Effect of weight loss on cardiac synchronization and proinflammatory cytokines in premenopausal obese women.
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.
Marfella
Raffaele
R
Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy. raffaele.marfella@unina2.it
Esposito
Katherine
K
Siniscalchi
Mario
M
Cacciapuoti
Federico
F
Giugliano
Francesco
F
Labriola
Domenico
D
Ciotola
Myriam
M
Di Palo
Carmen
C
Misso
Lucio
L
Giugliano
Dario
D
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*
D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8