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Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study

De Jong, Kirstie A., Czeczor, Juliane K., Sithara, Smithamol, McEwen, Kevin, Lopaschuk, Gary D., Appelbe, Alan, Cukier, Kimberly, Kotowicz, Mark and McGee, Sean L. 2017, Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study, Cardiovascular diabetology, vol. 16, pp. 1-12, doi: 10.1186/s12933-017-0504-z.

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Title Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study
Author(s) De Jong, Kirstie A.
Czeczor, Juliane K.
Sithara, Smithamol
McEwen, Kevin
Lopaschuk, Gary D.
Appelbe, Alan
Cukier, Kimberly
Kotowicz, MarkORCID iD for Kotowicz, Mark orcid.org/0000-0002-8094-1411
McGee, Sean L.
Journal name Cardiovascular diabetology
Volume number 16
Article ID 21
Start page 1
End page 12
Total pages 12
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017-02
ISSN 1475-2840
Keyword(s) Echocardiography
Left ventricular diastolic dysfunction
Left ventricular hypertrophy
Obesity
Type 2 diabetes
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Endocrinology & Metabolism
Cardiovascular System & Cardiology
CARDIOVASCULAR RISK
AORTIC STIFFNESS
PULSE PRESSURE
HYPERTROPHY
HYPERTENSION
MASS
DYSFUNCTION
RECOMMENDATIONS
ASSOCIATION
Summary Background
It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clinical indices and via LV geometric patterns (more commonly used in research settings). Importantly, our sample consisted of hypertensive patients that are routinely screened for LVH via echocardiography and normotensive patients that would normally be deemed low risk with no further action required.

Methods

This cross sectional study comprised a total of 353 Caucasian patients, grouped based on diagnosis of obesity, T2D and hypertension, with normotensive obese patients further separated based on metabolic health. Basic metabolic parameters were collected and LV structure and function were assessed via transthoracic echocardiography. Multivariable logistic and linear regression analyses were used to identify predictors of LVH and diastolic dysfunction.

Results
Metabolically healthy normotensive obese patients exhibited relatively low risk of LVH. However, normotensive metabolically non-healthy obese, T2D and obese/T2D patients all presented with reduced normal LV geometry that coincided with increased LV concentric remodelling. Furthermore, normotensive patients presenting with both obesity and T2D had a higher incidence of concentric hypertrophy and grade 3 diastolic dysfunction than normotensive patients with either condition alone, indicating an additive effect of obesity and T2D. Alarmingly these alterations were at a comparable prevalence to that observed in hypertensive patients. Interestingly, assessment of LVPWd, a traditional index of LVH, underestimated the presence of LV concentric remodelling. The implications for which were demonstrated by concentric remodelling and concentric hypertrophy strongly associating with grade 1 and 3 diastolic dysfunction respectively, independent of sex, age and BMI. Finally, pulse pressure was identified as a strong predictor of LV remodelling within normotensive patients.

Conclusions
These findings show that metabolically non-healthy obese, T2D and obese/T2D patients can develop LVH independent of hypertension. Furthermore, that LVPWd may underestimate LV remodelling in these patient groups and that pulse pressure can be used as convenient predictor of hypertrophy status.
Language eng
DOI 10.1186/s12933-017-0504-z
Field of Research 1102 Cardiovascular Medicine And Haematology
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30092956

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.