Obesity is associated with left atrial enlargement, E/A reversal and left ventricular hypertrophy

Abstract

Background and objective: Previous studies have found that obesity is associated with congestive heart failure. The goal of the present study was to evaluate the association between obesity and parameters of left ventricular (LV) diastolic dysfunction using a large echocardiographic database.

Method: Data from 13,382 echocardiograms were analyzed for associations between obesity and abnormal LV diastolic parameters. Body mass index (BMI) was categorized into two groups for univariate analysis (nonobese group: BMI less than 30 kg/m(2); obese group: BMI 30 kg/m(2) or greater). Obesity was correlated with left atrial (LA) enlargement (LA diameter greater than 40 mm), LV hypertrophy (posterior or anterior wall thickness greater than 11 mm), early versus late diastolic mitral flow reversal, abnormal LV mass (greater than 215 g) and abnormal relative wall thickness (greater than 0.43). Multivariate analysis was used to adjust for age and sex.

Results: All diastolic parameters of heart failure were associated with obesity using univariate and multivariate analyses. The ORs for patients with a BMI of 30 kg/m(2) or greater were 2.53 (95% CI 2.30 to 2.75; P<0.0001) for LA diameter greater than 40 mm, 1.61 (95% CI 1.45 to 1.80; P<0.0001) for LV hypertrophy, 1.14 (95% CI 1.02 to 1.25; P<0.0001) for early versus late diastolic mitral flow reversal, 2.33 (95% CI 2.10 to 2.58; P<0.0001) for LV mass greater than 215 g, and 1.14 (95% CI 1.02 to 1.26; P=0.01) for relative wall thickness greater than 0.43.

Conclusion: The present study suggests that obesity is associated with abnormal parameters of diastolic function.

Keywords: Body mass index; Congestive heart failure; Diastolic function; EF; Left ventricular dysfunction; Obesity.

Figure 1

Prevalence of risk factors of congestive heart failure according to body mass index (BMI). Significant differences in the prevalence of increasing BMI categories with left atrial (LA) enlargement (P<0.0001), left ventricular hypertrophy (LVH) (P<0.0001), early versus late diastolic mitral flow reversal (E/A reversal) (P<0.0001) and combination of all abnormal diastolic parameters (P<0.0001) are observed

Figure 2

Prevalence of risk factors of congestive heart failure according to body mass index (BMI). Significant differences in the prevalence of increasing BMI categories – using a lower cut-off value of 25 kg/m² –with left atrial (LA) enlargement (P<0.0001), left ventricular hypertrophy (LVH) (P<0.0001), early versus late diastolic mitral flow reversal (E/A reversal) (P<0.0001), abnormal LV mass (LVM) (greater than 215 g) (P<0.0001) and abnormal relative wall thickness (RWT) (greater than 0.43) (P=0.009) are observed

Figure 3

ORs for the association of BMI (body mass index) of 30 kg/m² or greater (versus less than 30 kg/m²) with abnormal diastolic parameters. The graph shows significant independent associations with abnormal diastolic parameters. Suspected diastolic dysfunction is defined as the occurrence of all abnormal parameters in the same patient. E/A reversal Early versus late diastolic mitral flow reversal