title: Effect of weight loss on cardiac synchronization and proinflammatory cytokines in premenopausal obese women.
abstract: OBJECTIVE
  Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of heart failure. We examined the relationship of ventricular synchronization abnormalities with the concentration of proinflammatory cytokines in obese women at baseline and after sustained weight loss.
  
  
  METHODS
  Echocardiographic parameters of ventricular dyssynchrony, circulating levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-18, and C-reactive protein (CRP) were investigated in 67 healthy, premenopausal obese women and 40 age-matched normal-weight women.
  
  
  RESULTS
  Compared with nonobese women, obese women had increased concentrations of CRP (P < 0.01), TNF-alpha (P < 0.01), IL-6 (P < 0.01), and IL-18 (P < 0.01). Moreover, obese women had a higher myocardial performance index (P < 0.02) and lower transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02), and ejection fraction (P < 0.05), indicating ventricular dyssynchrony. Concentrations of CRP, TNF-alpha, and IL-6 were related to anthropometric indexes of obesity and to echocardiographic parameters of ventricular dyssynchrony. After 1 year of a multidisciplinary program of weight reduction, obese women lost at least 10% of their original weight. This was associated with reduction of cytokine (P < 0.01) and CRP (P < 0.02) concentrations and with improvement of echocardiographic parameters of ventricular dyssynchrony, which correlated with changes in adiposity, particularly visceral adiposity.
  
  
  CONCLUSIONS
  In obese women, ventricular dyssynchrony correlates with body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating cardiac function in obese women.
authors.affiliation: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy. raffaele.marfella@unina2.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: Marfella
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.forename: Mario
authors.initials: M
authors.lastname: Siniscalchi
authors.forename: Federico
authors.initials: F
authors.lastname: Cacciapuoti
authors.forename: Francesco
authors.initials: F
authors.lastname: Giugliano
authors.forename: Domenico
authors.initials: D
authors.lastname: Labriola
authors.forename: Myriam
authors.initials: M
authors.lastname: Ciotola
authors.forename: Carmen
authors.initials: C
authors.lastname: Di Palo
authors.forename: Lucio
authors.initials: L
authors.lastname: Misso
authors.forename: Dario
authors.initials: D
authors.lastname: Giugliano
mesh_terms: D000328:Adult; D000886:Anthropometry; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008943:Mitral Valve / Q000502:physiology / Q000503:physiopathology; D009765:Obesity / Q000503:physiopathology*; D017697:Premenopause / Q000097:blood*; D012016:Reference Values; D016276:Ventricular Function / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology*
chemical_list: D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8