Predicting the risk of left ventricular diastolic dysfunction in obesity

Abstract

Obesity may develop heart failure with preserved ejection fraction, which is based on left ventricular diastolic dysfunction (LV DD). Currently, the search for effective predictors of LV DD is extremely relevant.Aim. To assess the prognostic value of key and additional metabolic risk factors (RFs), neurohumoral and profibrotic factors in the development of LV DD in obese patients.Material and methods. The study included 149 men with general obesity. The mean age was 49,7±7,9 years. The inclusion criteria was the presence of class I-III general obesity. The average body mass index was 32,9±3,6 kg/m2. The exclusion criteria were hypertension, coronary atherosclerosis, type 2 diabetes, as well as LV DD according to transthoracic echocardiography. Depending on the presence of epicardial adiposity, patients were divided into two groups: group 1 — epicardial adipose tissue (EAT) thickness ≥7 mm (n=70), group 2 — EAT <7 mm (n=31). In all patients, the following laboratory parameters were determined in blood serum using enzyme immunoassay: type I and III collagen, Procollagen I C-Terminal Propeptide (PICP), matrix metalloproteinase-3 (MMP-3), transforming growth factor β1, vascular endothelial growth factor, tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-10, C-reactive protein (CRP), adiponectin, soluble leptin receptor, leptin, lipid parameters and free fatty acids (FFA). After 4,7±0,3 years, echocardiography was repeated in order to assess LV diastolic function.Results. Comparative analysis of metabolic risk factors revealed a significant increase in the level of total cholesterol (p=0,001), low-density lipoprotein cholesterol (LDL-C) (p<0,0001), triglycerides (TGs) (p<0,0001). These groups had no differences in such parameters as high-density lipoprotein cholesterol (p=0,09) and glucose (p=0,12). An increase in the level of such pro-inflammatory cytokines as TNF-α (p<0,0001), CRP (p<0,0001), IL-6 (p<0,0001) in group 1 was revealed, while differences in IL-10 (p=0,34) levels were not significant. In group 1, there was a significant increase in leptin levels (p<0,0001), a decrease in levels of adiponectin (p<0,0001) and leptin receptor (p=0,001). In group 1, an increase in the level of all studied profibrotic factors was revealed. After 4,7±0,3 years, repeated echocardiography revealed that selected groups were comparable in such parameters as A, E, E/A, E/e’, e’, and the peak tricuspid regurgitation velocity. There was a significant difference in left atrial volume index (p=0,0003). LV DD was detected in 20 patients. Binary logistic regression revealed the following most significant predictors of LV DD in obese patients: glucose, LDL-C, triglycerides, leptin receptor, leptin, MMP-3, FFA, PICP, and EAT thickness.Conclusion. Thus, the following most significant predictors of LV DD in obese patients were identified glucose, LDL-C, triglycerides, leptin receptor, leptin, MMP-3, FFA, PICP, and EAT thickness.

Keywords

• epicardial obesity
• diastolic dysfunction
• heart failure