Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
Pediatr Cardiol. 2021 Feb;42(2):331-339. doi: 10.1007/s00246-020-02487-9. Epub 2020 Oct 20.
Left ventricular hypertrophy (LVH) is independently associated with a higher risk of cardiovascular morbidity and mortality in adults. Adiposity is a risk factor for LVH, independent of blood pressure. Potential causes of this nonhemodynamic pathogenesis identified in adults include adverse body fat distribution, insulin resistance, dyslipidemia, and obstructive sleep apnea syndrome (OSA). In severely obese adolescents, the determinants of obesity-induced changes in left ventricular structure are poorly characterized. Cardiac ultrasonographic, demographic, anthropometric, and comorbidity-related data were prospectively collected in adolescents with severe obesity refractory to conservative treatment who presented for surgical therapy. Differences between adolescents with LVH and without LVH were evaluated using independent samples t, chi-square, or Fisher's exact test. Multivariable linear regression analysis was performed to evaluate associations with left ventricular structural changes, corrected for body mass index (BMI) z score. Forty-three patients entered analysis, of whom 24 (55.8%) showed LVH. The most common geometrical change was eccentric LVH (eLVH), occurring in 21 subjects (48.8%). Demographic and anthropometric variables did not differ between patients with and without LVH. Independent of BMI z score, left ventricular mass index was significantly associated with apnea-hypopnea index (AHI) (regression parameter B = 0.8; 95% CI 0.3 to 1.2). Interventricular septum thickness (IVST) was significantly associated with HOMA-IR values (B = 0.1; 95% CI 0.04 to 0.2), HDL-cholesterol (B = - 1.2; 95% CI - 2.2 to 0.1), and triglyceride levels (B = 0.5; 95% CI 0.001 to 0.9). LVH, especially eLVH, is highly prevalent amongst severely obese adolescents. Adverse changes in cardiac structure, increased IVST in particular, are independently associated with several nonhemodynamic comorbidities that are common in this population, namely OSA, insulin resistance, and dyslipidemia.
左心室肥厚（LVH）与成年人心血管发病率和死亡率的升高独立相关。肥胖是 LVH 的一个危险因素，与血压无关。在成年人中，确定的这种非血流动力学发病机制的潜在原因包括不良的体脂分布、胰岛素抵抗、血脂异常和阻塞性睡眠呼吸暂停综合征（OSA）。在严重肥胖的青少年中，肥胖引起的左心室结构变化的决定因素尚不清楚。前瞻性收集了严重肥胖且经保守治疗无效的青少年患者的心脏超声、人口统计学、人体测量学和合并症相关数据，这些患者接受了手术治疗。使用独立样本 t 检验、卡方检验或 Fisher 精确检验评估 LVH 与非 LVH 青少年之间的差异。进行多变量线性回归分析，以评估与左心室结构变化的关联，校正体重指数（BMI）z 评分。43 例患者进入分析，其中 24 例（55.8%）存在 LVH。最常见的几何变化是偏心性 LVH（eLVH），发生在 21 例患者（48.8%）中。LVH 与非 LVH 患者的人口统计学和人体测量学变量无差异。独立于 BMI z 评分，左心室质量指数与呼吸暂停低通气指数（AHI）显著相关（回归参数 B=0.8；95%CI 0.3 至 1.2）。室间隔厚度（IVST）与 HOMA-IR 值显著相关（B=0.1；95%CI 0.04 至 0.2）、高密度脂蛋白胆固醇（B=-1.2；95%CI -2.2 至 0.1）和甘油三酯水平（B=0.5；95%CI 0.001 至 0.9）。严重肥胖的青少年中 LVH，尤其是 eLVH，非常普遍。特别是 IVST 的不良变化，与该人群中常见的几种非血流动力学合并症独立相关，即 OSA、胰岛素抵抗和血脂异常。
