Myocardial Work in Middle-Aged Adults with Overweight and Obesity: Associations with Sex and Central Arterial Stiffness.

We explored global myocardial work index (GWI), a novel measure of myocardial function that integrates left ventricular (LV) hemodynamic load, in relation to sex and increased body mass index (BMI). We used data from 467 individuals (61% women, average age 47 ± 9 years and BMI 31.2 kg/m2) without known cardiac disease. Central arterial function was analysed by applanation tonometry. GWI was calculated from global longitudinal strain (GLS) and post-echocardiography supine blood pressure (BP). Covariables of GWI were identified in linear regression analyses. Women had higher BMI, aortic augmentation pressure (12 ± 7 vs. 8 ± 6 mmHg), LV GLS (20.0 ± 2.8 vs. 18.8 ± 2.8%), and GWI (2126 ± 385 vs. 2047 ± 389 mmHg%) than men (all p < 0.05). In univariable analyses, higher GWI was associated with female sex, higher age, systolic BP, LV wall stress, LV ejection fraction, left atrial size, LV ejection time, and with lower waist circumference (all p < 0.05). In multivariable analysis, adjusting for these correlates, female sex remained independently associated with higher GWI (ß = 0.13, p = 0.007). After additional adjustment for aortic augmentation pressure or central pulse pressure, this association became non-significant. In conclusion, the higher GWI in women compared to men was mainly explained by increased LV workload due to higher aortic augmentation pressure in women.

Covariables of Myocardial Function in Women and Men with Increased Body Mass Index.

INTRODUCTION: Sex-difference in types of cardiac organ damage has been reported in subjects with increased body mass index (BMI). However less is known about sex-differences in left ventricular (LV) myocardial function assessed by global longitudinal strain (GLS) in these subjects. METHODS: 493 subjects (mean age 47 ± 9 years, 61% women) with BMI > 27.0 kg/m2 and without known cardiac disease underwent 24-hour (24h) ambulatory blood pressure (BP) recording, body composition analysis, carotid-femoral pulse wave velocity (PWV) measurement and echocardiography. LV peak systolic GLS was measured by two-dimensional speckle tracking echocardiography and LV ejection fraction (EF) by biplane Simpson's method. Insulin sensitivity was assessed by homeostatic model of insulin resistance (HOMA-IR). RESULTS: Women had higher prevalence of increased waist circumference (99% vs. 82%), lower prevalence of hypertension (59 vs. 74%), and lower serum triglycerides (1.3 ± 0.7 vs. 1.7 ± 0.9 mmol/L) and carotid-femoral PWV (7.3 ± 1.6 vs. 7.7 ± 1.6 m/s) compared to men (all p < 0.05). Women also had higher (more negative) GLS compared to men (- 19.9 ± 3.0 vs. - 18.6 ± 3.0%, p < 0.001), while EF did not differ between sexes. In multivariable linear regression analyses, lower GLS in women was associated with higher waist circumference and PWV and with lower EF (all p < 0.05). In men, lower GLS was associated with higher waist circumference and HOMA-IR, and with lower EF (all p < 0.05). CONCLUSIONS: Among subjects with increased BMI, GLS was higher in women than men. Lower GLS was associated with abdominal obesity in both sexes, and with impaired glucose metabolism in men, and with higher arterial stiffness in women. TRIAL REGISTRATION: https://www.clinicaltrials.gov NCT02805478, first registered 20.06.16.

Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients: the Norwegian stroke in the young study.

BACKGROUND: Hypertension is highly prevalent in ischemic stroke patients, but less is known about its impact on subclinical left ventricular (LV) dysfunction in such patients. METHODS: Conventional and speckle tracking echocardiography was performed in 276 young (15-44 years) and middle-aged (45-60 years) ischemic stroke patients (mean age 50 ±â€Š9 years, 66% men). Hypertension was defined as a history of hypertension, use of antihypertensive medications, persistently elevated blood pressure (BP) during hospitalization or elevated clinic BP (≥140/90 mmHg) and ambulatory BP (≥130/80 mmHg) at follow-up visits. LV myocardial dysfunction was assessed by peak systolic global longitudinal (GLS) and circumferential strain (GCS). RESULTS: Hypertension was present in 68% of patients and associated with higher age, BMI and LV mass, male sex and the presence of diabetes (all P < 0.01). Compared with normotensive patients, hypertensive patients had significantly lower peak systolic GLS (-16 ±â€Š3 vs. -19 ±â€Š2%, P < 0.001) and GCS (-16 ±â€Š3 vs. -18 ±â€Š4%, P < 0.001) while ejection fraction did not differ between groups (P = 0.134). In univariable regression analyses, reduced peak systolic GLS and GCS were both associated with hypertension (ß = 0.43 and 0.29, respectively, both P < 0.001). The association with hypertension remained significant for GLS (ß = 0.25) after adjustment for LV mass, ejection fraction, male sex, obesity and diabetes (multiple R = 0.35, P < 0.001), whereas the association of hypertension with reduced peak systolic GCS was attenuated. CONCLUSION: In ischemic stroke survivors, hypertension was associated with reduced peak systolic GLS but not GCS independent of confounders.

Covariables and types of abnormal left ventricular geometry in nonelderly ischemic stroke survivors: the Norwegian Stroke in the Young Study.

BACKGROUND: Abnormal left ventricular (LV) geometry types, like LV hypertrophy (LVH) and concentric remodelling, are independently associated with impaired prognosis in hypertension. Little is known about the prevalence and covariables of abnormal LV geometry types in younger ischemic stroke patients. METHODS: We used clinical and echocardiographic data from 280 patients aged 15-60 years included in the Norwegian Stroke in the Young Study. LVH was defined as LV mass index greater than 46.7 g/m in women and greater than 49.2 g/m in men. Concentric remodelling was considered present if posterior wall thickness/LV internal diameter ratio at least 0.43 in the absence of LVH. Arterial damage was assessed by mean common carotid intima-media thickness (IMT) and carotid-femoral pulse wave velocity (PWV). RESULTS: Abnormal LV geometry was found in 37% of patients. Concentric remodelling was the most prevalent abnormal LV geometry type, found in 21%, whereas LVH was found in 16%. In multivariable logistic regression analyses, LVH was associated with increased PWV, higher BMI and creatinine, and presence of diabetes and hypertension (all P < 0.05), whereas concentric remodelling was associated with higher mean carotid IMT independent of age (both P < 0.05). CONCLUSION: In ischemic stroke survivors less than 60 years of age, abnormal LV geometry was common, found in 37%. Presence of abnormal LV geometry may contribute to the known higher risk of recurrent cardiovascular events in ischemic stroke survivors.