Abstract
The aims of this study were (1) to quantify changes in 3-dimensional (3D) strain in obese children using real-time 3D echocardiography (RT3DE) and 3D speckle tracking echocardiography (3DSTE), and (2) to investigate the utility of left ventricular (LV) strain variables in measuring early cardiovascular changes in children with obesity. A total of 181 obese children (study group) aged 4–18 years old were prospectively enrolled and compared with 229 healthy subjects (control group). We acquired demographic, clinical, biochemical, and 2D echocardiography/Doppler data. Also, RT3DE and 3DSTE were performed to measure LV volume, left ventricular ejection fraction (LVEF), LV mass (LVM), LV peak systolic global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS), and global strain (GS). There were significant differences in anthropometric measurements, blood pressures, Cholesterol, C-reactive protein (CRP), Intima-media thickness (IMT), left atrium end-systolic dimension (LASD), interventricular septal end-diastolic dimension (IVSD), LV posterior wall end-diastolic dimension (LVPWD), LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD), LV end-diastolic volumes (LVEDV), and LV end-systolic volumes (LVESV), E and A velocities, E/A,e’, e’/a’, E/e’, LVM, LV mass index (LVMI), GLS, GRS, GCS, and GS between the study and control groups. The receiver operating characteristic curves (ROC) for the statistically significant echocardiographic variables showed that the range of areas of ROC curves varied from 0.76 (GLS), 0.74 (GRS), 0.72 (LASD), to 0.58 (LVESD), respectively. In conclusion, LV 3D strain variables by RT3DE and 3DSTE decrease in obese children. LV 3D strain is more sensitive than other echocardiographic and vascular ultrasound variables in detecting cardiovascular changes in children with obesity.
Highlights
The prevalence of obesity has increased significantly in children and adolescents and has become a major risk factor for cardiovascular disease (CVD) [1,2,3]
There was no significant difference in gender, height between the two groups; the study group had significantly increased weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, age and subcutaneous fat thickness (P < 0.001 to 0.05)
There was no significant difference in fasting glucose, triglyceride, and homocysteine levels between the two groups; the study group had significantly higher low-density lipoprotein cholesterol (LDL-C), total cholesterol, high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP) levels (P < 0.001 to< 0.05) than those of the normal control group (Table 2)
Summary
The prevalence of obesity has increased significantly in children and adolescents and has become a major risk factor for cardiovascular disease (CVD) [1,2,3]. In addition to traditional LV functional measurements, e.g. LV ejection fraction, myocardial velocities determined by tissue doppler imaging (TDI) do not rely on geometric assumptions but are inherently unidimensional, angle-dependent, variable with age, and influenced by anthropometrics and heart rate [11,12]. Using both echocardiography and cardiac magnetic resonance imaging, myocardial strain has been shown to be more robust for assessment of regional ventricular myocardial function [13,14,15,16,17]. Comparing with 2DSTE, 3DSTE has no geometrical assumption, unaffected by foreshortening of the LV, and more accurate and reproducible in patients with good image quality [18]
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