Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

CARDIOVASCULAR SCREENING IN ASYMPTOMATIC ADOLESCENTS WITH METABOLIC SYNDROME

  • BAE, HYUN KYUNG (DEPARTMENT OF PEDIATRICS, EWHA WOMANS UNIVERSITY SCHOOL OF MEDICINE) ;
  • CHOI, HAN SEUL (DEPARTMENT OF PEDIATRICS, EWHA WOMANS UNIVERSITY SCHOOL OF MEDICINE) ;
  • SOHN, SEJUNG (DEPARTMENT OF PEDIATRICS, EWHA WOMANS UNIVERSITY SCHOOL OF MEDICINE) ;
  • SHIN, HYE-JUNG (DEPARTMENT OF PEDIATRICS, NATIONAL MEDICAL CENTER) ;
  • NAM, JAE-HWAN (DEPARTMENT OF BIOTECHNOLOGY, THE CATHOLIC UNIVERSITY OF KOREA) ;
  • HONG, YOUNG MI (DEPARTMENT OF PEDIATRICS, EWHA WOMANS UNIVERSITY SCHOOL OF MEDICINE)
  • Received : 2014.11.21
  • Accepted : 2015.02.27
  • Published : 2015.03.27
⟨ Previous Next ⟩

Abstract

BACKGROUND: In recent days, the prevalence of childhood metabolic syndrome (MS) has increased substantially due to the increasing rate of childhood obesity on a global scale. The aims of this study were to detect the important parameters and provide the screening system to prevent cardiovascular disease in adolescents with MS. METHODS: Ninety one male adolescents were divided into two groups based on the presence or absence of MS. Anthropometric measurement and laboratory study were studied. Intimal medial thickness and pulse wave velocity were estimated. Left ventricular mass index (LVMI), ejection fraction, myocardial velocity, strain and strain rate were measured by tissue Doppler imaging and strain rate imaging. RESULTS: The prevalence of MS was 7.7%. Weight, body mass index (BMI), waist circumference (WC), glucose, insulin, homeostasis model assessment of insulin resistance, triglyceride and LVMI were significantly increased in the MS group. High density lipoprotein-cholesterol (HDL-C), peak early diastolic myocardial velocity (e'), systolic myocardial velocity (s') and global longitudinal strain were significantly lower in the MS group. In univariant analysis, LVMI was significantly correlated with BMI, WC, fat %, fat mass, systolic blood pressure, alanine aminotransferase, total cholesterol (TC) and low density lipoprotein-cholesterol. e' was significantly correlated with BMI, fat %, fat mass, and HDL-C. Global circumferential strain had significant correlation with glucose and TC. Basal anterolateral strain rate was significantly correlated with weight, BMI, WC, fat %, and fat mass. CONCLUSION: LVMI, strain and strain rate are practical and accurate parameters for assessment of left ventricular function in adolescents with MS.

Keywords

Acknowledgement

Supported by : Korean Society of Echocardiography

References

  1. Cruz ML, Goran MI. The metabolic syndrome in children and adolescents. Curr Diab Rep 2004;4:53-62. https://doi.org/10.1007/s11892-004-0012-x
  2. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003;157:821-7. https://doi.org/10.1001/archpedi.157.8.821
  3. Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, Mc- Crindle B, Mietus-Snyder ML; American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009;119:628-47. https://doi.org/10.1161/CIRCULATIONAHA.108.191394
  4. Ford ES, Li C. Defining the metabolic syndrome in children and adolescents: will the real definition please stand up? J Pediatr 2008;152:160-4. https://doi.org/10.1016/j.jpeds.2007.07.056
  5. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S; IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007;8:299-306. https://doi.org/10.1111/j.1399-5448.2007.00271.x
  6. Chen W, Srinivasan SR, Elkasabany A, Berenson GS. Cardiovascular risk factors clustering features of insulin resistance syndrome (Syndrome X) in a biracial (Black-White) population of children, adolescents, and young adults: the Bogalusa Heart Study. Am J Epidemiol 1999;150:667-74. https://doi.org/10.1093/oxfordjournals.aje.a010069
  7. Kibar AE, Pac FA, Balli S, Oflaz MB, Ece I, Bas VN, Aycan Z. Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study. Pediatr Cardiol 2013;34:1482-90. https://doi.org/10.1007/s00246-013-0674-8
  8. Shah N, Chintala K, Aggarwal S. Electrocardiographic strain pattern in children with left ventricular hypertrophy: a marker of ventricular dysfunction. Pediatr Cardiol 2010;31:800-6. https://doi.org/10.1007/s00246-010-9707-8
  9. Lorch SM, Sharkey A. Myocardial velocity, strain, and strain rate abnormalities in healthy obese children. J Cardiometab Syndr 2007;2:30-4. https://doi.org/10.1111/j.1559-4564.2007.06001.x
  10. Movahed MR, Saito Y. Obesity is associated with left atrial enlargement, E/A reversal and left ventricular hypertrophy. Exp Clin Cardiol 2008;13:89-91.
  11. Swaminathan S, Ferrer PL, Wolff GS, Gómez-MarÍn O, Rusconi PG. Usefulness of tissue Doppler echocardiography for evaluating ventricular function in children without heart disease. Am J Cardiol 2003;91:570-4. https://doi.org/10.1016/S0002-9149(02)03308-8
  12. Willens HJ, Chakko SC, Lowery MH, Byers P, Labrador E, Gallagher A, Castrillon JC, Myerburg RJ. Tissue Doppler imaging of the right and left ventricle in severe obesity (body mass index >35 kg/m2). Am J Cardiol 2004;94:1087-90. https://doi.org/10.1016/j.amjcard.2004.06.076
  13. Voigt JU, Arnold MF, Karlsson M, Hübbert L, Kukulski T, Hatle L, Sutherland GR. Assessment of regional longitudinal myocardial strain rate derived from Doppler myocardial imaging indexes in normal and infarcted myocardium. J Am Soc Echocardiogr 2000;13:588-98. https://doi.org/10.1067/mje.2000.105631
  14. Voigt JU, Lindenmeier G, Exner B, Regenfus M, Werner D, Reulbach U, Nixdorff U, Flachskampf FA, Daniel WG. Incidence and characteristics of segmental postsystolic longitudinal shortening in normal, acutely ischemic, and scarred myocardium. J Am Soc Echocardiogr 2003;16:415-23. https://doi.org/10.1016/S0894-7317(03)00111-1
  15. Yuda S, Short L, Leano R, Marwick TH. Myocardial abnormalities in hypertensive patients with normal and abnormal left ventricular filling: a study of ultrasound tissue characterization and strain. Clin Sci (Lond) 2002;103:283-93. https://doi.org/10.1042/cs1030283
  16. Gong HP, Tan HW, Fang NN, Song T, Li SH, Zhong M, Zhang W, Zhang Y. Impaired left ventricular systolic and diastolic function in patients with metabolic syndrome as assessed by strain and strain rate imaging. Diabetes Res Clin Pract 2009;83:300-7. https://doi.org/10.1016/j.diabres.2008.10.018
  17. Grandi AM, Maresca AM, Giudici E, Laurita E, Marchesi C, Solbiati F, Nicolini E, Guasti L, Venco A. Metabolic syndrome and morphofunctional characteristics of the left ventricle in clinically hypertensive nondiabetic subjects. Am J Hypertens 2006;19:199-205. https://doi.org/10.1016/j.amjhyper.2005.07.024
  18. Masugata H, Senda S, Goda F, Yoshihara Y, Yoshikawa K, Fujita N, Daikuhara H, Nakamura H, Taoka T, Kohno M. Left ventricular diastolic dysfunction as assessed by echocardiography in metabolic syndrome. Hypertens Res 2006;29:897-903. https://doi.org/10.1291/hypres.29.897
  19. Wong CY, O’Moore-Sullivan T, Fang ZY, Haluska B, Leano R, Marwick TH. Myocardial and vascular dysfunction and exercise capacity in the metabolic syndrome. Am J Cardiol 2005;96:1686-91. https://doi.org/10.1016/j.amjcard.2005.07.091
  20. Bokor S, Frelut ML, Vania A, Hadjiathanasiou CG, Anastasakou M, Malecka-Tendera E, Matusik P, Molnár D. Prevalence of metabolic syndrome in European obese children. Int J Pediatr Obes 2008;3 Suppl 2:3-8.
  21. Cote AT, Harris KC, Panagiotopoulos C, Sandor GG, Devlin AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol 2013;62:1309-19. https://doi.org/10.1016/j.jacc.2013.07.042
  22. Nakajima T, Fujioka S, Tokunaga K, Matsuzawa Y, Tarui S. Correlation of intraabdominal fat accumulation and left ventricular performance in obesity. Am J Cardiol 1989;64:369-73. https://doi.org/10.1016/0002-9149(89)90537-7
  23. Alpert MA, Lambert CR, Terry BE, Cohen MV, Mukerji V, Massey CV, Hashimi MW, Panayiotou H. Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity. Am Heart J 1995;130:1068-73. https://doi.org/10.1016/0002-8703(95)90210-4
  24. Kern PA, Di Gregorio GB, Lu T, Rassouli N, Ranganathan G. Adiponectin expression from human adipose tissue: relation to obesity, insulin resistance, and tumor necrosis factor-alpha expression. Diabetes 2003;52:1779-85. https://doi.org/10.2337/diabetes.52.7.1779
  25. Di Bello V, Giampietro O, Pedrinelli R, Matteucci E, Giorgi D, Bertini A, Bianchi M, Ferdeghini M, Boldrini E, Dell'Omo G, Paterni M, Giusti C. Can insulin action induce myocardial texture alterations in essential hypertension? Am J Hypertens 1999;12:283-90. https://doi.org/10.1016/S0895-7061(98)00227-1
  26. Mizushige K, Yao L, Noma T, Kiyomoto H, Yu Y, Hosomi N, Ohmori K, Matsuo H. Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model. Circulation 2000;101:899-907. https://doi.org/10.1161/01.CIR.101.8.899
  27. Vasan RS. Cardiac function and obesity. Heart 2003;89:1127-9. https://doi.org/10.1136/heart.89.10.1127
  28. Dhuper S, Abdullah RA, Weichbrod L, Mahdi E, Cohen HW. Association of obesity and hypertension with left ventricular geometry and function in children and adolescents. Obesity (Silver Spring) 2011;19:128-33. https://doi.org/10.1038/oby.2010.134
  29. Mahfouz RA, Dewedar A, Abdelmoneim A, Hossien EM. Aortic and pulmonary artery stiffness and cardiac function in children at risk for obesity. Echocardiography 2012;29:984-90. https://doi.org/10.1111/j.1540-8175.2012.01736.x
  30. Ingul CB, Tjonna AE, Stolen TO, Stoylen A, Wisloff U. Impaired cardiac function among obese adolescents: effect of aerobic interval training. Arch Pediatr Adolesc Med 2010;164:852-9.
  31. Schuster I, Karpoff L, Perez-Martin A, Oudot C, Startun A, Rubini M, Obert P, Vinet A. Cardiac function during exercise in obese prepubertal boys: effect of degree of obesity. Obesity (Silver Spring) 2009;17:1878-83. https://doi.org/10.1038/oby.2009.197
  32. Burchfiel CM, Skelton TN, Andrew ME, Garrison RJ, Arnett DK, Jones DW, Taylor HA Jr. Metabolic syndrome and echocardiographic left ventricular mass in blacks: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2005;112:819-27. https://doi.org/10.1161/CIRCULATIONAHA.104.518498
  33. Iacobellis G, Pellicelli AM, Sharma AM, Grisorio B, Barbarini G, Barbaro G. Relation of subepicardial adipose tissue to carotid intima-media thickness in patients with human immunodeficiency virus. Am J Cardiol 2007;99:1470-2. https://doi.org/10.1016/j.amjcard.2006.12.082
  34. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788-94. https://doi.org/10.1161/01.CIR.102.15.1788
  35. Fallah-Rad N, Walker JR, Wassef A, Lytwyn M, Bohonis S, Fang T, Tian G, Kirkpatrick ID, Singal PK, Krahn M, Grenier D, Jassal DS. The utility of cardiac biomarkers, tissue velocity and strain imaging, and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II-positive breast cancer treated with adjuvant trastuzumab therapy. J Am Coll Cardiol 2011;57:2263-70. https://doi.org/10.1016/j.jacc.2010.11.063
  36. Lago F, Gomez R, Gomez-Reino JJ, Dieguez C, Gualillo O. Adipokines as novel modulators of lipid metabolism. Trends Biochem Sci 2009;34:500-10. https://doi.org/10.1016/j.tibs.2009.06.008

Cited by

  1. Tracking Study About Adenovirus 36 Infection: Increase of Adiposity vol.25, pp.12, 2015, https://doi.org/10.4014/jmb.1509.09003
  2. Prevalence of Overweight and Obesity in Adolescents and Their Association with Cardiometabolic Risk Factors and Life-style vol.61, pp.3, 2015, https://doi.org/10.21101/hygiena.a1446
  3. Clinical Application of 2D Speckle Tracking Strain for Assessing Cardio-Toxicity in Oncology vol.1, pp.4, 2015, https://doi.org/10.3390/jfmk1040343
  4. Cardiac structure and function with and without metabolic syndrome: the Echocardiographic Study of Latinos (Echo-SOL) vol.6, pp.1, 2015, https://doi.org/10.1136/bmjdrc-2017-000484