O impacto da obesidade isolada na função do ventrículo direito em adultos jovens / The impact of isolated obesity on right ventricular function in young adults

FUNDAMENTO: A obesidade é um fator de risco independente para as doenças cardiovasculares. Os efeitos da obesidade sobre a estrutura e função do ventriculo esquerdo têm sido relatados, mas, relativamente, pouco se sabe sobre o funcionamento do ventrículo direito (VD) na obesidade. OBJETIVOS: Avaliar as alterações subclínicas do VD em adultos jovens obesos, porém saudáveis, por ecocardiografia convencional e Doppler tecidual (TDI). MÉTODOS: Neste estudo, foram incluídos 35 indivíduos saudáveis de peso normal, com um índice de massa corporal (IMC) < 25 kg/m2 (grupo I), 27 indivíduos com um IMC de 30-34,99 kg/m2 (grupo II) e 42 indivíduos com um IMC > 35 kg/m2 (grupo III). Todos os indivíduos foram submetidos a ecocardiografia transtorácica. Além de medidas ecocardiográficas padrão, as velocidades sistólicas de pico do anel tricúspide (Sm), e as velocidado pico diastólico precoce (Em) e final (Am), tempo de contração isovolumétrica (TCIm), tempo de relaxamento isovolumétrico (TRIm), e o tempo de ejecção (TEm) foram obtidos por TDI e o índice de desempenho do miocárdico do VD (IDMm) foi calculado. RESULTADOS: No grupo II, a razão Em/Am do VD foi significativamente menor e o TRIm e o IDMm foram significativamente maiores em relação ao grupo I (p < 0,01). A Sm, Em, e a razão Em/Am do VD foram significativamente menores e TRIm e IDMm do VD foram significativamente maiores no grupo III em relação ao grupo II (p < 0,05 para Sm e TRIm do VD e p < 0,01 para os outros parâmetros). A Am do VD diferiu significativamente entre os grupos I e III (p < 0,05). O IMC teve uma correlação negativa significante com a Sm, Em, e a razão Em/Am do VD, mas uma correlação positiva com o IDM do VD (p < 0,01). CONCLUSÃO: Nosso estudo mostrou que a obesidade isolada em adultos jovens normotensos foi associada com disfunções subclínicas na estrutura e função do VD.

BACKGROUND: Obesity is an independent risk factor for cardiovascular diseases. The effects of obesity on left ventricular structure and function have been reported, but relatively little is known regarding right ventricular (RV) function in obesity. OBJECTIVE: To evaluate subclinical RV alterations in obese, but otherwise healthy, young adults by conventional echocardiography and tissue Doppler imaging (TDI). METHODS: In this study, we included 35 normal weight healthy subjects with a body mass index (BMI) < 25 kg/m² (group I), 27 subjects with a BMI of 30-34.99 kg/m² (group II), and 42 subjects with a BMI > 35 kg/m² (group III). All subjects underwent transthoracic echocardiography. In addition to standard echocardiographic measurements, tricuspid annular peak systolic (Sm), peak early (Em), and late diastolic (Am) velocities, isovolumetric contraction (ICTm), relaxation (IRTm) time, and ejection time (ETm) were obtained by TDI, and RV myocardial performance index (MPIm) was calculated. RESULTS: In group II, RV Em/Am was significantly decreased and IRTm and MPIm were significantly increased compared to group I (p < 0.01). RV Sm, Em, and the Em/Am ratio were significantly lower and RV IRTm and MPIm were significantly higher in group III than in group II (p < 0.05 for RV Sm and IRTm and p < 0.01 for others). RV Am differed significantly between groups III and I (p < 0.05). BMI was significantly and negatively correlated with RV Sm, Em, and the Em/Am ratio, but positively correlated with RV MPI (p < 0.01). CONCLUSION: Our study showed that isolated obesity in young normotensive adults was associated with subclinical abnormalities in RV structure and function.

The impact of isolated obesity on right ventricular function in young adults.

BACKGROUND: Obesity is an independent risk factor for cardiovascular diseases. The effects of obesity on left ventricular structure and function have been reported, but relatively little is known regarding right ventricular (RV) function in obesity. OBJECTIVE: To evaluate subclinical RV alterations in obese, but otherwise healthy, young adults by conventional echocardiography and tissue Doppler imaging (TDI). METHODS: In this study, we included 35 normal weight healthy subjects with a body mass index (BMI) < 25 kg/m² (group I), 27 subjects with a BMI of 30-34.99 kg/m² (group II), and 42 subjects with a BMI > 35 kg/m² (group III). All subjects underwent transthoracic echocardiography. In addition to standard echocardiographic measurements, tricuspid annular peak systolic (Sm), peak early (Em), and late diastolic (Am) velocities, isovolumetric contraction (ICTm), relaxation (IRTm) time, and ejection time (ETm) were obtained by TDI, and RV myocardial performance index (MPIm) was calculated. RESULTS: In group II, RV Em/Am was significantly decreased and IRTm and MPIm were significantly increased compared to group I (p < 0.01). RV Sm, Em, and the Em/Am ratio were significantly lower and RV IRTm and MPIm were significantly higher in group III than in group II (p < 0.05 for RV Sm and IRTm and p < 0.01 for others). RV Am differed significantly between groups III and I (p < 0.05). BMI was significantly and negatively correlated with RV Sm, Em, and the Em/Am ratio, but positively correlated with RV MPI (p < 0.01). CONCLUSION: Our study showed that isolated obesity in young normotensive adults was associated with subclinical abnormalities in RV structure and function.

Relation of inflammatory and oxidative markers to the occurrence and recurrence of persistent atrial fibrillation.

OBJECTIVES: There is increasing evidence linking inflammation and oxidative stress to atrial fibrillation (AF). In this study, we tested the hypothesis that C-reactive protein (CRP) and oxidative stress markers can predict the recurrence of persistent AF after successful pharmacological cardioversion. A possible relationship with AF occurrence was also investigated. STUDY DESIGN: Using a case-control study design, CRP, catalase, superoxide dismutase (SOD), and malondialdehyde (MDA) levels of 42 patients (23 female, 19 male; mean age 58.4±13.6 years) with documented persistent AF episodes were compared with 21 controls (9 female; 12 male; mean age 58.1±6.9 years). RESULTS: Overall AF patients were followed for 6 months, and 17 showed recurrence. Then, they were divided into two groups (recurrence and no recurrence) and compared with each other. CRP, SOD, and MDA levels were significantly higher in AF patients compared with controls. However, only CRP levels were significantly higher in patients with AF recurrence compared to those without recurrence. CONCLUSION: Increased markers of inflammation and oxidative stress are found in patients with persistent AF, suggesting that inflammation and oxidative stress may be associated with the presence of arrhythmia.

Evaluation of atrial electromechanical delay and left atrial mechanical functions in patients with rheumatoid arthritis.

OBJECTIVES: The aim of this study was to evaluate atrial electromechanical delay measured by tissue Doppler imaging (TDI) and left atrial (LA) mechanical functions in patients with rheumatoid arthritis (RA). STUDY DESIGN: The study included 68 patients (53 females, 15 males; mean age 43.7 years) with RA. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). Left atrial volumes (maximal, minimal, and pre-systolic) were measured by the method of discs in the apical four-chamber view and were indexed to body surface area. Mechanical function parameters of the LA were calculated. The results were compared with those of 41 age- and gender-matched healthy volunteers (32 females, 9 males; mean age 41.9 years). RESULTS: Patients with RA had significantly prolonged PA lateral, PA septum, and intra- (PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical delays compared to controls (p<0.0001, p=0.05, p<0.0001, and p<0.0001, respectively). Left atrial volumes were similar in the two groups (p>0.05). Left atrial passive emptying fraction was significantly decreased, LA active emptying volume and active emptying fraction were increased in RA patients (p=0.05, p=0.01, and p<0.0001; respectively). Interatrial electromechanical delay was correlated with systolic blood pressure (r=0.20, p=0.04), left ventricular mass index (r=0.22, p=0.02), C-reactive protein (CRP) (r=0.27, p=0.005), and LA active emptying fraction (r=0.29, p=0.002). In linear regression analysis, LA active emptying fraction and CRP were independent variables of interatrial electromechanical delay (beta=0.28, p=0.002 and beta=0.25, p=0.006, respectively). CONCLUSION: Prolonged electromechanical delays and impaired LA mechanical functions may be an early manifestation of subclinical cardiac involvement in RA patients.