Maternal Obesity Affects Cardiac Remodeling and Recovery in Women with Peripartum Cardiomyopathy

Objective To examine the association between maternal obesity on left ventricular (LV) size and recovery in women with peripartum cardiomyopathy (PPCM). Study Design This was a prospective analysis of 100 women enrolled within 13 weeks of PPCM diagnosis and followed for a year in the Investigation of Pregnancy Associated Cardiomyopathy study. Adiposity was defined by standard body mass index (BMI) definitions for under/normal weight, overweight, and obesity. Demographic, clinical, and biomarker variables were compared across weight categories. Outcomes LV end-diastolic diameter (LVEDD) and ejection fraction were measured at entry, 6, and 12 months postpartum. Multivariable regression models examined the relationship between adiposity, LV size, and leptin levels with cardiac recovery at 6 and 12 months postpartum. Results Obese and nonobese women had similar LV dysfunction at entry. Obese women had greater LV size and less LV recovery at 6 and 12 months postpartum. BMI was positively associated with leptin and ventricular diameter. Greater BMI at entry remained associated with less ventricular recovery at 6 months (p = 0.02) in adjusted race-stratified models. LVEDD at entry predicted lower ejection fraction at 6 months (p < 0.001) and similarly at 12 months. Conclusion Obese women with PPCM had greater cardiac remodeling, higher leptin levels, and diminished cardiac recovery.

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Maternal early pregnancy obesity and depressive symptoms during and after pregnancy

Psychological Medicine ◽

10.1017/s0033291717003889 ◽

2018 ◽

Vol 48 (14) ◽

pp. 2353-2363 ◽

Cited By ~ 15

Author(s):

Satu M. Kumpulainen ◽

Polina Girchenko ◽

Marius Lahti-Pulkkinen ◽

Rebecca M. Reynolds ◽

Soile Tuovinen ◽

...

Keyword(s):

Depressive Symptoms ◽

Early Pregnancy ◽

Maternal Obesity ◽

Depression Scale ◽

Epidemiological Studies ◽

Normal Weight ◽

Overweight And Obesity ◽

Obese Women ◽

Medical Birth Register ◽

Clinically Significant

AbstractBackgroundPrevious studies have linked maternal obesity with depressive symptoms during and after pregnancy. It remains unknown whether obesity associates with consistently elevated depressive symptoms throughout pregnancy, predicts symptoms postpartum when accounting for antenatal symptoms, and if co-morbid hypertensive and diabetic disorders add to these associations. We addressed these questions in a sample of Finnish women whom we followed during and after pregnancy.MethodsEarly pregnancy body mass index, derived from the Finnish Medical Birth Register and hospital records in 3234 PREDO study participants, was categorized into underweight (<18.5 kg/m2), normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), and obese (⩾30 kg/m2) groups. The women completed the Center for Epidemiological Studies Depression Scale biweekly during pregnancy, and at 2.4 (s.d.= 1.2) and/or 28.2 (s.d.= 4.2) weeks after pregnancy.ResultsIn comparison to normal weight women, overweight, and obese women reported higher levels of depressive symptoms and had higher odds of clinically significant depressive symptoms during (23% and 43%, respectively) and after pregnancy (22% and 36%, respectively). Underweight women had 68% higher odds of clinically significant depressive symptoms after pregnancy. Overweight and obesity also predicted higher depressive symptoms after pregnancy in women not reporting clinically relevant symptomatology during pregnancy. Hypertensive and diabetic disorders did not explain or add to these associations.ConclusionsMaternal early pregnancy overweight and obesity and depressive symptoms during and after pregnancy are associated. Mental health promotion should be included as an integral part of lifestyle interventions in early pregnancy obesity and extended to benefit also overweight and underweight women.

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Relationship Between Overweight and Obesity and Cardiac Dimensions and Function in a Paediatric Population.

10.21203/rs.3.rs-921234/v1 ◽

2021 ◽

Author(s):

Juan Fernández Cabeza ◽

Cristhian H Aristizábal-Duque ◽

Isabel María Blancas Sánchez ◽

Martín Ruíz Ortiz ◽

Ana Rodríguez Almodóvar ◽

...

Keyword(s):

Left Ventricle ◽

Ejection Fraction ◽

Paediatric Population ◽

Left Ventricular ◽

Normal Weight ◽

Overweight And Obesity ◽

Left Ventricular Ejection ◽

Left Ventricle Mass ◽

Ventricular Ejection Fraction ◽

And Function

Abstract Obesity in adults is associated with left ventricular hypertrophy, dilatation and myocardial fibrosis, as well as heart failure and coronary heart disease. These associations have been studied to a lesser extent in the paediatric population. This study aims to investigate the relationship between obesity and cardiac structure and function in the paediatric population. In a southern Spanish town, we selected all inhabitants aged 6–17 years stratifying by age, gender, and educational centres. We performed a complete transthoracic echocardiogram evaluating all the cardiac morphological and functional parameters commonly measured in an echocardiographic study. There were 212 children and adolescents included. Of them, 48,1 % were males. The mean age was 10.9 ± 3.0 years. 106 (50%) were normal weight, 57 (26.9%) overweight and 49 (23.1%) obese. Sex and age were similar in all three groups. Overweight and obesity were associated with larger left ventricular end-diastolic and end-systolic volumes (p < 0.0005), greater left ventricular mass (p < 0.0005) and smaller ejection fraction (p < 0.0005). They were also associated with larger atrial, aortic and right ventricular size. Lateral and mean E/e' ratios were higher (p = 0.007 and p = 0.01 respectively). Body mass index was independently associated with all cavity size variables as well as left ventricular ejection fraction. Conclusion: Childhood obesity is independently associated with larger heart chambers, greater left ventricle mass, and smaller left ventricle ejection fraction.

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P3444Overweight and obesity in a Mediterranean pediatric population: impact in cardiac chambers morphology and systolic function

European Heart Journal ◽

10.1093/eurheartj/ehz745.0317 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Fernandez Cabeza ◽

C U Aristizabal Duque ◽

I M Blancas Sanchez ◽

M Ruiz Ortiz ◽

M Delgado Ortega ◽

...

Keyword(s):

Left Ventricle ◽

Ejection Fraction ◽

Right Ventricle ◽

Systolic Function ◽

Pediatric Population ◽

Left Ventricular ◽

Normal Weight ◽

Left Ventricle Ejection Fraction ◽

Overweight And Obesity ◽

Age And Sex

Abstract Background Obesity is a major medical and public health problem. A high body mass index has been associated with increased mortality and cardiovascular disease morbidity. Obesity in adults is related to hypertrophy and left ventricular dilatation. Previous studies have shown that, in Spain, the prevalence of overweight and obesity in childhood is 26% and 12.6% respectively. The association between obesity and left ventricular morphology has been poorly studied in the pediatric population. Aim To investigate the relationship between childhood obesity and the dimensions of cardiac structures and systolic function in a Mediterranean pediatric population. Methods A random sample of children and adolescents in primary and secondary education was selected, stratified by age, gender and educational centers in a rural town of 2864 inhabitants in southern Spain. Children between 6 and 17 years old were included. A transthoracic echocardiogram was performed for the evaluation of cardiac chambers morphology and systolic function. Results A total of 212 children were studied (10.9±3.0 years old and 51.9% males): 106 (50%) were normal weight, 57 (26.9%) were overweight and 49 (23.1%) were obese. Results are shown in the table. Age and sex were similar in the three groups. Overweight and obesity were related to larger values of left ventricle end-diastolic diameter and volume, left atrial volume and right ventricle basal diameter, and lower values of left ventricle ejection fraction. Normal weight Overweight Obese p Age 10.9±3.2 10.7±2.7 11.0±2.8 0.79 Male (%) 50.9% 49.1% 57.1% 0.69 End-diastolic left ventricle diameter (mm) 41.1±5.5 42.8±5.4 44.2±5.5 0.003 End-diastolic left ventricle volume (mm) 57.9±18.6 64.3±18.3 78.1±22.4 <0.0005 Interventricular septum (mm) 6.3±1.4 6.7±1.3 7.0±1.7 0.01 Left ventricle mass (g) 69.3±30.1 80.9±30.2 94.8±36.5 <0.0005 Left atrium volume (mm) 19.7±6.8 22.6±6.5 27.9±7.4 0.004 Basal right ventricle diameter (mm) 27.6±4.5 28.0±3.9 30.2±4.2 0.001 Left ventricle ejection fraction (%) 65.7±3.6 63.6±4.7 61.5±4.6 <0.0005 Conclusions Overweight and obese children have larger cardiac chambers, higher left ventricular mass, and worse systolic function compared with normal weight children of similar age and sex.

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Echocardiographic Evaluation of Cardiac Remodeling After Surgical Closure of Ventricular Septal Defect in Different Age Group

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v2i2.34097 ◽

2017 ◽

Vol 2 (2) ◽

pp. 69-74

Author(s):

Mohammad Aminullah ◽

Fahmida Akter Rima ◽

Asraful Hoque ◽

Mokhlesur Rahman Sazal ◽

Prodip Biswas ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Ejection Fraction ◽

Cardiac Remodeling ◽

Septal Defect ◽

Left Ventricular ◽

Age Group ◽

Surgical Closure ◽

Group A ◽

Group B ◽

Fractional Shortening

Background: Cardiac remodeling is important issue after surgical closure of ventricular septal defect.Objective: The purpose of the present study was to evaluate cardiac remodeling by echocardiography by measuring the ejection fraction, fractional shortening, left ventricular internal diameter during diastole (LVIDd) and left ventricular internal diameter during systole (LVIDs) after surgical closure of ventricular septal defect in different age group. Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) aged range was 18.1-42.0 years. Echocardiographic variables such as ejection fraction, fractional shortening, LVIDd, LVIDs were taken preoperatively and at 1st and 3rd month of postoperative values. Result: A total number of 24 patients was recruited for this study. The mean ages of all groups were 12.60±12.09. After 1 month ejection fraction were decreased by 5.97%, 6.71% and 5.66% in group A, group B and group C respectively. After 3 months ejection fraction were increased by 6.13%, 5.13% and 5.14% in group A, group B and group C respectively. After 1 month fractional shortening were decreased by 13.55%, 9.30% and 9.09% in group A, group B and group C respectively. After 3 months fractional shortening were increased by 7.23%, 7.35% and 4.55% in group A, group B and group C respectively. After 1 month LVIDd were increased by 1.97%, 1.91% and 1.32% in group A, group B and group C respectively. After 3 months LVIDd were decreased by 10.84%, 9.89% and 7.34% in group A, group B and group C respectively. After 1 month LVIDs were increased by 2.19%, 2.86% and 1.98% in group A, group B and group C respectively. After 3 months LVIDs were decreased by 11.68%, 10.97% and 8.87% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2):69-74

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Effect of overweight and obesity on the left ventricular systolic and diastolic functions in patients with acute myocardial infarction

Clinical & Investigative Medicine ◽

10.25011/cim.v35i4.17152 ◽

2012 ◽

Vol 35 (4) ◽

pp. 229 ◽

Cited By ~ 2

Author(s):

Fatih Poyraz ◽

Murat Turfan ◽

Sinan A. Kocaman ◽

Huseyin U. Yazici ◽

Nihat Sen ◽

...

Keyword(s):

Myocardial Infarction ◽

Diastolic Function ◽

Systolic Function ◽

Study Groups ◽

Left Ventricular ◽

Normal Weight ◽

Overweight And Obesity ◽

Weight Group ◽

Normal Weight Group ◽

Diastolic Functions

Purpose: The purpose of this study was to evaluate whether a association exits among overweight and obesity and left ventricular systolic and diastolic functions in patients admitted with first ST-elevation myocardial infarction (STEMI). Methods: The present study was performed on 451 consecutive patients diagnosed with first STEMI (376 men, 75 women; mean age 56.1±10.8 years). The patients were classified into three groups based on their body mass index (BMI) as normal weight (BMI < 25 kg/m2), overweight (BMI: 25-29.9 kg/m2) and obese (BMI > 30 kg/m2). Echocardiographic features were evaluated and compared among the three groups. Results: Mitral annulus E velocities were higher in obese individuals than normal weight group (p < 0.01). In contrast, mitral A velocities were lower (p =0.03); consequently, E\A and E'\A' ratios were lower (both p =0.01) in the obese group with respect to normal weight group. When the correction of entire variations existing among the groups were performed using multivariate linear regressions analyses, it turned out that BMI was independently associated with E/A (β= -0.19, p =0.044) and with E'/A' (β= -0.016, p=0.021). Ejection fraction, wall motion score index and myocardial S velocities were comparable among the study groups (p > 0.05). Conclusion: These results suggest that while obesity has no adverse effect on the left ventricular systolic function, it has unfavorable consequences on the left ventricular diastolic function in the patients with first STEMI. In contrast, no unfavorable effects of overweight on the left ventricular systolic and diastolic function were detected.

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Association between Serum N-Terminal Pro-Brain Natriuretic Peptide Concentration and Left Ventricular Dysfunction and Extracellular Water in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080602600314 ◽

2006 ◽

Vol 26 (3) ◽

pp. 360-365 ◽

Cited By ~ 41

Author(s):

Jung-Ahn Lee ◽

Do-Hyoung Kim ◽

Soo-Jeong Yoo ◽

Dong-Jin Oh ◽

Suk-Hee Yu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Ejection Fraction ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Left Ventricular ◽

Extracellular Water ◽

Volume Load ◽

Lv Dysfunction ◽

Lv Ejection Fraction

Background This study investigated the association between serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels and extracellular water (ECW%) and left ventricular (LV) dysfunction in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods The study involved 30 stable CAPD patients: 14 males, 16 females; mean age 52 ± 14 years; mean CAPD duration 34 ± 12 months; 12 with diabetes mellitus (DM) and 18 non-DM. Serum NT-pro-BNP levels were determined using electrochemiluminescence immunoassay. Baseline echocardiography was performed using a Hewlett-Packard Sonos 1000 (Andover, Massachusetts, USA) device equipped with a 2.25-MHz probe, allowing M-mode, two-dimensional, and pulsed Doppler measurements. Left ventricular mass index (LVMI) was calculated according to the Penn formula. A multifrequency bioimpedance analyzer was used; ECW% was calculated as a percentage of total body water and was considered the index of volume load. Results ( 1 ) Serum NT-pro-BNP level, ECW%, LVMI, and LV ejection fraction in CAPD patients were 3924 (240 – 74460) pg/mL, 36.7% ± 2.2%, 158 ± 48 g/m2, and 60.5% ± 11.2%, respectively. ( 2 ) Patients were divided into three tertiles (10 patients each) according to their serum NT-pro-BNP concentration [1st tertile 1168 (240 – 2096), 2nd tertile 4856 (2295 – 20088), 3rd tertile 35012 (20539 – 74460) pg/mL]. The tertiles did not differ significantly in terms of age, sex, presence of DM, body mass index, or PD duration. Patients in the 3rd tertile (highest serum NT-pro-BNP concentration) had the highest LVMI (126 ± 45 vs 160 ± 41 vs 200 ± 23 g/m2 for 1st, 2nd, 3rd tertiles, respectively) and the lowest LV ejection fraction (66% ± 11% vs 62% ± 6% vs 55% ± 9%). ECW% did not differ significantly between tertiles (35.5% ± 2.0% vs 37.5% ± 2.0% vs 36.5% ± 2.0%). ( 3 ) In CAPD patients, serum NT-pro-BNP levels correlated positively with LVMI ( r = 0.628, p = 0.003) and negatively with LV ejection fraction ( r = –0.479, p = 0.033). Serum NT-pro-BNP levels did not correlate with ECW% ( r = 0.227, p = 0.25). ( 4 ) Stepwise regression analysis showed that LV ejection fraction (b = -0.610, p = 0.015) and LVMI (b = 0.415, p = 0.007) were independently associated with the serum NT-pro-BNP concentration. Conclusions There was no link between ECW% and serum NT-pro-BNP concentration. Thus, serum NT-pro-BNP levels may not provide objective information with respect to pure hydration status in CAPD patients. In contrast, serum NT-pro-BNP levels were linked to LVMI and LV ejection fraction in CAPD patients. Therefore, while the serum NT-pro-BNP concentration might not be a useful clinical marker for extracellular fluid volume load, it appears useful for evaluating LV hypertrophy and LV dysfunction in CAPD patients.

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The Predictive role of speckle-tracking and left ventricular ejection fraction estimation using 2D and 3D echocardiography in the detection of chemotherapy related cardiotoxicity

European Heart Journal ◽

10.1093/eurheartj/ehab724.2859 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C C Oliveira ◽

R Coutinho ◽

R Flores ◽

P Medeiros ◽

C Pires ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Parameters Estimation ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Lv Dysfunction ◽

Number Of Patients ◽

2D And 3D

Abstract Background 2D left ventricular ejection fraction (LVEF) estimation through echocardiography has been the classic parameter for cancer therapy–related cardiac dysfunction (CTrCD) detection. However, it is hypothesized that other parameters can be used in order to detect early stages of subclinical cardiotoxicity when LVEF is still preserved. Therefore, 3D LVEF and 2D and 3D strain parameters assessments have been evaluated in patients submitted to anthracyclines treatment. Objectives To compare 2D and 3D LVEF and strain parameters estimation using echocardiography regarding its ability to predict and detect subclinical and clinical cardiotoxicity during and after anthracyclines treatment. Search methods and criteria A systematic review was done and search was performed on PubMed and EMBASE from January 1st of 2000 to October 31th of 2020. Observational studies comparing 2D and 3D echocardiographic exams performed in adult patients submitted to anthracyclines were analyzed. Studies that evaluated survivors of pediatric cancer were excluded. 11 studies were included (n=844 patients). Main results 2D and 3D LVEF decreased throughout the echocardiographic assessments of 7 studies, but 2D LVEF drops were not statistically significant in 4 studies and 3 studies showed that 3D LVEF detected a superior number of patients with abnormal LVEF. Compared to 3D LVEF, 2D GLS decreased at an earlier point of treatment and detected a superior number of patients with subclinical LV dysfunction. Despite 2D and 3D GLS decreased throughout treatment, 3D GLS measurements were consistently lower and had higher relative variation. All 3D strain parameters decreased during and after the treatment and have higher relative variations than 2D GLS, with the exception of 1 study. 3D GLS reference values are not yet recognized by guidelines, so subclinical LV dysfunction was not evaluated. Conclusions LVEF estimation through 3D proved to be a better parameter for CTrCD detection vs 2D imaging. GLS is superior to 3D LVEF in detecting earlier LV changes, even if calculated using 2D echocardiography. Moreover, GLS reduction can be a predictor of subsequent LVEF decrease. 3DE is a growing potential technique and may be superior to 2DE in detecting and predicting subclinical LVEF dysfunction and CTrCD, respectively. Though 3D strain parameters presented promising results, more studies are needed to prove its incremental value over 2D strain echocardiography FUNDunding Acknowledgement Type of funding sources: None.

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The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

American Journal of Perinatology ◽

10.1055/s-0039-1694982 ◽

2019 ◽

Vol 37 (04) ◽

pp. 349-356

Author(s):

April D. Adams ◽

Elizabeth M. Coviello ◽

Daphnie Drassinower

Keyword(s):

Vaginal Delivery ◽

Maternal Obesity ◽

Normal Weight ◽

University Hospital ◽

Obese Women ◽

Class Iii ◽

Class I Obesity ◽

Class Iii Obesity ◽

Higher Doses ◽

Hospital Center

Abstract Objective Our objective was to determine if obese women are more likely to require oxytocin rates > 20 mU/min to achieve vaginal delivery, compared with normal weight women. Study Design This is a retrospective cohort study of deliveries at the MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Results There were 4,284 births included in the analysis. Thirty-three per cent of deliveries were among women classified as overweight (body mass index [BMI] 25–29.9 kg/m2) and 58% were among women classified as obese (BMI >30.0 kg/m2), 12% were classified as class III obesity (BMI >40 kg/m2). Overall 110 (2.6%) women required an oxytocin rate of >20 mU/min. Doses of oxytocin >20 mU/min for women in the overweight, class I obesity, and class II obesity groups were 2.6, 1.9, and 1.6%, respectively. Deliveries among women with class III obesity had a significantly longer duration of oxytocin exposure (10.7 hours) compared with the normal weight group (8.2 hours, p < 0.001), and had a higher maximum rate of oxytocin compared (10 mU/min) to normal weight women (8 mU/min, p < 0.001). Conclusion Obese women are more likely to require oxytocin rates more than 20 mU/min, higher doses of oxytocin, and greater duration of oxytocin exposure to achieve a vaginal delivery.

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