Document Detail


Comparison of Clinical Presentation, Left Ventricular Morphology, Hemodynamics, and Exercise Tolerance in Obese Versus Nonobese Patients With Hypertrophic Cardiomyopathy.
MedLine Citation:
PMID:  24079444     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Obesity is independently associated with left ventricular (LV) hypertrophy and thus may be an important modifier of the hypertrophic cardiomyopathy (HC) phenotype. We examined if obesity modifies the clinical presentation, LV morphology, outflow hemodynamics, and exercise tolerance in HC. In this cross-sectional study, 88 obese (body mass index [BMI] ≥30 kg/m(2)) and 154 nonobese (BMI <30 kg/m(2)) patients from the Johns Hopkins HC clinic were compared with respect to a variety of clinical and LV echocardiographic measurements. Obese patients (36.4%) were more likely to report exertional dyspnea (p = 0.04) and chest pain (p = 0.002) and had greater prevalence of hypertension (p = 0.008). LV posterior wall thickness (p = 0.01) but not the septal wall (p ≥0.21) was significantly greater in obese patients, resulting in an increased LV mass index (p = 0.003). No significant differences in LV systolic and diastolic functions were observed, but obesity was associated with higher LV stroke volume (p = 0.03), inducible LV outflow tract gradients (p = 0.045), and chance of developing LV outflow tract obstruction during stress (p = 0.035). In multivariate analysis, BMI was associated with increased posterior (but not septal) wall thickness (β = 0.15, p = 0.02) and LV mass index (β = 0.18, p = 0.005), particularly in those with hypertension. Obesity was also associated with reduced exercise time and functional capacity, and BMI independently correlated with reduced exercise tolerance. In conclusion, obesity is associated with larger LV mass, worse symptoms, lower exercise tolerance, and labile obstructive hemodynamics in HC. The association with increased outflow tract gradients has particular importance as contribution of obesity to the pressure gradients may influence clinical decisions in labile obstructive HC.
Authors:
Marco Canepa; Lars L Sorensen; Iraklis Pozios; Veronica L Dimaano; Hong-Chang Luo; Aurelio C Pinheiro; James B Strait; Claudio Brunelli; M Roselle Abraham; Luigi Ferrucci; Theodore P Abraham
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  The American journal of cardiology     Volume:  112     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1182-1189     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institute of Health, Baltimore, Maryland; Division of Cardiology, Research Center of Cardiovascular Biology, University of Genova, Italy.
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