Impaired myocardial deformation and ventricular vascular coupling in obese adolescents with dysglycemia

Abstract Background It is unknown that dysglycemia in obese adolescents has effects on myocardial deformation that are more pronounced when compared to obesity alone. We hypothesized that obesity associated abnormal glucose tolerance (dysglycemia) would have adverse effects on two-dimensional speckle tracking echocardiography derived longitudinal, radial and circumferential strain (LS, RS, CS) compared to age and gender lean controls. We also examined if changes in deformation would be reflected in abnormal ventricular vascular coupling indices (VVI). Methods In a prospective cross-sectional design 39 obese adolescents (15.9 ± 1.7 years; 101.5 ± 39 kg; female − 58%) were compared to age and gender matched lean controls (15.7 ± 1.8 yrs, 60 ± 12.8 kg). Based on results from an oral glucose tolerance test (OGTT), obese adolescents were categorized as obese normoglycemic (ONG, n = 25) or obese dysglycemic (ODG, n = 14). Left ventricular (LV) global and average LS, CS, RS and strain rate were measured. LV ejection fraction and mass index were measured and VVI approximated as ratio of arterial elasticity (Ea) and end-systolic elastance (Ees). Results Adolescents with ODG had significantly (P = 0.005) impaired global LS (− 20.98% ± 2.8%) compared to controls (− 23.01% ± 2.3%). A similar (P = 0.0027) reduction was observed in average LS for adolescents with ODG (18.87% ± 2.5%) compared to controls (20.49% ± 2%). Global CS was also decreased (P = 0.03) in ODG (− 23.95%) compared to ONG (− 25.80). A similar trend was observed in average CS after multivariate regression for BMI and blood pressure. CS correlated with HbA1c in both groups (P = 0.05). VVI had a negative correlation with both LS (r = − 0.4, P = 0.025) and CS rate (r = − 0.36, P = 0.04). Conclusions Myocardial strain and strain rate were significantly altered in obese adolescents. Unfavorable subclinical reductions in global and average CS were more pronounced in adolescents with dysglycemia compared to obese adolescents with normoglycemia and controls. These data indicate progressive worsening of subendocardial function across the spectrum of glucose tolerance. Strain rate was predictive of VVI in obese adolescents, suggesting strain rate may be a sensitive marker for cardiac remodeling in abnormal glucose homeostasis states.

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Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children

Cardiology in the Young ◽

10.1017/s1047951118002378 ◽

2019 ◽

Vol 29 (3) ◽

pp. 325-337

Author(s):

Laurens P. Koopman ◽

Bas Rebel ◽

Devi Gnanam ◽

Mirthe E. Menting ◽

Willem A. Helbing ◽

...

Keyword(s):

Left Ventricle ◽

Strain Rate ◽

Longitudinal Strain ◽

Circumferential Strain ◽

Left Ventricular ◽

Myocardial Deformation ◽

Healthy Children ◽

Deformation Parameters ◽

Strain And Strain Rate ◽

Echocardiographic Parameters

AbstractBackgroundMyocardial deformation by speckle tracking echocardiography provides additional information on left ventricular function. Values of myocardial deformation (strain and strain rate) depend on the type of ultrasound machine and software that is used. Normative values for QLAB (Philips) are scarce, especially for children. It is important to evaluate the influence of age and body size on myocardial deformation parameters, since anthropometrics strongly influence many standard echocardiographic parameters. The aim of this study was to provide comprehensive normal values for myocardial deformation of the left ventricle using a Philips platform and to evaluate the association with anthropometric and standard echocardiographic parameters.MethodsHealthy children between 1 and 18 years of age were prospectively examined using a standard echocardiographic protocol. Short-axis and apical four-chamber, two-chamber, and three-chamber views were used to measure peak systolic circumferential and longitudinal strain and systolic and early diastolic strain rate of the left ventricle using dedicated software.ResultsA total of 103 children were included with a mean age of 10.8 and inter-quartile range 7.3–14.3 years. Global circumferential strain values (±SD) were −24.2±3.5% at basal, −25.8±3.5% at papillary muscle, and −31.9±6.2% at apex levels. Global left ventricular longitudinal strain values were −20.6±2.6% in apical four-chamber view, −20.9±2.7% in apical two-chamber, and −21.0 ±2.7% in apical three-chamber. Age was associated with longitudinal strain, longitudinal systolic and early diastolic strain rate, but not with circumferential strain.ConclusionsNormal values for left ventricular deformation parameters in children are obtained using a Philips platform. Age partly explains normal variation of strain and strain rate.

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Index-Beat Assessment of Left Ventricular Systolic and Diastolic Function during Atrial Fibrillation Using Myocardial Strain and Strain Rate

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2012.06.009 ◽

2012 ◽

Vol 25 (9) ◽

pp. 953-959 ◽

Cited By ~ 47

Author(s):

Kenya Kusunose ◽

Hirotsugu Yamada ◽

Susumu Nishio ◽

Noriko Tomita ◽

Junko Hotchi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Strain Rate ◽

Diastolic Function ◽

Myocardial Strain ◽

Left Ventricular ◽

Strain And Strain Rate ◽

Systolic And Diastolic Function

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Quantification of myocardial deformation in children by cardiovascular magnetic resonance feature tracking: determination of reference values for left ventricular strain and strain rate

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-016-0310-x ◽

2016 ◽

Vol 19 (1) ◽

Cited By ~ 12

Author(s):

Florian André ◽

Daniëlle Robbers-Visser ◽

Astrid Helling-Bakki ◽

Angela Föll ◽

Andreas Voss ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Strain Rate ◽

Reference Values ◽

Feature Tracking ◽

Left Ventricular ◽

Myocardial Deformation ◽

Left Ventricular Strain ◽

Strain And Strain Rate

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Stiffness- and relaxation-based quantitation of radial left ventricular oscillations: elucidation of regional diastolic function mechanisms

Journal of Applied Physiology ◽

10.1152/japplphysiol.01219.2006 ◽

2007 ◽

Vol 102 (5) ◽

pp. 1862-1870 ◽

Cited By ~ 5

Author(s):

Matt M. Riordan ◽

Sándor J. Kovács

Keyword(s):

Strain Rate ◽

Diastolic Function ◽

Causal Relation ◽

Myocardial Strain ◽

Left Ventricular ◽

Tissue Imaging ◽

Short Axis ◽

Strain Rate Imaging ◽

Strain And Strain Rate ◽

Volume Property

Traditionally, global and longitudinal (i.e., regional) left ventricular (LV) diastolic function (DF) assessment has utilized features of transmitral Doppler E and A waves or Doppler tissue imaging (DTI)-derived mitral annular E′ and A′ waves, respectively. Quantitation of regional DF has included M-mode echocardiography-based approaches and strain and strain rate imaging (in selected imaging planes), while analysis of mitral annular “oscillations” has recently provided a new window into longitudinal (long-axis) function. The remaining major spatial degree of kinematic freedom during diastole, radial (short-axis) motion, has not been fully characterized, nor has it been exploited for its potential to provide radial LV stiffness ( krad) and relaxation/damping ( crad) indexes. Prior characterization of regional (longitudinal) DF used only annular E′- and A′-wave peak velocities or, alternatively, myocardial strain and strain rate. By kinematically modeling short-axis tissue motion as damped radial oscillation, we present a novel method of estimating krad and crad during early filling. As required by the (near) constant-volume property of the heart and tissue/blood incompressibility, in subjects ( n = 10) with normal DF, we show that oscillation duration-determined longitudinal ( klong and clong) and radial ( klong and crad) parameters are highly correlated ( R = 0.69 and 0.92, respectively). Selected examples of diabetic and LV hypertrophic subjects yield radial ( klong and crad) parameters that differ substantially from controls. Results underscore the utility of the incompressibility-based causal relation between DTI-determined mitral annular long-axis (longitudinal mode) and short-axis (radial mode) oscillations in healthy subjects. Selected pathological examples provide mechanistic insight and illustrate the value and potential role of regional (longitudinal and radial) DF indexes in fully characterizing normal vs. impaired DF states.

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Metabolomics analysis reveals altered metabolites in lean compared with obese adolescents and additional metabolic shifts associated with hyperinsulinaemia and insulin resistance in obese adolescents: a cross-sectional study

Metabolomics ◽

10.1007/s11306-020-01759-y ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Elisabeth Müllner ◽

Hanna E. Röhnisch ◽

Claudia von Brömssen ◽

Ali A. Moazzami

Keyword(s):

Insulin Resistance ◽

Amino Acids ◽

Glucose Tolerance ◽

Insulin Response ◽

Oral Glucose ◽

Response Level ◽

Metabolic Alterations ◽

Obese Adolescents ◽

Branched Chain ◽

Metabolomics Analysis

Abstract Introduction Hyperinsulinaemia and insulin resistance (IR) are strongly associated with obesity and are forerunners of type 2 diabetes. Little is known about metabolic alterations separately associated with obesity, hyperinsulinaemia/IR and impaired glucose tolerance (IGT) in adolescents. Objectives To identify metabolic alterations associated with obesity, hyperinsulinaemia/IR and hyperinsulinaemia/IR combined with IGT in obese adolescents. Methods 81 adolescents were stratified into four groups based on body mass index (lean vs. obese), insulin responses (normal insulin (NI) vs. high insulin (HI)) and glucose responses (normal glucose tolerance (NGT) vs. IGT) after an oral glucose tolerance test (OGTT). The groups comprised: (1) healthy lean with NI and NGT, (2) obese with NI and NGT, (3) obese with HI and NGT, and (4) obese with HI and IGT. Targeted nuclear magnetic resonance-based metabolomics analysis was performed on fasting and seven post-OGTT plasma samples, followed by univariate and multivariate statistical analyses. Results Two groups of metabolites were identified: (1) Metabolites associated with insulin response level: adolescents with HI (groups 3–4) had higher concentrations of branched-chain amino acids and tyrosine, and lower concentrations of serine, glycine, myo-inositol and dimethylsulfone, than adolescents with NI (groups 1–2). (2) Metabolites associated with obesity status: obese adolescents (groups 2–4) had higher concentrations of acetylcarnitine, alanine, pyruvate and glutamate, and lower concentrations of acetate, than lean adolescents (group 1). Conclusions Obesity is associated with shifts in fat and energy metabolism. Hyperinsulinaemia/IR in obese adolescents is also associated with increased branched-chain and aromatic amino acids.

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GW24-e1717 Assessment on the changes of myocardial strain rate and aneurysm volume of left ventricular aneurysm in a rabbit model

Heart ◽

10.1136/heartjnl-2013-304613.737 ◽

2013 ◽

Vol 99 (Suppl 3) ◽

pp. A261.2-A261 ◽

Cited By ~ 1

Author(s):

Mu YuMing ◽

Zhai Hong ◽

Guliqiman Hhuojiaabudula ◽

Wang Chunmei ◽

Han Wei ◽

...

Keyword(s):

Strain Rate ◽

Myocardial Strain ◽

Rabbit Model ◽

Left Ventricular ◽

Left Ventricular Aneurysm ◽

Ventricular Aneurysm ◽

Aneurysm Volume

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Left Ventricular Adaptations in Herding Dogs

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.90864 ◽

2019 ◽

Vol 47 (1) ◽

Author(s):

Raimy Costa Martins ◽

João Paulo Da Exaltação Pascon ◽

Karen Guzmán Béltran ◽

Maria Ligia De Arruda Mistieri

Keyword(s):

Physical Activity ◽

Physical Exercise ◽

Strain Rate ◽

Blood Pressure Measurement ◽

Left Ventricular ◽

Tei Index ◽

Strain And Strain Rate ◽

Deformation Velocity ◽

Conventional Echocardiography ◽

Exercise In Humans

Background: Athlete’s heart syndrome comprises a set of functional and anatomic cardiac changes secondary to intense and prolonged physical exercise in humans and animals. The heart adapts to the type of activity performed, and Doppler echocardiography is the best tool for identifying these changes. Speckle tracking echocardiography (STE) has provided new data on cardiovascular adaptations secondary to physical exercise in humans, information that conventional echocardiography cannot provide. Although physical activity and work in dogs are well documented, there are few studies on cardiovascular adaptations secondary to exercise in dogs, and no studies to date evaluated these adaptations using STE.Materials, Methods &Results:A total of 31 dogs of the Border Collie and OvelheiroGaúchoBrasileiro breeds were divided into two groups: a herding group (HG, n = 15), which performed herding activity five to six times a week for at least 4 months, and a sedentary group (SG, n = 16), with no history of physical activity in the past twelve months. All dogs were previously subjected to electrocardiography and blood pressure measurement. After that, the animals underwent echocardiographic examination at rest at a single time point. The data were analyzed by two-way multivariate analysis of variance (ANOVA) at a level of significance of 5% (P < 0.05) and a trend at 90% (P < 0.1). The dogs of the HG had higher values for left-ventricular end-systolic diameter (LVESD) and systolic volume (SV), and lower values for left-ventricular myocardial performance index (Tei index) and systolic septal movement. STE results indicated that the HG presented lower values for strain and strain rate in some myocardial segments in the radial, circumferential, longitudinal, and transverse directions.Discussion:The increase in LVESD is justified by the increase in preload (volume) required to meet the increased oxygen demand, whereas SV is directly related to the Frank-Starling mechanism. The lower Tei index in the HG indicates better systolic-diastolic performance, explained by a shorter isovolumetric relaxation time and isovolumetric contraction time and by an increase in left ventricular (LV) ejection time. Similar results were not observed in LV systolic wall motion. Therefore, we believe that the most likely explanation is a higher systolic efficiency, associated with lower energy demand at rest. According to STE criteria, the lower strain and strain rate in the HG in some myocardial segments in all directions suggest less need for myocardial deformation and lower deformation velocity in order to maintain systolic function. In conclusion, conventional echocardiography and STE were complementary and fundamental to understand cardiovascular adaptations in herding dogs.

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