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Effect of Obesity and Overweight on Left Ventricular Diastolic Function: A Community-Based Study in an Elderly Cohort
Study Questions:
What is the effect of increased body size on left ventricular (LV) diastolic dysfunction?
Methods:
The study investigators evaluated LV diastolic function in 950 participants from the CABL (Cardiovascular Abnormalities and Brain Lesions) study, using traditional and tissue Doppler imaging. They measured peak early transmitral diastolic flow velocity (E), late transmitral diastolic flow velocity (A), and early diastolic mitral annulus velocity (E=), and calculated E/A and E/E’. They divided the study sample into three groups: normal weight (body mass index [BMI] <25.0 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obese (BMI ≥30 kg/m2).
Results:
Using multivariate analyses, they found that BMI was independently associated with higher E, A, and E/E’, an indicator of LV filling pressure (all p ≤ 0.01). Overweight and obese had lower E’ (both p < 0.01) and higher E/E’ (both p < 0.01) than normal weight participants. The E/A was lower in obese subjects than in normal weight subjects (p < 0.01). The investigators also found that the risk of diastolic dysfunction was significantly greater in overweight individuals (adjusted odds ratio, 1.52; 95% confidence interval, 1.04-2.22) and obese subjects (adjusted odds ratio, 1.60; 95% confidence interval, 1.06-2.41) compared to normal weight subjects.
Conclusions:
The study authors concluded that increased BMI was associated with worse LV diastolic function independent of LV mass and associated risk factors, and that the increased risk of LV diastolic dysfunction in both overweight and obese persons may partially account for the increased risk of heart failure associated with both conditions.
Perspective:
The findings of this large study are important because some of the data support the results of an earlier paper (in a smaller cohort) that reported that left and right ventricular masses were significantly increased, LV diastolic function was impaired, and aortic distensibility was reduced in the obese (J Am Coll Cardiol 2009;54:718-26). Given that there is significant ventriculo-ventricular interaction influencing cardiac function and that obesity is associated with sleep apnea, the findings of this study would have been significantly enhanced if the investigators had included data pertaining to right ventricular function and structure, and aortic distensibility.
Keywords: Body Mass Index, Cardiovascular Abnormalities, Ventricular Function, Left, Overweight, Heart Failure, Obesity, Diastole
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