Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance studyReportar como inadecuado

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Journal of Cardiovascular Magnetic Resonance

, 19:49

First Online: 28 June 2017Received: 05 January 2017Accepted: 17 May 2017


BackgroundPediatric obesity is a growing public health problem, which is associated with increased risk of cardiovascular disease and premature death. Left ventricular LV remodeling increased myocardial mass and thickness and contractile dysfunction impaired longitudinal strain have been documented in obese children, but little attention has been paid to the right ventricle RV. We hypothesized that obese-overweight children would have evidence of RV remodeling and contractile dysfunction.

MethodsOne hundred and three children, ages 8–18 years, were prospectively recruited and underwent cardiovascular magnetic resonance CMR, including both standard cine imaging and displacement encoding with stimulated echoes DENSE imaging, which allowed for quantification of RV geometry and function-mechanics. RV free wall longitudinal strain was quantified from the end-systolic four-chamber DENSE image. Linear regression was used to quantify correlations of RV strain with LV strain and measurements of body composition adjusted for sex and height. Analysis of variance was used to study the relationship between RV strain and LV remodeling types concentric remodeling, eccentric-concentric hypertrophy.

ResultsThe RV was sufficiently visualized with DENSE in 70 68% subjects, comprising 36 healthy weight 13.6 ± 2.7 years and 34 12.1 ± 2.9 years obese-overweight children. Obese-overweight children had a 22% larger RV mass index 8.2 ± 0.9 vs 6.7 ± 1.1 g-m, p < 0.001 compared to healthy controls. RV free wall longitudinal strain was impaired in obese-overweight children −16 ± 4% vs −19 ± 5%, p = 0.02. Ten 14% out of 70 children had LV concentric hypertrophy, and these children had the most impaired RV longitudinal strain compared to those with normal LV geometry −13 ± 4% vs −19 ± 5%, p = 0.002. RV longitudinal strain was correlated with LV longitudinal strain r = 0.34, p = 0.004, systolic blood pressure r = 0.33, p = 0.006, as well as BMI z-score r = 0.28, p = 0.02, waist r = 0.31, p = 0.01, hip r = 0.40, p = 0.004 and abdominal r = 0.38, p = 0.002 circumference, height and sex adjusted.

ConclusionsObese-overweight children have evidence of RV remodeling increased RV mass and RV contractile dysfunction impaired free wall longitudinal strain. Moreover, RV longitudinal strain correlates with LV longitudinal strain, and children with LV concentric hypertrophy show the most impaired RV function. These results suggest there may be a common mechanism underlying both remodeling and dysfunction of the left and right ventricles in obese-overweight children.

KeywordsDENSE Right ventricle Strain Pediatric obesity AbbreviationsANCOVAAnalysis of covariance

ANOVAAnalysis of variance

BMIBody mass index

CMRCardiac magnetic resonance

CoVCoefficient of variation

DENSEDisplacement encoding with stimulated echoes

EDVEnd-diastolic volume

ESVEnd-systolic volume

LVLeft ventricle

LVMILeft ventricular mass index

RVRight ventricle

SDStandard deviation

SSFPSteady-state free-precession

SVStroke volume

Electronic supplementary materialThe online version of this article doi:10.1186-s12968-017-0363-5 contains supplementary material, which is available to authorized users.

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Autor: Linyuan Jing - Arichanah Pulenthiran - Christopher D. Nevius - Abba Mejia-Spiegeler - Jonathan D. Suever - Gregory J. Weh


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