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Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study

BACKGROUND: It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clini...

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Autores principales: De Jong, Kirstie A., Czeczor, Juliane K., Sithara, Smithamol, McEwen, Kevin, Loopaschuk, Gary D., Appelbe, Alan, Cukier, Kimberly, Kotowicz, Mark, McGee, Sean L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299776/
https://www.ncbi.nlm.nih.gov/pubmed/28178970
http://dx.doi.org/10.1186/s12933-017-0504-z
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author De Jong, Kirstie A.
Czeczor, Juliane K.
Sithara, Smithamol
McEwen, Kevin
Loopaschuk, Gary D.
Appelbe, Alan
Cukier, Kimberly
Kotowicz, Mark
McGee, Sean L.
author_facet De Jong, Kirstie A.
Czeczor, Juliane K.
Sithara, Smithamol
McEwen, Kevin
Loopaschuk, Gary D.
Appelbe, Alan
Cukier, Kimberly
Kotowicz, Mark
McGee, Sean L.
author_sort De Jong, Kirstie A.
collection PubMed
description BACKGROUND: It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clinical indices and via LV geometric patterns (more commonly used in research settings). Importantly, our sample consisted of hypertensive patients that are routinely screened for LVH via echocardiography and normotensive patients that would normally be deemed low risk with no further action required. METHODS: This cross sectional study comprised a total of 353 Caucasian patients, grouped based on diagnosis of obesity, T2D and hypertension, with normotensive obese patients further separated based on metabolic health. Basic metabolic parameters were collected and LV structure and function were assessed via transthoracic echocardiography. Multivariable logistic and linear regression analyses were used to identify predictors of LVH and diastolic dysfunction. RESULTS: Metabolically healthy normotensive obese patients exhibited relatively low risk of LVH. However, normotensive metabolically non-healthy obese, T2D and obese/T2D patients all presented with reduced normal LV geometry that coincided with increased LV concentric remodelling. Furthermore, normotensive patients presenting with both obesity and T2D had a higher incidence of concentric hypertrophy and grade 3 diastolic dysfunction than normotensive patients with either condition alone, indicating an additive effect of obesity and T2D. Alarmingly these alterations were at a comparable prevalence to that observed in hypertensive patients. Interestingly, assessment of LVPWd, a traditional index of LVH, underestimated the presence of LV concentric remodelling. The implications for which were demonstrated by concentric remodelling and concentric hypertrophy strongly associating with grade 1 and 3 diastolic dysfunction respectively, independent of sex, age and BMI. Finally, pulse pressure was identified as a strong predictor of LV remodelling within normotensive patients. CONCLUSIONS: These findings show that metabolically non-healthy obese, T2D and obese/T2D patients can develop LVH independent of hypertension. Furthermore, that LVPWd may underestimate LV remodelling in these patient groups and that pulse pressure can be used as convenient predictor of hypertrophy status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12933-017-0504-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-52997762017-02-13 Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study De Jong, Kirstie A. Czeczor, Juliane K. Sithara, Smithamol McEwen, Kevin Loopaschuk, Gary D. Appelbe, Alan Cukier, Kimberly Kotowicz, Mark McGee, Sean L. Cardiovasc Diabetol Original Investigation BACKGROUND: It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clinical indices and via LV geometric patterns (more commonly used in research settings). Importantly, our sample consisted of hypertensive patients that are routinely screened for LVH via echocardiography and normotensive patients that would normally be deemed low risk with no further action required. METHODS: This cross sectional study comprised a total of 353 Caucasian patients, grouped based on diagnosis of obesity, T2D and hypertension, with normotensive obese patients further separated based on metabolic health. Basic metabolic parameters were collected and LV structure and function were assessed via transthoracic echocardiography. Multivariable logistic and linear regression analyses were used to identify predictors of LVH and diastolic dysfunction. RESULTS: Metabolically healthy normotensive obese patients exhibited relatively low risk of LVH. However, normotensive metabolically non-healthy obese, T2D and obese/T2D patients all presented with reduced normal LV geometry that coincided with increased LV concentric remodelling. Furthermore, normotensive patients presenting with both obesity and T2D had a higher incidence of concentric hypertrophy and grade 3 diastolic dysfunction than normotensive patients with either condition alone, indicating an additive effect of obesity and T2D. Alarmingly these alterations were at a comparable prevalence to that observed in hypertensive patients. Interestingly, assessment of LVPWd, a traditional index of LVH, underestimated the presence of LV concentric remodelling. The implications for which were demonstrated by concentric remodelling and concentric hypertrophy strongly associating with grade 1 and 3 diastolic dysfunction respectively, independent of sex, age and BMI. Finally, pulse pressure was identified as a strong predictor of LV remodelling within normotensive patients. CONCLUSIONS: These findings show that metabolically non-healthy obese, T2D and obese/T2D patients can develop LVH independent of hypertension. Furthermore, that LVPWd may underestimate LV remodelling in these patient groups and that pulse pressure can be used as convenient predictor of hypertrophy status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12933-017-0504-z) contains supplementary material, which is available to authorized users. BioMed Central 2017-02-08 /pmc/articles/PMC5299776/ /pubmed/28178970 http://dx.doi.org/10.1186/s12933-017-0504-z Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Investigation
De Jong, Kirstie A.
Czeczor, Juliane K.
Sithara, Smithamol
McEwen, Kevin
Loopaschuk, Gary D.
Appelbe, Alan
Cukier, Kimberly
Kotowicz, Mark
McGee, Sean L.
Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
title Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
title_full Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
title_fullStr Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
title_full_unstemmed Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
title_short Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
title_sort obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299776/
https://www.ncbi.nlm.nih.gov/pubmed/28178970
http://dx.doi.org/10.1186/s12933-017-0504-z
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