Left Ventricular Geometrical Changes in Severely Obese Adolescents: Prevalence, Determinants, and Clinical Implications

Ali Talib*, Yvonne G. M. Roebroek, Givan F. Paulus, Kris van Loo, Bjorn Winkens, Nicole D. Bouvy, Ernst L. W. E. van Heurn

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

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 samplest, 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)zscore. 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 BMIzscore, left ventricular mass index was significantly associated with apnea-hypopnea index (AHI) (regression parameterB = 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.

Original languageEnglish
Pages (from-to)331-339
Number of pages9
JournalPediatric Cardiology
Volume42
Issue number2
Early online date20 Oct 2020
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Left ventricular hypertrophy
  • Left ventricular geometry
  • Severe obesity
  • Adolescents
  • OBSTRUCTIVE SLEEP-APNEA
  • BODY-MASS INDEX
  • CARDIOVASCULAR RISK-FACTORS
  • GROWTH-FACTOR-I
  • METABOLIC SYNDROME
  • BLOOD-PRESSURE
  • INTERVENTRICULAR SEPTUM
  • WALL THICKNESS
  • WAIST CIRCUMFERENCE
  • INSULIN-RESISTANCE

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