Different Patterns of Left Ventricular Hypertrophy in Metabolically Healthy and Insulin-Resistant Obese Subjects.

Angela Sciacqua,Sofia Miceli,Antonio Cimellaro,Maria Perticone,Francesco Perticone,Teresa V Fiorentino,Francesco Andreozzi,Velia Cassano,Luana Mancuso,Elena Succurro,Giorgio Sesti

doi:10.3390/nu12020412

Abstract

Obese subjects showed different cardiovascular risk depending by different insulin sensitivity status. We investigated the difference in left ventricular mass and geometry between metabolically healthy (MHO) and unhealthy (MUHO) obese subjects. From a cohort of 876 obese subjects (48.3 ± 14.1 years) without cardio-metabolic disease and stratified according to increasing values of Matsuda index after 75 g oral glucose tolerance test, we defined MHO (n = 292) those in the upper tertile and MUHO (n = 292) those in the lower tertile. All participants underwent echocardiographic measurements. Left ventricular mass was calculated by Devereux equation and normalized by height2,7 and left ventricular hypertrophy (LVH) was defined by values >44 g/m2.7 for females and >48 g/m2.7 for males. Left ventricular geometric pattern was defined as concentric or eccentric if relative wall thickness was higher or lower than 0.42, respectively. MHO developed more commonly a concentric remodeling (19.9 vs. 9.9%; p = 0.001) and had a reduced risk for LVH (OR 0.46; p < 0.0001) than MUHO, in which the eccentric type was more prevalent (40.4 vs. 5.1%; p < 0.0001). We demonstrated that obese subjects—matched for age, gender and BMI—have different left ventricular mass and geometry due to different insulin sensitivity status, suggesting that diverse metabolic phenotypes lead to alternative myocardial adaptation.

Highlights

Obesity represents a crucial problem for public health due to reach epidemic proportion worldwide and to strongly associate with an increased risk for type 2 diabetes mellitus and cardiovascular (CV)disease, both conditions able to worse clinical outcome [1]
No differences in gender distribution, age, body mass index (BMI), smokers, diastolic blood pressure (DBP) and LDL-cholesterol values were observed between metabolically unhealthy obese (MUHO) and metabolically healthy obesity (MHO) groups
MUHO showed a worse hemodynamic, metabolic and inflammatory profile when compared to MHO, as suggested by significantly higher values of systolic blood pressure (SBP) and pulse pressure, heart rate, waist circumference, triglycerides, fasting glucose, fasting insulin, homeostasis model assessment of insulin-resistance (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP) and uric acid

Summary

Introduction

Obesity represents a crucial problem for public health due to reach epidemic proportion worldwide and to strongly associate with an increased risk for type 2 diabetes mellitus and cardiovascular (CV)disease, both conditions able to worse clinical outcome [1]. Nutrients 2020, 12, 412 obese subjects are free of any metabolic abnormalities, are relatively insulin sensitive and have a rather favorable CV risk profile, they exhibit metabolically healthy obesity (MHO) [3,4,5] This wide range may be justified by the fact that, despite the enhanced interest in MHO, there are not unique criteria to define MHO, the implications of MHO phenotype on CV risk is still not clear. It is known that left ventricular hypertrophy (LVH) represents an independent risk factor for CV morbidity and mortality in different clinical settings [6,7]. In consideration of the different obesity phenotypes, it is possible to speculate that it is not obesity itself, but the obesity-related metabolic abnormalities that affect LVM and LVH development with possible consequence on clinical outcome

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