）；所有其他舒张变量不变。肥胖亚组间未发现差异。亚临床舒张功能障碍在肥胖受试者中更普遍（p = 0.002），轻度肥胖者中有2例（12%）、中度肥胖者中有7例（35%）、重度肥胖者中有5例（45%）存在该情况。BMI与左心室功能指标显著相关。
所有程度的单纯肥胖均存在亚临床左心室舒张功能障碍，与BMI相关，且在肥胖早期与收缩功能增加有关。
