Russo Cesare, Sera Fusako, Jin Zhezhen, Palmieri Vittorio, Homma Shunichi, Rundek Tatjana, Elkind Mitchell S V, Sacco Ralph L, Di Tullio Marco R
Department of Medicine, Columbia University, New York, NY, USA.
Department of Biostatistics, Columbia University, New York, NY, USA.
Eur J Heart Fail. 2016 May;18(5):537-44. doi: 10.1002/ejhf.521. Epub 2016 Apr 24.
General obesity, measured by body mass index (BMI), and abdominal adiposity, measured as waist circumference (WC) and waist-to-hip ratio (WHR), are associated with heart failure and cardiovascular events. However, the relationship of general and abdominal obesity with subclinical left ventricular (LV) dysfunction is unknown. We assessed the association of general and abdominal obesity with subclinical LV systolic dysfunction in a population-based elderly cohort.
Participants from the Cardiovascular Abnormalities and Brain Lesions study underwent measurement of BMI, WC, and WHR. Left ventricular systolic function was assessed by two-dimensional echocardiographic LV ejection fraction (LVEF) and speckle-tracking global longitudinal strain (GLS). The study population included 729 participants (mean age 71 ± 9 years, 60% women). In multivariate analysis, higher BMI (but not WC and WHR) was associated with higher LVEF (β = 0.11, P = 0.003). Higher WC (β = 0.08, P = 0.038) and higher WHR (β = 0.15, P < 0.001) were associated with lower GLS, whereas BMI was not (P = 0.720). Compared with normal WHR, high WHR was associated with lower GLS in all BMI categories (normal, overweight, and obese), and was associated with subclinical LV dysfunction by GLS both in participants without [adjusted odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1-3.6, P = 0.020] and with general obesity (adjusted OR 5.4, 95% CI 1.1-25.9, P = 0.034). WHR was incremental to BMI and risk factors in predicting LV dysfunction.
Abdominal adiposity was independently associated with subclinical LV systolic dysfunction by GLS in all BMI categories. BMI was not associated with LV dysfunction. Increased abdominal adiposity may be a risk factor for LV dysfunction regardless of the presence of general obesity.
通过体重指数（BMI）衡量的全身肥胖以及通过腰围（WC）和腰臀比（WHR）衡量的腹部肥胖与心力衰竭和心血管事件相关。然而，全身肥胖和腹部肥胖与亚临床左心室（LV）功能障碍之间的关系尚不清楚。我们在一个基于人群的老年队列中评估了全身肥胖和腹部肥胖与亚临床左心室收缩功能障碍的关联。
心血管异常与脑病变研究的参与者接受了BMI、WC和WHR的测量。通过二维超声心动图左心室射血分数（LVEF）和斑点追踪整体纵向应变（GLS）评估左心室收缩功能。研究人群包括729名参与者（平均年龄71±9岁，60%为女性）。在多变量分析中，较高的BMI（而非WC和WHR）与较高的LVEF相关（β=0.11，P=0.003）。较高的WC（β=0.08，P=0.038）和较高的WHR（β=0.15，P<0.001）与较低的GLS相关，而BMI则不然（P=0.720）。与正常WHR相比，高WHR在所有BMI类别（正常、超重和肥胖）中均与较低的GLS相关，并且在无全身肥胖[调整后的优势比（OR）2.0，95%置信区间（CI）1.1 - 3.6，P=0.020]和有全身肥胖的参与者中均通过GLS与亚临床左心室功能障碍相关（调整后的OR 5.4，95%CI 1.1 - 25.9，P=0.034）。在预测左心室功能障碍方面，WHR相对于BMI和危险因素具有增量作用。
在所有BMI类别中，腹部肥胖通过GLS与亚临床左心室收缩功能障碍独立相关。BMI与左心室功能障碍无关。无论是否存在全身肥胖，腹部肥胖增加可能是左心室功能障碍的一个危险因素。
