Zeybek Cenap, Celebi Ahmet, Aktuglu-Zeybek Cigdem, Onal Hasan, Yalcin Yalim, Erdem Abdullah, Akdeniz Celal, Imanov Elnur, Altay Suheyla, Aydin Ahmet
Pediatric Cardiology Clinic, Siyami Ersek Cardiovascular Training and Research Hospital, Istanbul, Turkey.
Pediatr Int. 2010 Apr;52(2):218-23. doi: 10.1111/j.1442-200X.2009.02940.x. Epub 2009 Aug 7.
This study was conducted to evaluate left ventricle (LV) functions using conventional and tissue Doppler imaging in childhood obesity and to identify the effects of diet on LV diastolic functions.
Conventional and tissue Doppler echocardiographic measurements were compared in 34 obese children and 24 age- and gender-matched lean controls. Fasting plasma glucose, insulin and homeostatic model assessment of insulin resistance levels were also obtained. Thirty-one of the obese children were subjected to a low-carbohydrate diet and their follow-up measurements were obtained after 6 months.
Left atrial diameter, LV mass and LV mass index were higher in obese children than in lean controls. Lateral mitral myocardial early diastolic (E(m)) and peak E(m)/myocardial late diastolic (A(m)) were lower, and mitral E/E(m) and lateral mitral myocardial isovolumetric relaxation time were higher in obese subjects than in lean controls. Insulin and homeostatic model assessment of insulin resistance levels were higher in obese patients and decreased significantly after diet. After diet therapy, lateral mitral E(m) and peak E(m)/A(m), were increased, mitral E/E(m) and myocardial isovolumetric relaxation time were decreased.
Obesity predisposes children to increased preload reserve, left ventricular subclinical diastolic dysfunction and deterioration in diastolic filling. Weight reduction with a low-carbohydrate diet seems to be associated with significant improvement in LV diastolic function and a decrease in diastolic filling, as well as causing reversal in insulin resistance seen in obese children.
本研究旨在利用传统及组织多普勒成像评估儿童肥胖症患者的左心室（LV）功能，并确定饮食对左心室舒张功能的影响。
对34名肥胖儿童和24名年龄及性别匹配的瘦对照组儿童进行传统及组织多普勒超声心动图测量。同时获取空腹血糖、胰岛素及胰岛素抵抗稳态模型评估水平。31名肥胖儿童接受低碳水化合物饮食，6个月后进行随访测量。
肥胖儿童左心房直径、左心室质量及左心室质量指数高于瘦对照组。肥胖受试者二尖瓣外侧心肌舒张早期（E(m)）及E(m)峰值/心肌舒张晚期（A(m)）较低，二尖瓣E/E(m)及二尖瓣外侧心肌等容舒张时间高于瘦对照组。肥胖患者胰岛素及胰岛素抵抗稳态模型评估水平较高，饮食后显著降低。饮食治疗后，二尖瓣外侧E(m)及E(m)峰值/A(m)增加，二尖瓣E/E(m)及心肌等容舒张时间降低。
肥胖使儿童易出现前负荷储备增加、左心室亚临床舒张功能障碍及舒张期充盈恶化。低碳水化合物饮食减重似乎与左心室舒张功能显著改善、舒张期充盈减少以及肥胖儿童胰岛素抵抗逆转有关。
