Document Type : Original Article(s)

Authors

1 Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Resident, Student Research Committee AND Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Department of General and Laparoscopic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

BACKGROUND: It has been proposed that left ventricular diastolic dysfunction (LVDD) is a possible physiological link between high body mass index (BMI) and future occurrence of heart failure (HF). The present cross-sectional study was aimed to analyze the association between BMI and LVDD by transthoracic echocardiography (TTE).METHODS: This study was conducted from May 2017 to September 2019 in Khorshid Hospital of Isfahan University of Medical Sciences, Isfahan, Iran. Based on the calculated BMI (kg/m²), patients were divided into three groups: group 1: subjects with BMI < 25, as a normal group (n = 75), group 2: volunteer cases with 40 > BMI ≥ 30, as an obese group (n = 98), and group 3: patients with BMI ≥ 40, as a morbidly obese group (n = 100). TTE was performed by a trained cardiologist and associated variables including left atrium (LA) volume, E, septal e’, lateral e’,andE/e’ were assessed and also subjects were characterized as normal diastolic function, abnormal diastolic function, and inconclusive diagnosis of diastolic dysfunction (DD).RESULTS: Apart from the ejection fraction (EF) and the tricuspid regurgitation velocity (TRV), there was a significant difference between the other echocardiographic variables including LA volume, E, septal e’, lateral e’, and E/e’ (P < 0.05). One patient with morbid obesity in our study revealed LVDD. There was no significant difference between three groups (P = 0.42).CONCLUSION: There is no considerable relationship between obesity and LVDD. It seems that the absence of associated comorbidities such as diabetes, coronary disorders, etc. plays a crucial role in preventing LVDD, but for realistic and definitive decision, more cellular and molecular investigations and studies with larger sample size are necessary.

Keywords

  1. Eikendal ALM, Gohar A, Rutten FH, Bots ML, Appelman Y, Hofstra L, et al. Sex-specific relations of cardiovascular risk factors with left ventricular diastolic dysfunction/heart failure with preserved ejection fraction are underreported: A call for action. J Card Fail 2018; 24(6): 412-4.
  2. Jadhav S, Valery R, Seliverstov P, Sitkin S. Risk factors for developing diastolic dysfunction in nonalcoholic steatohepatitis. Archiv Euromedica 2019; 9(1): 104-5.
  3. van Heerebeek L, Franssen CP, Hamdani N, Verheugt FW, Somsen GA, Paulus WJ. Molecular and cellular basis for diastolic dysfunction. Curr Heart Fail Rep 2012; 9(4): 293-302.
  4. Kane GC, Karon BL, Mahoney DW, Redfield MM, Roger VL, Burnett JC, et al. Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 2011; 306(8): 856-63.
  5. Teo SG, Yang H, Chai P, Yeo TC. Impact of left ventricular diastolic dysfunction on left atrial volume and function: A volumetric analysis. Eur J Echocardiogr 2010; 11(1): 38-43.
  6. Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, et al. Effect of obesity and overweight on left ventricular diastolic function: A community-based study in an elderly cohort. J Am Coll Cardiol 2011; 57(12): 1368-74.
  7. Choy B, Hansen E, Moss AJ, McNitt S, Zareba W, Goldenberg I. Relation of body mass index to sudden cardiac death and the benefit of implantable cardioverter-defibrillator in patients with left ventricular dysfunction after healing of myocardial infarction. Am J Cardiol 2010; 105(5): 581-6.
  8. Saeedi Borujeni MJ, Esfandiary E, Taheripak G, Codoner-Franch P, Alonso-Iglesias E, Mirzaei H. Molecular aspects of diabetes mellitus: Resistin, microRNA, and exosome. J Cell Biochem 2018; 119(2): 1257-72.
  9. Saeedi Borujeni MJ, Esfandiary E, Baradaran A, Valiani A, Ghanadian M, Codoner-Franch P, et al. Molecular aspects of pancreatic beta-cell dysfunction: Oxidative stress, microRNA, and long noncoding RNA. J Cell Physiol 2019; 234(6): 8411-25.
  10. Gishti O, Gaillard R, Durmus B, Abrahamse M, van der Beek EM, Hofman A, et al. BMI, total and abdominal fat distribution, and cardiovascular risk factors in school-age children. Pediatr Res 2015; 77(5): 710-8.
  11. Porter TR, Shillcutt SK, Adams MS, Desjardins G, Glas KE, Olson JJ, et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the American Society of Echocardiography. J Am Soc Echocardiogr 2015; 28(1): 40-56.
  12. De Pergola G, Nardecchia A, Giagulli VA, Triggiani V, Guastamacchia E, Minischetti MC, et al. Obesity and heart failure. Endocr Metab Immune Disord Drug Targets 2013; 13(1): 51-7.
  13. Pascual M, Pascual DA, Soria F, Vicente T, Hernandez AM, Tebar FJ, et al. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart 2003; 89(10): 1152-6.
  14. Herszkowicz N, Barbato A, Salvi W, Pinheiro D, Pantaleao D, Halpern A, et al. Contribution of Doppler echocardiography to the evaluation of systolic and diastolic function of obese women versus a control group. Arq Bras Cardiol 2001; 76(3): 189-96.
  15. Rozenbaum Z, Topilsky Y, Khoury S, Pereg D, Laufer-Perl M. Association of body mass index and diastolic function in metabolically healthy obese with preserved ejection fraction. Int J Cardiol 2019; 277: 147-52.
  16. van Grootel RWJ, Kauling RM, Menting ME, McGhie J, Roos-Hesselink JW, van den Bosch AE. Influence of age and sex on left ventricular diastolic strain analysis. Int J Cardiovasc Imaging 2019; 35(3): 491-8.
  17. Sharpe JA, Naylor LH, Jones TW, Davis EA, O'Driscoll G, Ramsay JM, et al. Impact of obesity on diastolic function in subjects < or = 16 years of age. Am J Cardiol 2006; 98(5): 691-3.
  18. Harada K, Orino T, Takada G. Body mass index can predict left ventricular diastolic filling in asymptomatic obese children. Pediatr Cardiol 2001; 22(4): 273-8.
  19. Mehta SK, Holliday C, Hayduk L, Wiersma L, Richards N, Younoszai A. Comparison of myocardial function in children with body mass
  20. indexes >/=25 versus those <25 kg/m2. Am J Cardiol 2004; 93(12): 1567-9.
  21. Alpert MA, Lambert CR, Panayiotou H, Terry BE, Cohen MV, Massey CV, et al. Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol 1995; 76(16): 1194-7.
  22. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 2013; 10(6): 330-44.
  23. Forlano R, Mullish BH, Nathwani R, Dhar A, Thursz MR, Manousou P. Non-alcoholic fatty liver disease and vascular disease. Curr Vasc Pharmacol 2021; 19(3): 269-79.
  24. Pagidipati NJ, Zheng Y, Green JB, McGuire DK, Mentz RJ, Shah S, et al. Association of obesity with cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease: Insights from TECOS. Am Heart J 2020; 219: 47-57.
  25. Lee KS, Moser DK, Lennie TA, Pelter MM, Nesbitt T, Southard JA, et al. Obesity paradox: Comparison of heart failure patients with and without comorbid diabetes. Am J Crit Care 2017; 26(2): 140-8.
  26. Cornier MA, Despres JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, et al. Assessing adiposity: A scientific statement from the American Heart Association. Circulation 2011; 124(18): 1996-2019.
  27. Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr 2005; 81(3): 555-63.