Association of Subclinical Right Ventricular Dysfunction With Obesity

• Published in: Journal of the American College of Cardiology 2006-02, Vol.47 (3), p.611-616
• Main Authors: Wong, Chiew Y., O’Moore-Sullivan, Trisha, Leano, Rodel, Hukins, Craig, Jenkins, Carly, Marwick, Thomas H.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood Pressure; Body Mass Index; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Echocardiography; Exercise Test; Female; Gender; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Insulin; Male; Medical sciences; Metabolic diseases; Middle Aged; Obesity; Obesity - complications; Obesity - diagnostic imaging; Obesity - physiopathology; Overweight; Oxygen Consumption; Patients; Polysomnography; Pulmonary arteries; Sleep apnea; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - physiopathology; Sleep disorders; Stroke Volume; Variance analysis; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2005.11.015

Association of Subclinical Right Ventricular Dysfunction With Obesity Chiew Y. Wong, Trisha O’Moore-Sullivan, Rodel Leano, Craig Hukins, Carly Jenkins, Thomas H. Marwick This study sought the determinants of right ventricular (RV) dysfunction in 112 overweight and obese subjects and 36 referents using tissue Doppler imaging. Obese and overweight subjects had reduced RV function, evidenced by reduction of myocardial systolic and diastolic velocity and strain indexes irrespective of the presence of sleep apnea. Body mass index remained independently related to these differences after adjusting for age, insulin, and mean arterial pressures. These changes were shown to be associated with reduced exercise capacity but not to sleep apnea severity. The purpose of this research was to identify the determinants of right ventricular (RV) dysfunction in overweight and obese subjects. Right ventricular dysfunction in obese subjects is usually ascribed to comorbid diseases, especially obstructive sleep apnea. We used tissue Doppler imaging to identify the determinants of RV dysfunction in overweight and obese subjects. Standard and tissue Doppler echocardiography was performed in 112 overweight (body mass index [BMI] 25 to 29.9 kg/m2) or obese (BMI >30 kg/m2) subjects and 36 referents (BMI 35 kg/m2had reduced RV function compared with referent subjects, evidenced by reduced sm(6.5 ± 2.4 cm/s vs. 10.2 ± 1.5 cm/s, p < 0.001), peak strain (−21 ± 4% vs. −28 ± 4%, p < 0.001), peak strain rate (−1.4 ± 0.4 s−1vs. −2.0 ± 0.5 s−1, p < 0.001), and em(−6.8 ± 2.4 cm/s vs. −10.3 ± 2.5 cm/s, p < 0.001), irrespective of the presence of sleep apnea. Similar but lesser degrees of reduced systolic function (p < 0.05) were present in overweight (BMI 25 to 29.9 kg/m2) and mildly obese (BMI 30 to 35 kg/m2) groups. Differences in RV em, sm, and strain indexes were demonstrated between the severely versus overweight and mildly obese groups (p < 0.05). Body mass index remained independently related to RV changes after adjusting for age, log insulin, and mean arterial pressures. In obese patients, these changes were associated with reduced exercise capacity but not the duration of obesity and presence of sleep apnea or its severity. Increasing BMI is associated with increasing severity of RV dysfunct