Kibar Ayşe Esin, Paç Feyza Ayşenur, Oflaz Mehmet Burhan, Ballı Sevket, Ece Ibrahim
Department of Pediatric Cardiology, Türkiye Yüksek İhtisas Education And Research Hospital, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2012 Jun;40(4):337-46. doi: 10.5543/tkda.2012.49344.
The purpose of our study was to determine structural and functional changes on left ventricular function (LV) according to body mass index (BMI) in normotansive overweight and obese children.
Thirty normotansive overweight children (group 2; mean age: 13.2 ± 2.1 years, BMI: 25-30 kg/m²), 30 obese children (group 3; mean age: 13.3 ± 2.0 years, BMI ≥ 30 kg/m²), and 50 healthy controls (mean age: 13.2 ± 1.8 years, BMI: 18-24.9 kg/m²) were included in this study. Continuous ambulatory pressure was monitored in the obese group, while standard and pulsed wave (PW) Doppler echocardiographic examinations were evaluated in all three study groups.
In overweight and obese children, left atrial volume, left atrial/aortic root diameter ratio, LV interventricular septum, LV posterior wall thickness, LV end-diastolic diameter and volume, and LV mass were significantly higher than those children in the control group (p<0.01). Blood pressure was within the normal range but was increased in the obese groups. Transmitral E/A and pulmonary vein (PV) systolic/diastolic velocity (S/D) ratios were decreased, but E-wave deceleration time, PVA velocities, and the end-diastolic distance from the mitral annulus to the LV apex were increased in both obese groups (p<0.05). BMI was significantly correlated with duration of obesity and LV mass (r=0.527, r=0.506, p<0.01, respectively). Significantly negative correlations were found between BMI, Mitral E/A, and PV S/D ratio (r=-0.230, r=-0.577, p<0.01, respectively).
Subclinical LV myocardial dysfunction was noted in obese subgroups. Determination of diastolic dysfunction by PV PW Doppler can be useful a pre-obese period.
我们研究的目的是确定血压正常的超重和肥胖儿童中，根据体重指数（BMI）左心室功能（LV）的结构和功能变化。
本研究纳入了30名血压正常的超重儿童（第2组；平均年龄：13.2±2.1岁，BMI：25 - 30kg/m²）、30名肥胖儿童（第3组；平均年龄：13.3±2.0岁，BMI≥30kg/m²）和50名健康对照儿童（平均年龄：13.2±1.8岁，BMI：18 - 24.9kg/m²）。对肥胖组进行连续动态血压监测，而对所有三个研究组进行标准和脉冲波（PW）多普勒超声心动图检查。
超重和肥胖儿童的左心房容积、左心房/主动脉根部直径比值、左心室室间隔、左心室后壁厚度、左心室舒张末期直径和容积以及左心室质量均显著高于对照组儿童（p<0.01）。血压在正常范围内，但在肥胖组中有所升高。肥胖组的二尖瓣E/A和肺静脉（PV）收缩/舒张速度（S/D）比值降低，但E波减速时间、PVA速度以及二尖瓣环至左心室心尖的舒张末期距离增加（p<0.05）。BMI与肥胖持续时间和左心室质量显著相关（分别为r = 0.527，r = 0.506，p<0.01）。在BMI、二尖瓣E/A和PV S/D比值之间发现显著的负相关（分别为r = -0.230，r = -0.577，p<0.01）。
在肥胖亚组中发现了亚临床左心室心肌功能障碍。通过PV PW多普勒确定舒张功能障碍在肥胖前期可能有用。
