Di Salvo Giovanni, Pacileo Giuseppe, Del Giudice Emanuele Miraglia, Natale Francesco, Limongelli Giuseppe, Verrengia Marina, Rea Alessandra, Fratta Fiorella, Castaldi Biagio, D'Andrea Antonello, Calabrò Paolo, Miele Tiziana, Coppola Filomena, Russo Maria Giovanna, Caso Pio, Perrone Laura, Calabrò Raffaele
Second University of Naples, Via Omodeo 45, Naples 80128, Italy.
Eur Heart J. 2006 Nov;27(22):2689-95. doi: 10.1093/eurheartj/ehl163. Epub 2006 Aug 11.
The prevalence of obesity is increasing among children in the developed world. The association of obesity and abnormal cardiac function is still debated. The reported changes may reflect the role of comorbidities that contribute to ventricular dysfunction. Obese children, without arterial hypertension, may be a unique clinical opportunity to evaluate the effect of obesity, per se, on myocardial function, excluding the influence of possible comorbidities. We sought to define the preclinical effects of obesity on the cardiovascular system, of healthy children with excess weight who have no other clinically appreciable cause of heart disease, using the more sensitive ultrasonic-derived strain and strain rate (SR) imaging.
We studied 300 subjects divided into two groups: (i) obese children (Group O: n=150; age, 12+/-3 years); (ii) healthy lean children comparable for age, sex, and pubertal stage (Referents: n=150; mean age, 12+/-3 years). Systolic (SBP) and diastolic blood pressure (DBP), as well as 24 h-SBP and 24 h-DBP were comparable between groups. Left ventricular (LV) mass/height(2.7) was increased (P<0.0001) in Group O (46+/-12 g/m(2.7)) when compared with Referents (31+/-14 gm(2.7)). Standard echocardiographic indices of global systolic function were similar in the two groups. Intima-media thickness measured at the common carotid artery was not significantly different (P=0.4) in obese children (0.46+/-0.09 mm) when compared with Referents (0.45+/-0.07 mm). Obese children showed regional longitudinal peak systolic myocardial deformation properties (SR=-1.4+/-0.7 s(-1)) lower (P<0.0001) than those of Referents (SR=-2.2+/-0.5) in both left and right ventricle. In multivariable analysis, average peak systolic SR was significantly correlated with homeostasis model assessment of insulin resistance (P<0.01; coefficient, 0.02; SE, 0.011), and insulin serum concentration (P<0.01; coefficient, 0.05; SE, 0.023). Average LV peak systolic strain was significantly correlated with body mass index (P=0.0001; coefficient, 0.06; SE, 0.016), LVM/H(2.7) (P=0.006; coefficient, 0.016; SE, 0.018).
Our study demonstrated that obesity, in absence of hypertension, is associated with significant reduction in systolic myocardial deformation properties already in childhood involving both right and left ventricle. Obesity not only is a risk factor for later cardiovascular disease, but also is associated with contemporaneous and significant impairment of longitudinal myocardial deformation properties.
在发达国家，儿童肥胖的患病率正在上升。肥胖与心脏功能异常之间的关联仍存在争议。所报道的变化可能反映了导致心室功能障碍的合并症的作用。没有动脉高血压的肥胖儿童可能是一个独特的临床机会，可用于评估肥胖本身对心肌功能的影响，排除可能合并症的影响。我们试图利用更敏感的超声衍生应变和应变率（SR）成像，确定超重但无其他临床明显心脏病病因的健康儿童肥胖对心血管系统的临床前影响。
我们研究了300名受试者，分为两组：（i）肥胖儿童（O组：n = 150；年龄，12±3岁）；（ii）在年龄、性别和青春期阶段相匹配的健康瘦儿童（参照组：n = 150；平均年龄，12±3岁）。两组之间的收缩压（SBP）和舒张压（DBP）以及24小时SBP和24小时DBP相当。与参照组（31±14 g/m(2.7)）相比，O组的左心室（LV）质量/身高(2.7)增加（P<0.0001）（46±12 g/m(2.7)）。两组的整体收缩功能的标准超声心动图指标相似。与参照组（0.45±0.07 mm）相比，肥胖儿童颈总动脉内膜中层厚度无显著差异（P = 0.4）（0.46±0.09 mm）。肥胖儿童左、右心室的区域纵向收缩期心肌变形特性（SR = -1.4±0.7 s(-1)）均低于参照组（SR = -2.2±0.5）（P<0.0001）。在多变量分析中，平均收缩期峰值SR与胰岛素抵抗的稳态模型评估显著相关（P<0.01；系数，0.02；标准误，0.011），与胰岛素血清浓度也显著相关（P<0.01；系数，0.05；标准误，0.023）。平均左心室收缩期峰值应变与体重指数显著相关（P = 0.0001；系数，0.06；标准误，0.016），与左心室质量/身高(2.7)也显著相关（P = 0.006；系数，0.016；标准误，0.018）。
我们的研究表明，在无高血压的情况下，肥胖在儿童期就与收缩期心肌变形特性的显著降低相关，累及左、右心室。肥胖不仅是后期心血管疾病的危险因素，还与纵向心肌变形特性的同时显著损害相关。
