Institute of Hypertension, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
Department of Echocardiography, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
ESC Heart Fail. 2021 Aug;8(4):3058-3069. doi: 10.1002/ehf2.13403. Epub 2021 May 2.
The association of strictly defined metabolic healthy obese (MHO) with subclinical cardiac function was unclear. Our study aims to examine the role of MHO in subclinical cardiac dysfunction in a Chinese population.
The study subjects were recruited from Danyang from 2017 to 2019. Obesity was defined by body mass index (BMI) categories (normal weight, overweight and obesity). Metabolic health was strictly defined as having neither any of the guidelines recommended metabolic syndrome components nor insulin resistance. Thus, subjects were grouped by BMI categories and metabolic health status as six groups. Preclinical systolic (global longitudinal strain [GLS]) and diastolic function were assessed by 2D speckle tracking, and transmitral and tissue Doppler imaging, respectively. The 2757 participants (mean age ± standard deviation, 52.7 ± 11.7 years) included 1613 (58.5%) women, 999 (36.2%) obese, 2080 (75.4%) metabolically unhealthy and 93 (3.4%) MHO participants. After adjustment for covariates, the trend was similar for left ventricular (LV) ejection fraction (P ≥ 0.07) but significantly worse for GLS, e' and E/e' (P ≤ 0.02) across the six groups or passing from normal weight to obese individuals irrespective of metabolic status. MHO participants had lower GLS (20.4 vs. 21.4%) and e' (9.6 vs. 10.6 cm/s) compared with controls (P < 0.0001) but had similar GLS (P = 0.47) compared with metabolically unhealthy obese (MUO). Regardless of obesity status, metabolically unhealthy participants had worse diastolic function compared with their metabolically healthy counterparts (P ≤ 0.0004). Compared with controls, MHO individuals were at higher risk of subclinical LV systolic dysfunction (OR = 3.44, 95% CI = 1.25-9.49, P = 0.02). These results were robust to sensitivity analysis.
MHO was substantially associated with worse subclinical systolic function although early diastolic dysfunction seemed to be more accentuated in MUO.
代谢健康肥胖（MHO）与亚临床心功能的关联尚不清楚。本研究旨在探讨 MHO 在中国人亚临床心功能障碍中的作用。
研究对象于 2017 年至 2019 年期间从丹阳招募。肥胖的定义为体重指数（BMI）类别（正常体重、超重和肥胖）。代谢健康是严格定义的，即没有任何推荐的代谢综合征成分或胰岛素抵抗。因此，根据 BMI 类别和代谢健康状况将受试者分为六组。通过二维斑点追踪和组织多普勒成像分别评估亚临床收缩（整体纵向应变[GLS]）和舒张功能。2757 名参与者（平均年龄±标准差，52.7±11.7 岁）包括 1613 名（58.5%）女性、999 名（36.2%）肥胖者、2080 名（75.4%）代谢不健康者和 93 名（3.4%）MHO 参与者。在调整协变量后，左心室（LV）射血分数的趋势相似（P≥0.07），但在六组或从正常体重到肥胖个体，GLS、e'和 E/e'（P≤0.02）的变化趋势更差。与对照组相比，MHO 患者的 GLS（20.4%比 21.4%）和 e'（9.6 比 10.6cm/s）更低（P<0.0001），但与代谢不健康肥胖（MUO）患者相比，GLS 相似（P=0.47）。无论肥胖状况如何，代谢不健康的患者与代谢健康的患者相比，舒张功能更差（P≤0.0004）。与对照组相比，MHO 个体发生亚临床 LV 收缩功能障碍的风险更高（OR=3.44，95%CI=1.25-9.49，P=0.02）。这些结果在敏感性分析中是稳健的。
尽管早期舒张功能障碍在 MUO 中更为明显，但 MHO 与亚临床收缩功能障碍密切相关。
