Fatih ATİK, Cihat ŞANLI, Ayça TÖREL ERGÜR, Ayşegül ALPCAN

Çocukluk çağı obezitesinin kardiyak yapı ve fonksiyonlara etkisi

Amaç: Bu çalışmada nonkomplike obez ve obez olmayan çocuklarda sol ventrikül yapı ve fonksiyonların karşılaştırılması amaçlandı. Gereç ve Yöntemler: 40 sağlıklı obez olmayan ve obezitenin komplikasyonu (hipertansiyon, hiperkolesterolemi vs) veya başka bir hastalığı olmayan 40 obez çocukta kardiyak geometrinin antropometik ve konvansiyonel ekokardiyografik parametreleri ve sol ventrikül fonksiyonu elde edildi. Açlık plazma glukozu ve insülini bakılıp insülin direnç parametresi (HOMA-IR) hesaplandı. Bulgular: Boy, ağırlık, vücut yüzey alanı, vücut kitle indeksi obez grupta anlamlı olarak yüksek tespit edildi (P < 0,001). İnsülin ve HOMA-IR obez grupta yüksekti. Sol ventrikül sistolik ve diyastolik çapları arasında fark tespit edilmedi (P ˃ 0,05). Sol ventrikül kitlesi (LVM), LVM/ht, LVM/BMI, rölatif duvar kalınlığı (RWT), obez çocuklarda kontrol grubuna göre oldukça artmıştı (P < 0,001) ve bunların da en önemli olanı ekzantrik sol ventrikül hipertrofisiydi. Ejeksiyon fraksiyon belirgin olarak azalmıştı. BMI, LV posterior duvar kalınlığı ve interventriküler septal kalınlık arasında belirgin korelasyon görüldü (R > 0,45, P < 0,05). İnsülin rezistan obez grupta hipertrofinin her iki tipi de görüldü. Sonuçlar: Değişen homeostatik ve nörohumoral mekanizmaların, yüksek metabolik ihtiyacın kompansasyonunun artmış sol ventrikül kitlesi, azalmış myokardiyal performans hemodinamik yük sebebi olduğu, bunun da yüksek kardiyovasküler morbidite ve mortalite oranları ile ilişkili olduğu biliniyor. Değişmiş homeostatik ve nörohumoral mekanizmalar, artmış metabolik gereksinimler, artmış ventriküler kitle, azalmış myokardiyal performans hemodinamik yol ile ilişkili olarak kardiyovasküler morbidite ve mortalite oranlarını artırmaktadır.

Anahtar Kelimeler:

Çocukluk çağı, venriküler disfonksiyon, ekokardiyografi

Impact of childhood obesity on cardiac structure and functions

Aim: The aim of this study was to compare the left ventricle structure and its functions in obese children without established complications and none obese children. Material and Methods: Anthropometric and conventional echocardiographic parameters of cardiac geometry and left ventricular function were obtained in 40 obese children without any other disease and complication of obesity like hypertension, hypercholesterolemia, and a control group of 40 healthy lean. Fasting plasma glucose, insulin levels were obtained and homeostatic model assessment of insulin resistance (HOMA‐IR) were calculated. Results: Height, weight, body surface area and body mass index (BMI), were found significantly higher in the obese group (P < 0.001). Insulin and HOMA‐IR scores were higher in obese group. No significant differences were observed for left ventricular systolic and diastolic diameter (P > 0.05). Left ventricular mass (LVM), LVM/ht, LVM/BMI and relative wall thickness (RWT) were significantly increased in obese children than the controls (P < 0.001) and most of them had eccentric left ventricular (LV) hypertrophy. Ejection fraction was significantly decreased seen obese group. A positive correlation was seen between BMI and LV posterior wall thickness and interventricular septal thickness (R > 0.45, P < 0.05). Both types of hypertrophy were seen in insulin resistant obese group. Conclusion: The known causes are altered homeostatic and neurohumoral mechanisms and compensation of higher metabolic demands and increased left ventricular mass, reduced myocardial performance due to hemodynamic load associated with higher cardiovascular morbidity and mortality rates.

Keywords:

Pediatric obesity, ventricular dysfunction, echocardiography,

PDF

___

McCrindle BW. Cardiovascular Consequences of Childhood Obesity. Can J Cardiol 2015; 31: 124-130.
Karuparthi PR, Yerram P, Govindarajan G, Hayden MR. Obesity and Cardiovascular Risk. Current Cardiovascular Risk Reports 2008; 2:113-9.
Chinalli M, de Simone G, Roman MJ, et al. Impact of Obesity on Cardiac Geometry and Function in a Population of Adolescents. The Strong Heart Study. J Am Coll Cardiol 2006; 47: 2267-73.
Maron BJ, Thompson PD, Ackerman MJ, et al. American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007; 115: 1643-55.
Zeybek C, Celebi A, Aktuglu, Zeybek C, et al. The Effect of Low Carbohydrate Diet on Left Ventricular Diastolic Function in obese children. Pediatr Int 2010; 52: 218-23.
Freedman D, Dietz W, Srinivasan S, Berenson G. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa heart study. Pediatrics 1999; 103:1175‐82.
Pascual M, Pascual DA, Soria F et al. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart 2003; 10:1152-6.
Weiss R, Dziura J, Burgert TS, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004, 350: 2363-74.
Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet 1982; 1:1165-8.
Ku CS, Lin SL, Wang DJ, Chang SK, Lee WJ. Left ventricular filling in young normotensive obese adults. Am J Cardiol 1994; 8: 613-5.
Ozturk A, Mazicioglu MM, Hatipoglu N et al. Reference body mass index curves for Turkish children 6 to 18 years of age. J Pediatr Endocrinol Metab 2008; 9: 827-36.
Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 2002; 246: 1-190.
Conwell LS, Trost SG, Brown WJ, Batch JA. Indexes of insulin resistance and secretion in obese children and adolescents. Diabetes Care. 2004; 27: 314-9.
Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072-83.
Teicholz LE, Cohen MV, Sonnenblick BM, Gorlin R. Study of left ventricular geometry and function by Biscan ultrasonography in patients with and without asynergy. N Engl J Med 1964; 291:120-8.
Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy-comparison to necropsy findings. Am J Cardiol 1987; 56: 450-8.
Daniels SR, Meyer RA, Liang YC, Bove KE. Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults. J Am Coll Cardiol 1988; 12: 703-8.
Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358-67.
Williams CL, Hayman LL, Daniels SR, et al. Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002; 106: 143-60.
Hirschler V, Acebo HLP, Fernandez GB Gonzalez C, Jadzinsky M. The influence of obesity and, insulin resistance on left atrial size in children. Pediatric Diabetes 2006; 7: 39-44.
Peterson LR, Waggoner AD, Schechtman KB, et al. Alterations in left ventricular structure and function in young healthy obese women, assesment by echocardiography and tissue doppler imaging. J Am Coll Cardiol. 2004; 43:1399-404.
Koch R, Sharma AM. Obesity and Cardiovascular Hemodynamic Function. Current Hypertension Reports 1999; 1:127-130.
Movahed MR, Saito Y. Lack of Association between Obesity and Left Ventricular Systolic Dysfunction. Echocardıography 2009; 26: 128-132.
Berkalp B, Cesur V, Corapcioglu D, Erol C, Baskal N. Obesity and left ventricular diastolic dysfunction. Int J Cardiol 1995; 1: 23-6.
Chiarelli F, Marcovecchio ML. Insulin resistance and obesity in childhood. Eur J Endocrinol 2008; 159: 67-74.
Masugata H, Senda S, Goda F et al. Left ventricular diastolic dysfunction as assessed byechocardiography in metabolic syndrome. Hypertens Res 2006; 11: 897-903.
De Simone G, Devereux RB, Daniels SR, et al. Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight. Circulation 1997, 95: 1837-43.
Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347: 305-13.
Dorbala S, Crugnale S, Yang D, et al. Effect of body mass index on left ventricular cavity size and ejection fraction. Am J Cardiol 2006; 97: 725-9.
Wong CY, O’Moore-Sullivan T, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 2004; 110: 3081-7.
Tumuklu MM, Etikan I, Kisacik B, Kayikcioglu M. Effect of obesity on left ventricular structure and myocardial systolic function: Assesment by tissue doppler imaging and strain/strain rate imaging. Echocardiography 2007; 24: 802-9.