Effect of Weight Loss Due to Lifestyle Intervention on Subclinical Cardiovascular Dysfunction in Obesity (Body Mass Index >30 kg/m2)

doi:10.1016/j.amjcard.2006.07.037

The American Journal of Cardiology

Volume 98, Issue 12, 15 December 2006, Pages 1593-1598

https://doi.org/10.1016/j.amjcard.2006.07.037 Get rights and content

Subclinical myocardial and vascular dysfunctions occur in subjects with obesity. We investigated whether these changes were reversible with weight loss due to lifestyle intervention. Quantitative assessment of myocardial and vascular functions was performed at baseline and after a minimum of 8 weeks of a lifestyle intervention program in 106 subjects with significant risk factors but no history of cardiovascular disease and normal ejection fractions. Myocardial function was assessed using strain rate, strain, regional myocardial systolic velocity, and diastolic velocity (e_m). Myocardial reflectivity was assessed by calibrated integrated backscatter. Vascular function was assessed using brachial arterial reactivity and arterial compliance. Exercise capacity was measured by peak oxygen consumption per unit time (VO₂). Weight loss (−4.5 ± 2.0%) was achieved by 48 subjects, and 58 maintained or increased weight (+1 ± 1.5%, p <0.001). Compared with the stable weight group, the weight loss group showed significant improvement in brachial arterial reactivity (8.6 ± 4.9% vs 6.7 ± 4.9%, p <0.05), e_m (6.4 ± 1.9 vs 5.5 ± 1.9 cm/s, p <0.01), and reflectivity (calibrated integrated backscatter, 18.3 ± 4.9 vs 16.2 ± 5.2 dB, p <0.01). The magnitude of weight change correlated with changes in e_m (r = 0.36) and calibrated integrated backscatter (r = 0.33). The change in e_m correlated with peak VO₂ (r = 0.38, p <0.001) and was an independent predictor for peak VO₂ even after adjustment for age and body mass index in a multivariate model (R² = 0.45, p <0.001). Weight loss was not associated with a significant change in systolic parameters (regional myocardial systolic velocity, global strain, and strain rate) or arterial compliance.

Section snippets

Patient selection

We studied 106 obese men and women (BMI >30 kg/m²) with cardiovascular risk factors but without known cardiovascular symptoms, structural heart disease on echocardiography, or ischemic heart disease on stress testing. Obese subjects were recruited from general practice clinics, specialist clinics, and the general community. Informed written consent for participation was obtained, and the hospital and university ethics committees approved the protocol.

Clinical assessment

Demographic details of age, gender, clinical

Patient characteristics

Two groups were identified based on whether weight loss was demonstrated at the end of lifestyle intervention programs. The 2 groups had a high proportion (>2/3) of subjects with metabolic syndrome⁵ and diabetes. The weight stable group had slightly more metabolic risk factors of hypertension and abnormal lipid profile, and therefore, higher prevalence in angiotensin-converting enzyme inhibitor and statin use (Table 1).

Metabolic and anthropometric characteristics

As anticipated, baseline BMI correlated significantly with waist

Discussion

The results of this study indicate that weight loss through a short-term lifestyle modification can reverse endothelial dysfunction, increase left ventricular diastolic function and reflectivity, and increase exercise capacity in presymptomatic obese subjects. Myocardial improvement is related to degree of weight loss and corresponds to increased exercise capacity. Lack of myocardial and vascular responses to exercise training in the absence of weight loss supports the argument that increasing

References (20)

S. Sasaki et al.
A low-calorie diet improves endothelium-dependent vasodilation in obese patients with essential hypertension
Am J Hypertens
(2002)
H.J. Willens et al.
Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging
Am J Cardiol
(2005)
B.A. Haluska et al.
Noninvasive tests for arterial structure, function, and compliance: do they identify risk or diagnose disease?
J Am Soc Echocardiogr
(2004)
G.L. Freeman et al.
Analysis of myocardial response to significant weight loss in obese rats
Am J Clin Nutr
(1994)
M.A. Alpert et al.
Effect of weight loss on left ventricular diastolic filling in morbid obesity
Am J Cardiol
(1995)
A.H. Mokdad et al.
The continuing epidemics of obesity and diabetes in the United States
JAMA
(2001)
C.Y. Wong et al.
Alterations of left ventricular myocardial characteristics associated with obesity
Circulation
(2004)
The IDF consensus worldwide definition of the metabolic syndrome, 2005. Available at:...
G. de Simone et al.
Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults
Hypertension
(1994)
S. Urheim et al.
Myocardial strain by Doppler echocardiographyValidation of a new method to quantify regional myocardial function
Circulation
(2000)

There are more references available in the full text version of this article.

Cited by (44)

Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: A randomized controlled trial
2017, International Journal of Cardiology
Citation Excerpt :
Effective antihypertensive treatment in hypertension has shown to improve e´ [38]. Weight reduction in obese patients also improves e′ [39]. Physical training has also been found to improve e´ in patients with heart failure and preserved LVEF [40].
Obstructive sleep apnea (OSA) has been associated with worse diastolic function in patients with coronary artery disease (CAD). This analysis determined whether continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA.
Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) ≥ 15/h, Epworth Sleepiness Scale [ESS] score < 10) were randomly assigned to CPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, and after 3 and 12 months.
A total of 171 patients with preserved left ventricular ejection fraction (≥ 50%), no atrial fibrillation or severe valve abnormalities, and technically adequate echocardiograms at baseline and follow-up visits were included (CPAP, n = 87; no-CPAP, n = 84). In the intention-to-treat analysis, CPAP had no significant effect on echocardiographic parameters of mild (enlarged left atrium or decreased diastolic relaxation velocity) or worse (increased E/é filling index [presumed elevated left ventricular filling pressure]) diastolic function. Post-hoc analysis revealed a significant association between CPAP usage for ≥ 4 h/night and an increase in diastolic relaxation velocity at 12 months' follow-up (odds ratio 2.3, 95% confidence interval 1.0–4.9; p = 0.039) after adjustment for age, sex, body mass index, and left atrium diameter at baseline.
CPAP did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, good CPAP adherence was significantly associated with an increase in diastolic relaxation velocity after one year.
Young Women With Abdominal Obesity Have Subclinical Myocardial Dysfunction
2015, Canadian Journal of Cardiology
Abdominal obesity is an independent risk factor for cardiovascular disease. The effect of abdominal obesity on myocardial function in young obese women remains unknown. Therefore, we aimed to investigate cardiac morphology and function, myocardial deformation, and mechanical indices, in young women with and without abdominal obesity.
Cross-sectional analyses of 39 women with abdominal obesity (waist circumference ≥ 80 cm) and 33 nonobese control subjects (waist circumference < 80 cm) aged 18-30 years underwent conventional echocardiographic measures of cardiac morphology and function together with tissue Doppler, and 2-dimensional speckle tracking measures of myocardial deformation and mechanics. Cardiometabolic risk factors including anthropometric, hypertension, biochemistry, and fitness were also assessed.
Standard echocardiography results for cardiac morphology and function were similar between groups, with the exception of larger left atrial dimensions in women with abdominal obesity (P ≤ 0.05). Compared with control subjects, women with abdominal obesity also demonstrated reduced systolic and diastolic mitral annular plane velocities, increased left atrial pressure surrogates (E/diastolic mitral annular plane velocity), and prolonged timing measures of diastolic function including isovolumic relaxation time and transmitral deceleration time (P ≤ 0.05). In addition, longitudinal strain and diastolic strain rate were reduced in women with abdominal obesity (P ≤ 0.05) but circumferential deformation and myocardial mechanics (twist indices and rotation) were preserved. Markers of abdominal obesity retained an independent direct correlation with parameters of cardiac dysfunction, explaining 12%-39% of the overall variability.
A young, otherwise healthy group of women with abdominal obesity displayed subclinical cardiac dysfunction indicated using selected tissue Doppler imaging and speckle tracking echocardiography measures.
L’obésité abdominale est un facteur de risque indépendant de la maladie cardiovasculaire. Nous ignorons les conséquences de l’obésité abdominale sur la fonction du myocarde chez les jeunes femmes obèses. Par conséquent, notre but était d’examiner la morphologie et la fonction cardiaque, la déformation du myocarde et les indices mécaniques chez les jeunes femmes souffrant ou non d’obésité abdominale.
Les analyses transversales de 39 femmes souffrant d’obésité abdominale (tour de taille ≥ 80 cm) et 33 sujets témoins non obèses (tour de taille < 80 cm) qui étaient âgées de 18 à 30 ans ont subi des mesures échocardiographiques traditionnelles de la morphologie et de la fonction cardiaque par Doppler tissulaire et des mesures par échocardiographie bidimensionnelle Speckle Tracking (suivi de pixel) de la déformation et de la mécanique du cœur. Les facteurs de risque cardiométabolique, y compris l’anthropométrie, l’hypertension, la biochimie et la condition physique ont également été évalués.
Les résultats de l’échocardiographie standard de la morphologie et de la fonction cardiaque étaient similaires entre les groupes, à l’exception des dimensions plus grandes de l’oreillette gauche chez les femmes souffrant d’obésité abdominale (P ≤ 0,05). Comparativement aux sujets témoins, les femmes souffrant d’obésité abdominale démontraient également une réduction des vitesses systoliques et diastoliques du plan de l’anneau mitral, une augmentation des substituts de la pression auriculaire gauche (E/vitesse diastolique du plan de l’anneau mitral) et des mesures prolongées de la durée de la fonction diastolique, y compris le temps de relaxation isovolumique et du temps de décélération du flux transmitral (P ≤ 0,05). De plus, la déformation longitudinale et le taux de déformation diastolique étaient réduits chez les femmes souffrant d’obésité abdominale (P ≤ 0,05), mais la déformation circonférentielle et la mécanique du myocarde (indices de torsion et rotation) étaient préservées. Les marqueurs de l’obésité abdominale conservaient une corrélation directe indépendante avec les paramètres de la dysfonction cardiaque, ce qui explique 12 % à 39 % de la variabilité globale.
Un groupe de femmes jeunes, mais en santé, souffrant d’obésité abdominale montraient une dysfonction sous-clinique cardiaque selon les mesures de l’imagerie Doppler tissulaire et de l’échocardiographie Speckle Tracking (suivi de pixel).
A six-month exercise intervention in subclinical diabetic heart disease: Effects on exercise capacity, autonomic and myocardial function
2014, Metabolism: Clinical and Experimental
Autonomic dysfunction may contribute to the etiology and exercise intolerance of subclinical diabetic heart disease. This study sought the efficacy of exercise training for improvement of peak oxygen uptake (VO_2peak) and cardiac autonomic function in type 2 diabetic patients with non-ischemic subclinical left-ventricular (LV) dysfunction.
Forty-nine type 2 diabetic patients with early diastolic tissue Doppler velocity > 1 standard deviation below the age-based mean entered an exercise intervention (n = 24) or usual care (n = 25) for 6-months (controlled, pre-/post- design). Co-primary endpoints were treadmill VO_2peak and 5-min heart-rate variability (by the coefficient of variation of normal RR intervals [CVNN]). Autonomic function was additionally assessed by resting heart-rate (for sympathovagal balance estimation), baroreflex sensitivity, cardiac reflexes, and exercise/recovery heart-rate profiles. Echocardiography was performed for LV function (systolic/diastolic tissue velocities, myocardial deformation) and myocardial fibrosis (calibrated integrated backscatter).
VO_2peak increased by 11% during the exercise intervention (p = 0.001 vs. − 1% in controls), but CVNN did not change (p = 0.23). Reduction of resting heart-rate in the intervention group (p < 0.05) was associated with an improvement in the secondary endpoint of heart-rate variability total spectral power (p < 0.05). However, baroreflex sensitivity, cardiac reflexes, and exercise/recovery heart-rate profiles showed no significant benefit. No effects on LV function were observed despite favorable reduction of calibrated integrated backscatter in the intervention group (p < 0.05).
The exercise intolerance of subclinical diabetic heart disease was amenable to improvement by exercise training. Despite a reduction in resting heart-rate and potential attenuation of myocardial fibrosis, no other cardiac autonomic or LV functional adaptations were detected.
Low-carbohydrate/high-protein diet improves diastolic cardiac function and the metabolic syndrome in overweight-obese patients with type 2 diabetes
2014, IJC Metabolic and Endocrine
Diastolic dysfunction/heart failure in the metabolic syndrome and type 2 diabetes (T2D) is an epidemic without evidence-based treatment strategies. While improved glycemic control/insulin sensitivity has been associated with augmented cardiac function in pharmacologic studies, studies on dietary intervention are scarce. Low-carbohydrate nutrition (LC) improves postprandial glucose control and insulin resistance more than standard low-fat diet (LF). We tested the hypothesis, that LC improves cardiac function in overweight-obese patients with T2D more than LF.
Two matched groups of 16 T2D patients without overt heart disease (52 ± 7 years, BMI 34 ± 6 kg/m²) were studied in a parallel and partial cross-over design during a 3-week rehabilitation programme with either LC or LF followed by 2 weeks LC. Cardiac function was assessed as myocardial velocity during systole and early diastole (E′) using Doppler tissue imaging and metabolic control before and after a standardised breakfast.
In the parallel groups, both diets induced similar and significant reductions of weight, HbA1c and cholesterol. LC considerably improved insulin resistance, fasting and postmeal triglycerides, blood pressure and diastolic cardiac function E′ (by 0.9 ± 1.4 cm/s, p = 0.023). None of these variables changed on LF, but all of them improved significantly after subsequent LC (E′ by 0.9 ± 1.1 cm/s, p = 0.023). Postprandial intact proinsulin was unchanged on LF but decreased with subsequent LC (p = 0.032).
These data indicate, that a low-glycaemic/high-protein but not a low-fat/high-carbohydrate nutrition modulates diastolic dysfunction in overweight T2D patients, improves insulin resistance and may prevent or delay the onset of diabetic cardiomyopathy and the metabolic syndrome.
Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: Results of the Ex-DHF (exercise training in diastolic heart failure) pilot study
2011, Journal of the American College of Cardiology
We sought to determine whether structured exercise training (ET) improves maximal exercise capacity, left ventricular diastolic function, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF).
Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies are sparse.
A total of 64 patients (age 65 ± 7 years, 56% female) with HFpEF were prospectively randomized (2:1) to supervised endurance/resistance training in addition to usual care (ET, n = 44) or to usual care alone (UC) (n = 20). The primary endpoint was the change in peak Vo₂ after 3 months. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL.
Peak Vo₂ increased (16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg; p < 0.001) with ET and remained unchanged (16.7 ± 4.7 ml/min/kg to 16.0 ± 6.0 ml/min/kg; p = NS) with UC. The mean benefit of ET was 3.3 ml/min/kg (95% confidence interval [CI]: 1.8 to 4.8, p < 0.001). E/e′ (mean difference of changes: −3.2, 95% CI: −4.3 to −2.1, p < 0.001) and left atrial volume index (milliliters per square meter) decreased with ET and remained unchanged with UC (−4.0, 95% CI: −5.9 to −2.2, p < 0.001). The physical functioning score (36-Item Short-Form Health Survey) improved with ET and remained unchanged with UC (15, 95% CI: 7 to 24, p < 0.001). The ET-induced decrease of E/e′ was associated with 38% gain in peak Vo₂ and 50% of the improvement in physical functioning score.
Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF. This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function. (Exercise Training in Diastolic Heart Failure–Pilot Study: A Prospective, Randomised, Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life [Ex-DHF-P]; ISRCTN42524037)
Demonstration of subclinical left ventricular electrical and mechanical dysfunction in overweight subjects by frontal QRS-T angle and 3D-speckle tracking echocardiography
2023, Echocardiography

View all citing articles on Scopus

: This study was supported in part by a Centers of Clinical Research Excellence Award from the National Health and Medical Research Council, Canberra, Australia.

View full text

Preventive cardiologyEffect of Weight Loss Due to Lifestyle Intervention on Subclinical Cardiovascular Dysfunction in Obesity (Body Mass Index >30 kg/m2)

Section snippets

Patient selection

Clinical assessment

Patient characteristics

Metabolic and anthropometric characteristics

Discussion

Am J Hypertens

Am J Cardiol

J Am Soc Echocardiogr

Am J Clin Nutr

Am J Cardiol

The continuing epidemics of obesity and diabetes in the United States

JAMA

Alterations of left ventricular myocardial characteristics associated with obesity

Circulation

Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults

Hypertension

Myocardial strain by Doppler echocardiographyValidation of a new method to quantify regional myocardial function

Circulation

Preventive cardiology
Effect of Weight Loss Due to Lifestyle Intervention on Subclinical Cardiovascular Dysfunction in Obesity (Body Mass Index >30 kg/m²)