Two-Dimensional Strain and Twist by Vector Velocity Imaging in Adolescents With Severe Obesity
Abstract
The prevalence of severe obesity is increasing worldwide in adolescents. Whether it is associated with functional
myocardial abnormalities remains largely unknown, potentially because of its frequent association with other
cardiovascular risk factors and also use of insensitive techniques to detect subclinical changes in myocardial function.
We used 2D vector velocity imaging (VVI) to investigate early changes in left ventricular (LV) myocardial function in
youths with isolated severe obesity. Thirty-seven asymptomatic severely obese adolescents free of diabetes and
hypertension, and 24 lean controls were enrolled. LV longitudinal, basal, and apical circumferential strain, strain rate
(SR), rotations, and LV twist were measured. Obese adolescents had greater LV mass and reduced systolic and early
diastolic tissue Doppler imaging (TDI) velocities than lean counterparts. L strain (−24%) and systolic and early diastolic
SR were also diminished in the obese, whereas no intergroup differences existed for the circumferential deformation
indexes. LV twist was more pronounced in the obese (+1.7°, P < 0.01) on account of greater apical rotation only (4.1 ±
0.9 vs. 5.2 ± 1.2°, P < 0.01), potentially compensating for the loss in longitudinal function. Systolic–diastolic coupling,
an important component of early filling and diastolic function, was maintained with severe obesity. No intergroup
differences were reported regarding time to peak values for all VVI indexes highlighting that dynamics of strain and
twist/untwist along the cardiac cycle was preserved with severe obesity. Isolated severe obesity in adolescents, at a
preclinical stage, is associated with changes in myocardial deformation and torsional mechanics that could be in part
related to alterations in relaxation and contractility properties of subendocardial fibers.