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Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study

International Journal of Obesity volume 30, pages 948–956 (2006)Cite this article

Abstract

Background:

The aim of this study was to evaluate the relationship between insulin resistance and preclinical abnormalities of the left ventricular structure and function detected in severe obesity by Color Doppler Myocardial Imaging (CDMI). Forty-eight consecutive severely obese patients (Group O) (11 males, 37 females, mean age 32.8±7 years) were enrolled. Forty-eight sex- and age-matched non-obese healthy subjects were also recruited as controls (Group C). All subjects underwent conventional 2D-Color Doppler echocardiography and CDMI. The homeostasis model assessment insulin resistance index (HOMA-IR) was used to assess insulin resistance results. Obese subjects had a greater left ventricular mass index (by height) (58.8±14 g/m2.7) than controls (37±8 g/m2.7) (P<0.0001), owing to compensation response to volume overload caused by a greater cardiac output (P<0.02). Preload reserve was increased in obese subjects, as demonstrated by a significant increase in left atrial dimension (P<0.0001). Obese patients had a slightly reduced LV diastolic function (transmitral E/A ratio: Group O, 1.1±0.8 vs Group C, 1.5 ±0.5; P<0.002). Cardiac deformation assessed by regional myocardial systolic strain and strain rate (SR) values was significantly lower (abnormal) in obese patients than in controls, both at the septum and lateral wall level. These strain and SR abnormalities were significantly related to body mass index. In addition, the early phase of diastolic function, evaluated using SR, was compromised in obese patients (P<0.001). The HOMA-IR values in obese patients were significantly higher (3.09±1.6) than those determined in the control group (0.92±0.5) (P<0.0001). The HOMA-IR values, in the obese group, were significantly related to systolic strain and SR values sampled at the septum level (P<0.0001).

Conclusion:

In conclusion, this study has demonstrated that obese patients pointed out systolic structural and functional abnormalities at a preclinical stage, in particular through strain and SR analysis; on the other hand, those altered CDMI parameters well distinguish obese subjects as compared with the control group. Furthermore, another main finding of the study was that myocardial deformation (systolic strain) could have a correlation with insulin resistance level.

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Acknowledgements

We thank EMAC srl (Genua, Italy) for their precious technological support and Dr Giovanna Lastrucci for editorial assistance. This work was supported by ‘Centro Multidisciplinare per la Diagnosi e la Terapia dell'Obesita e dei Disturbi del Comportamento Alimentare’, University Hospital of Pisa.

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Authors and Affiliations

  1. Cardiac and Thoracic Department, University of Pisa, Pisa, Italy

    V Di Bello, A Di Cori, C Palagi, M G Delle Donne, E Talini, C Nardi & A Balbarini

  2. Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy

    F Santini, A Pucci, M Giannetti, P Fierabracci, P Vitti & A Pinchera

  3. Dipartimento Ingegneria Civile, University of Trieste, Trieste, Italy

    G Pedrizzetti

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Correspondence to V Di Bello.

Appendices

Appendix A

A myocardial segment contained inside a region of interest (ROI) is considered in its entirely. The frame rate ranged between 75 and 90 Hz. The ROI is bounded by four segments, two of them across the tissue and the other two parallel to the segment in a way that the enclosed area always contains the entire tissue segment during its movement. One example of such a segmental ROI is shown in Figure 1. The software automatically recognizes the moving tissue inside the outlined area and the analysis is performed on the myocardial wall segment contained inside the area. In this way, the ROI becomes a responsive area that continuously follows the wall.

The velocity along the entire segment is computed and it is then averaged across the myocardial thickness, called V(s,t), the resulting velocity, where s is the material coordinate (or the transmural level, see Figure 3), along the segment, and t indicated the time along the frames. The strain rate (Eulerian), SR(s,t), is evaluated on each frame and at every section along the segment, s, as the velocity gradient along the wall dV/ds. When the tissue is not aligned with the scan line, the velocity projected along the tissue is used. The derivative is computed by best fitting (in the least-squares sense) the slope in the V(s) profile, over a length of 2 cm about every point s. The strain (Lagrangian), St(s,t), is computed from the time integration of the SR as reported in the literature.1A, 2A, 3A

Strain is defined up to a constant value; this is fixed when a zero-strain state is automatically selected as the instant of maximum elongation over the entire selected tissue.4A, 5A The presence of uncontrolled noise in the data may lead to the appearance of a drift, a systematic trend, in the strain signal. This phenomenon is automatically eliminated here by requiring that every heartbeat must begin/close with zero trend-diastolic strain.

As described, all the quantities are computed as averaged across the thickness. This approach produces profiles that are smoother than punctual values. For this, results are evaluated and presented without any additional artificial smoothing.

Appendix references

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(2A):

Edvardsen T, Gerber BL, Garot J, Bluemke DA, Lima JAO, Smiseth OA. Quantitative assessment of intrinsic regional myocardial deformation by Doppler strain rate echocardiography in humans. Circulation 2002; 106:50–56.

(3A):

Sutherland GR, Stewart MJ, Groundstroem KWE, Moran CM, Fleming AD, Guell-Peris PJ, Rimersma RA, Flenn LN, Fox KAA, McDicken WN. Color Doppler myocardial imaging: a new technique for the assessment of myocardial function. J Am Soc Echocardiogr 1994;7:441–758.

(4A):

Donovan CL, Armstrong WF, Bach DS. Quantitative Doppler tissue imaging of the left ventricular myocardium: validation in normal subjects. Am Heart J 1995;130:100–104.

(5A):

Sutherland GR, Di Salvo G, Claus P, D'hooge J, Bijnens B. Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 2004; 17:788–802.

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Di Bello, V., Santini, F., Di Cori, A. et al. Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study. Int J Obes 30, 948–956 (2006). https://doi.org/10.1038/sj.ijo.0803206

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