Early echocardiography abnormalities in obese children and adolescent and reversibility of these abnormalities after significant weight reduction

Obesity is becoming an epidemic threat for the individual and society. The increasing prevalence of overweight children and adolescents is likely to have a great impact on the future cardiovascular health of these subjects. Obesity is a strong risk factor for cardiovascular morbidity and mortality. Cardiac abnormalities of obese children and adolescents include the echocardiographically revealed early and preclinical LV or septal hypertrophy, and left or right ventricular dysfunction. Most of these abnormalities, which are usually more pronounced in patients with morbid obesity, can be partially reversed after weight reduction. Evaluate early echocardiography changes in obese children and whether these cardiac abnormalities reverse with significant weight reduction in children and adolescents or not. We started this study by 50 obese children and adolescents and 30 non obese controls matched for age and sex. BMI was calculated. Complete echocardiographic study was performed on each patient and control subject. Hematological and biochemical variables were determined in the obese subjects from fasting blood samples and included glucose, total cholesterol, triglycerides [TG], HDL cholesterol and LDL cholesterol. All our patients' strict dietetic regime with exercises for 6 months. After 6 months full examination, including all measurements and echocardiography and laboratory investigations were done again. Obese children has abnormalities of left ventricle structure and function [consisting of increased left ventricular wall dimensions and mass and alteration of diastolic function] that can be detected by echocardiography. Furthermore, [parameters of lipid metabolism] were found to be independent predictors of adverse LV remodeling and of diastolic dysfunction. As well as this study provides evidence that abnormalities of left ventricular wall dimension and mass in obese children and adolescents can improve with significant weight reduction. This study has demonstrated that young, obese children and adolescents have early significant changes in left ventricular wall dimensions and early diastolic filling compared with non obese and this changes are reversible with weight reduction

Risk stratification in patients with coronary artery disease: the impact of aortic stiffness

Identification of individuals at high risk of coronary heart disease and future events is an important challenge for primary prevention of cardio-vascular disease. Intra-vascular ultrasound confirmed. the link between aortic stiffness and coronary atheromatous plaques, beside the proved relation between aortic elasticity and coronary endothelial function. The purpose of the present study was to assess the value of non-invasive assessment of aortic elastic properties by tissue Doppler versus conventional measures in predicting coronary artery disease and long-term risk of major coronary events. 48 pts with documented coronary artery disease [CAD] were compared to 12 pts with normal coronary angiogram. Ascending [A SC] aortic diameters and pulse pressure were used to calculateo aortic stiffness index. Pulsed wave velocity [PWV] measured as the time taken by the pulse wave to travel along the thoracic aorta. Systolic [SW] and diastolic [EW and A W] velocity waves of ASC and descending [DSC.] aortic wall were measured by tissue Doppler imaging. Patients with CAD had significantly higher Aortic stiffness index [14.77 +/- 5.31 vs. 8.94 +/- 1.76, p=0.0001], faster PWV [13.73 +/- 1.25 vs. 5.82 +/- 1.19 mlsec, p=0.0001], and slower ASC aortic wall velocities [SW [8.87 +/- 3.23 vs. 13.02 +/- 1, 3 cm/sec, p=0.003], EW [9.34 +/- 3.14 vs. By multivariate Cox model analysis, aortic stiffness [relative risk: 95% Cl: 6.4-10.6; P=0.001], SW velocity of ASC aorta [relative risk: 95% CI: 6.2-8.1; P=0.001], and PWV [relative risk: 95% CI: 12.5-15.92; P=0.01], were the strongest predictors of progression to any end-point. In patients with coronary artery disease, aortic stiffness properties are independent risk factors and predictors of major coronary events. Tissue Doppler recording of ascending aortic wall velocity is simple, non-invasive measurement of aortic elastic properties with good correlation and comparable prognostic value to conventional aortic stiffness parameters