Tumuklu Mustafa Murat, Etikan Ilker, Kisacik Bunyamin, Kayikcioglu Meral
Department of Cardiology, Faculty of Medicine, University of Gaziosmanpasa, Tokat, Turkey.
Echocardiography. 2007 Sep;24(8):802-9. doi: 10.1111/j.1540-8175.2007.00484.x.
Obesity is associated with heart failure, cardiovascular morbidity, and mortality. A direct effect of weight on left ventricle (LV) structure and myocardial function is not well-established.
The aim of our study is to determine the effect of obesity on LV morphology and systolic function by using LV standard Doppler echocardiographic indices, myocardial Doppler imaging and strain/strain rate imaging indices.
We studied 33 obese and 34 age, sex-adjusted control subjects who had no other pathological conditions. Standard transthoracic Doppler echocardiographical measurements, reconstructed spectral pulsed wave tissue Doppler velocities, strain and strain rate imaging of six different myocardial regions were obtained. Peak systolic velocity (SR), peak systolic strain (I), peak systolic strain rate (SR) for each region and as a global systolic longitidunal LV function mean of peak systolic strain of six myocardial regions (glsca) were compared.
Age, body surface area, blood pressure, and heart rate were comparable between the two groups. Obese subjects had significantly increased LV end-diastolic volume, septal wall thickness, left atrial diameter, and decreased transmitral early to late diastolic velocity ratio. In obese subjects, reconstructed spectral pulsed-wave tissue Doppler analysis showed significantly decreased basal lateral peak systolic (Sm) velocity (6.68 +/- 1.89 vs. 8.08 +/- 2.50, P < 0.05), mid lateral Sm (5.01 +/- 2.17 vs. 6.78 +/- 3.22, P < 0.05). Differences in regional strain rate (mid septal SR, 1.45 +/- 0.23 vs. 1.63 +/- 0.18, P < 0.05), regional strain (basal septum I, 19.13 +/- 3.83 vs. 22.09 +/- 4.60, P < 0.05; mid-septum I, 18.03 +/- 2.91 vs. 20.25 +/- 4.77, P < 0.05; radial I, 27.50 +/- 7.32 vs. 35.53 +/- 9.48, P < 0.05), and global strain (glsca, 19.38 +/- 1.34 vs. 21.24 +/- 2.82, P < 0.05) were identified between obese and the referent subjects.
Obesity is associated with morphologic alterations in left ventricle and left atrium and subclinical changes in left ventricle systolic function which can be detected by strain and strain rate imaging even without overt heart disease.
肥胖与心力衰竭、心血管疾病发病率及死亡率相关。体重对左心室（LV）结构和心肌功能的直接影响尚未完全明确。
本研究旨在通过使用左心室标准多普勒超声心动图指标、心肌多普勒成像以及应变/应变率成像指标，确定肥胖对左心室形态和收缩功能的影响。
我们研究了33名肥胖受试者以及34名年龄、性别匹配且无其他病理状况的对照受试者。获取标准经胸多普勒超声心动图测量值、重建的频谱脉冲波组织多普勒速度、六个不同心肌区域的应变及应变率成像。比较每个区域的收缩期峰值速度（SR）、收缩期峰值应变（I）、收缩期峰值应变率（SR），以及作为左心室整体收缩期纵向功能的六个心肌区域收缩期峰值应变平均值（glsca）。
两组之间的年龄、体表面积、血压及心率具有可比性。肥胖受试者的左心室舒张末期容积、室间隔厚度、左心房直径显著增加，二尖瓣舒张早期与晚期速度比值降低。在肥胖受试者中，重建的频谱脉冲波组织多普勒分析显示，基底外侧收缩期峰值（Sm）速度显著降低（6.68±1.89对8.08±2.50，P<0.05），中间外侧Sm（5.01±2.17对6.78±3.22，P<0.05）。肥胖受试者与对照受试者之间在区域应变率（中间间隔SR，1.45±0.23对1.63±0.18，P<0.05）、区域应变（基底间隔I，19.13±3.83对22.09±4.60，P<0.05；中间间隔I，18.03±2.91对20.25±4.77，P<0.05；径向I，27.50±7.32对35.53±9.48，P<0.05）以及整体应变（glsca，19.38±1.34对21.24±2.82，P<0.05）方面存在差异。
肥胖与左心室和左心房的形态改变以及左心室收缩功能的亚临床变化相关，即使在无明显心脏病的情况下，通过应变和应变率成像也可检测到这些变化。
