The importance of a shared definition of left ventricular hypertrophy: The case of obese women.

BACKGROUND: Left ventricular hypertrophy (LVH) is a risk factor for all-cause mortality. Left ventricular (LV) mass is usually indexed for normalizing the value to the patients phenotype and a correction by body surface area (BSA) is widely utilized being the only approved one according to the last echocardiography guidelines. However indexing LV mass by BSA may cause an underestimation of LVH prevalence in obese subjects and many authors have utilized in the obese subset of patients a correction by height2.7. The aim of our study was to quantify the number of obese patients who, despite having an increased LV mass, fall in the range of normality because they do not reach the LVH cutoff according to the new guidelines. METHODS: We reviewed the echocardiograms of 384 white women free from cardiovascular disease. Ninety-six patients (25%) were obese: among them 42 had mild obesity and 54 had moderate or severe obesity. RESULTS: In the obese group, the prevalence of LVH using the absolute LV mass value was similar to the one obtained with the height2.7 correction while a significant smaller number of patients had LVH according to BSA correction. Our study confirms that the method used for correcting LV mass significantly influences the diagnosis of LVH in a non-selected female population: using body surface area underestimates the prevalence of LVH as compared to allometric measures in the obese subset of patients. CONCLUSION: We recommend that height2.7 be used for LV mass correction in obese patients.

Short-term effects of a multi-disciplinary cardiac rehabilitation programme on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: a practice-level study.

Given that many patients referred to cardiac rehabilitation (CR) are obese, diet therapy, exercise training, nutritional and psychological counselling for both obesity and psychological distress should be included as important components in all CR programmes. In this practice-level, observational study we evaluated the short-term within-group effects of a four-week multi-factorial inpatient CR programme specifically addressed to weight loss, fitness improvement and psychological health increase on 176 obese in-patients with coronary heart disease (CHD). Outcome measures were exercise capacity measured with estimated metabolic equivalents (METs), body mass index (BMI) and psychological well-being (PGWBI). Results show statistically significant improvements in all the PGWBI sub-scales and total score, except in general health (p = 0.393). No moderation effects were found for BMI class, age, diabetes and ejection fraction (EF). METs significantly increased by 30.3% (p < 0.001) and BMI decreased by 1.37 points (p < 0.001). Significant correlations were found between BMI and weight reductions with PGWBI anxiety and total score improvements. This multi-disciplinary CR programme including diet therapy, exercise training and psychological counselling provides indication for short-term within-group effectiveness on functional exercise capacity, BMI and PGWBI in a sample of obese in-patients with CHD. However, controlled studies are needed to corroborate the results we found.

What are we measuring? Considerations on subjective ratings of perceived exertion in obese patients for exercise prescription in cardiac rehabilitation programs.

We sought to describe the differences in exercise prescription in obese subjects using attained METs as compared to the subjective perception of the effort using the Borg scale ratings of perceived exertion (Borg RPE). We studied 552 obese patients who underwent an exercise stress test in the setting of a rehabilitation program. Exercise was prescribed at 70% of peak attained METS. This method was compared to an exercise level prescription that induces a subjective perception of mild fatigue (13 on the 20 points Borg scale). Attained METS were 6.2+/-2.5 and Borg RPE was 15.2+/-1.7. Borg RPE was negatively related to intensity and duration of exercise. Females, patient with a lower level of education and patients on diuretics perceived higher efforts. Patients who stopped exercising because of dyspnea or angina reached a lower level of METs (4.7+/-1.7 vs 6.3+/-2.7 METs; P<0.001) but the perceived effort was similar (15.5+/-1.7 vs 15.2+/-1.7; P=0.252). The subjective method would have yielded a significantly higher training workload: 5.4+/-2.3 vs 4.3+/-1.8 (P<0.001). In conclusion, in obese patients, Borg RPE is not equivalent to attained METs in exercise prescription and it influenced by educational level.

Short-term effects of a hypocaloric diet and a physical activity programme on weight loss and exercise capacity in obese subjects with chronic ischaemic heart disease: a study in everyday practice.

OBJECTIVE: The objective of this paper is to describe the effects of a rehabilitation programme in obese patients affected with chronic ischaemic heart disease; to identify the factors that influence weight loss and improvement in exercise capacity in everyday practice. METHODS AND RESULTS: We studied 562 white patients (381 men) who followed a 23.3 +/- 3.9 days in-hospital programme. They attended daily sessions of aerobic activity (cycloergometer, walking, and strength exercise); a low-calorie diet was set at approximately 80% of resting energy expenditure. By the end of the programme BMI decreased from 38.0 +/- 4.9 to 36.7 +/- 4.8 kg/m2 (P < 0.001 ). Attained metabolic equivalents (METs) increased from 6.2 +/- 2.5 METs to 7.3 +/- 2.7 (P < 0.001). Age, sex, presence of diabetes and education level were significantly related to the outcomes. Patients who took beta-blockers and statins had less BMI improvement: -1.2 +/- 0.7 kg/m2 vs. -1.4 +/- 0.6 (P = 0.013) and -1.3 +/- 0.6 vs. -1.4 +/- 0.7 (P = 0.023), respectively. Patients that took diuretics and angiotensin receptor blockers (ARB) had less improvement in exercise capacity: 0.9 +/- 1.0 METS vs. 1.3 +/- 1.3 (P < 0.001) and 0.8 +/- 1.3 vs. 1.2 +/- 1.3 (P = 0.011 ), respectively. After a median interval of 358 days, 152 patients were seen at a follow-up visit: their BMI increased by 1.0 +/- 2.4 kg/m2 and only 21% of patients lost weight. CONCLUSIONS: Rehabilitation improves exercise capacity and induces significant weight loss in obese patients with stable IHD, but women, diabetic, elderly and poorly educated subjects obtained unsatisfactory results. Use of diuretics and ARB seem to worsen the results. At follow-up only a small percentage of patients further improves BMI.