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泰国超重和肥胖儿童心脏功能异常及相关危险因素的超声心动图评估

Echocardiographic assessment of cardiac function abnormalities and related risk factors in Thai overweight and obese children.

作者信息

Nimpum Darunwan, Jittham Worawan

机构信息

Department of Cardio-Thoracic Technology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.

Department of Pediatric, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.

出版信息

Ann Pediatr Cardiol. 2023 Nov-Dec;16(6):413-421. doi: 10.4103/apc.apc_134_23. Epub 2024 Apr 23.

Abstract

BACKGROUND

Childhood obesity has become a global concern, with its prevalence steadily increasing over the past decade. This condition negatively impacts the cardiovascular system, increasing the risk of morbidity and mortality in adulthood. This study aimed to identify cardiac function abnormalities and related risk factors among overweight and obese Thai children.

MATERIALS AND METHODS

A cross-sectional observational study of 70 children with body mass index (BMI) >1 standard deviation above the mean for Thai children was conducted at Naresuan University Hospital. Body fat percentage (%Fat) was measured, and standard transthoracic echocardiography was performed. Metabolic profiles were collected from medical records.

RESULTS

The thickness and diameter of the Left ventricle (LV) wall, including the LV posterior wall, LV internal diameter, and interventricular septum (IVS), were significantly increased in both systolic and diastolic phases in obese children. LV concentric hypertrophy and an abnormal E/E' ratio were found in 27% and 34.3% of participants, respectively. Right ventricular systolic dysfunction indicated by abnormal tricuspid annular plane systolic excursion values was found in 55.7% of all participants. In addition, 27.1% of all obese children had pulmonary hypertension. Significant differences in BMI and %Fat were detected between children with abnormal and normal IVS diastolic (IVSd) ( = 0.016). Our univariate and multivariate correlation analyses revealed a significant positive association between abnormal IVSd and %Fat, with an odd ratio (OR) of 1.13 (95% confidence interval [CI]: 1.01-1.27; = 0.047) and an adjusted OR of 1.17 (95% CI: 1.01-1.36; = 0.04).

CONCLUSIONS

Cardiac function abnormalities in childhood obesity exhibit a significant positive correlation with BMI and various cardiac dimensions, including ventricular wall thickness. One important related risk factor for increased IVS thickness is %Fat. Therefore, multidisciplinary management of obesity should be initiated as early as possible to prevent future cardiovascular morbidity and mortality.

摘要

背景

儿童肥胖已成为全球关注的问题,在过去十年中其患病率稳步上升。这种情况对心血管系统产生负面影响,增加了成年期发病和死亡的风险。本研究旨在确定泰国超重和肥胖儿童的心脏功能异常及相关危险因素。

材料与方法

在那黎宣大学医院对70名体重指数(BMI)高于泰国儿童平均水平1个标准差的儿童进行了横断面观察性研究。测量了体脂百分比(%Fat),并进行了标准经胸超声心动图检查。从病历中收集代谢谱。

结果

肥胖儿童左心室(LV)壁的厚度和直径,包括左心室后壁、左心室内径和室间隔(IVS),在收缩期和舒张期均显著增加。分别有27%和34.3%的参与者出现左心室向心性肥厚和异常的E/E'比值。在所有参与者中,55.7%的人出现三尖瓣环平面收缩期位移值异常提示的右心室收缩功能障碍。此外,所有肥胖儿童中有27.1%患有肺动脉高压。IVS舒张期(IVSd)异常和正常的儿童之间,BMI和%Fat存在显著差异(P = 0.016)。我们的单因素和多因素相关性分析显示,异常IVSd与%Fat之间存在显著正相关,比值比(OR)为1.13(95%置信区间[CI]:1.01 - 1.27;P = 0.047),调整后的OR为1.17(95%CI:1.01 - 1.36;P = 0.04)。

结论

儿童肥胖中的心脏功能异常与BMI以及包括心室壁厚度在内的各种心脏维度呈显著正相关。IVS厚度增加的一个重要相关危险因素是%Fat。因此,应尽早启动肥胖的多学科管理,以预防未来的心血管发病和死亡。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c297/11135886/5b7d7e2aca87/APC-16-413-g001.jpg

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